Bradley J. Dyer, MD, FAAP
Robert C. Duncheskie, MD, FAAP
Kathryn E. Italia, MD
ALL STAR Jennifer Melnychuk, MD, FAAP
Aaron A. Chambers, MD
PEDIATRICS Jill Schwartz, RN, CPNP, IBCLC
"where every child is a star 702 Gordon Drive
Exton, PA 19341
Phone: (610)-363-1330
Fax: (610)-524-8574
BRONCHIOLITIS
Bronchiolitis is an acute viral illness of the lower respiratory tract most often signaled by the onset of rapid,
noisy breathing.
Bronchiolitis most often occurs during the fall, winter and early spring months. Bronchiolitis means a viral
infection of the lower respiratory tract. There are a number of different viruses that cause bronchiolitis, the most
common being RSV (respiratory syncitial virus). These infections primarily effect children under the age of2
years. As with most viral infections, the illness is spread by direct contact with infected secretions.
Bronchiolitis begins with symptoms of a usual "cold" (runny nose, congestion, cough) that quickly moves into
the chest. The cough progresses to a deep, wet cough of increasing frequency. At this time, young children may
develop "junky" breathing, high-pitched "whistling sounds" (wheezing), and rapid breathing. The virus causes a
large amount of mucus production in the lower airways leading to the cough. Other symptoms include fever,
hoarse voice and restlesness.
What can I expect?
Bronchiolitis begins as a regular cold and quickly progresses into a deeper, thicker cough. Most cases are mild
and are easily treated at home. The children often sound worse then they appear - ''the happy wheezer."
Symptoms usually improve within 3-5 days but the cough may linger for 1-2 weeks.
When should I worry?
Bronchiolitis involves congestion ofthe lower airways, so most of the worrisome symptoms will be related to
breathing. Please monitor for flaring of the nostrils, rapid breathing, tugging between the ribs when
breathing, bluish lips, inability to take feeds, listlessness and irritability. As with any illness, also please
monitor fluid intake and activity level. Please call us if any of these symptoms becomes apparent.
What can I do at home?
Fluids are important for hydration and to loosen thick secretions. A cool mist humidifier, nasal saline drops and
elevation of the head of the bed may help with the cough and comfort during sleep. We do not recommend any
cough or cold medicines for patients under the age of2 years. Acetaminophen or ibuprofen (if older than 6
months) may be used for fever as per dosing chart in the All Star baby book.
What will the physician/nurse practitioner prescribe?
Most children require nothing more than supportive care and close observation at home. Antibiotics are not
helpful as bronchiolitis is a viral infection. Some children with significant wheezing may benefit from a
breathing treatment but not all children will respond to the treatment. This medicine can be tried in the office
and if successful, can be administered by the family at home for a few days.