What are the signs and symptoms
of bronchiolitis or RSV?
Well, typically, they begin with
normal, cold-like symptoms,
including nasal congestion, cough, a
fever, and a diminished appetite.
As the infection worsens, the
child may develop tachypnea,
or an increased respiratory rate, to help
compensate for the decreased air movement
and exchange due to the narrowed air
passages and the presence of mucus.
The children will also develop
wheezing and difficulty feeding,
as the child will prioritize
breathing over eating and drinking.
The nose can be obstructed by mucus
making it really difficult for
the child to feed and breath,
especially if they're
breastfed or bottle fed.
These kids have an
incredible amount of mucus.
Some children will progress
to severe bronchiolitis.
These children appear quite ill, and they
require close observation in the hospital.
The child may show signs and
symptoms of dehydration
due to the increased work of breathing,
and their decreased oral intake.
Remember, when the respiratory
the patient loses more water,
through their respiration.
Retractions are seen
in severe bronchiolitis.
This is a compensatory use of
intercostal and chest wall muscles
to further try to expand
and compress the lungs.
The child may also have nasal flaring
and this is when you attempt
to enlarge the space
for the air to flow through
the nasal passageways.
The child may begin to grunt
when they're breathing,
which is heard during the expiratory phase.
And may also display signs
and symptoms of hypoxia,
or decreased oxygen levels
that reach the tissue.
There is a resultant cyanosis
from the decreased oxygen.
All of these signs and symptoms
of severe bronchiolitis
require immediate intervention to
prevent further deterioration.
So how do you diagnose bronchiolitis or RSV?
Well, it's a clinical diagnosis,
which means the clinician combines data
from the history and the physical exam,
and excludes all other causes to
try to diagnose the condition.
The clinician will then
do a respiratory exam,
evaluate the child for hypoxia by
checking their pulse oxymeter,
and sometimes, you'll do a chest
X-ray to exclude other causes.
You can also perform nasopharyngeal
testing and send this to the lab,
but you wouldn't wait on this to
diagnose a child with bronchiolitis.
The severity of bronchiolitis drives
the interventions and the management.
A clinician can stratify a
child based on these criteria,
and can monitor for improvement
In mild disease, the child is alert
and active, they're feeding well,
and they may have minimal
Their respiratory rate is normal,
and may be just mildly elevated.
In moderate bronchiolitis, the infant
is still alert and able to be consoled.
They may have decreased feeding, and minimal
to moderate intercostal retractions.
Their respiratory rate may be
mildly to moderately elevated.
In severe bronchiolitis,
the infant is a mess.
They're fussy, difficult to
console, they have poor feeding,
moderate to severe intercostal retractions,
and their respiratory rate is going to
be moderately to severely elevated.
Bronchiolitis is usually self-limiting
because it's usually caused by a virus.
There's no specific treatment
for these viruses,
and remember, antibiotics are not effective,
unless there's a rare bacterial cause
of your patient's bronchiolitis,
but that's not usually the case.
You would practice supportive measures,
so keep these children hydrated,
keep them comfortable.
You can administer anti-pyretics, if the
fever is making them sore or grouchy,
and this includes Tylenol and
ibuprofen in infants >6 months old.
You can suction their nose,
and this is actually a very helpful
These children get so much mucus
in their airway and in their nose
that remember, they don't feed as well.
So, the nurse can go in with a bulb
syringe or with a deep suction catheter
and can actually help remove
those secretions for the baby.
These children are way too young
to actually blow their nose.
Supplemental oxygen may be needed.
The benefits have been seen from
delivering high flow oxygen.
The child will usually improve without
any treatment in about 1 week's time.
Just like any other viral illness, the
child can usually be managed at home.
Complications of bronchiolitis are rare.
They can be cyanosis, as the
result of the lack of oxygen,
and it's displayed as blue lips or skin.
The child can become apneic, which
is a pause in their breathing.
This is most likely to occur
in premature infants
and in infants within
their first 2 months of life,
as their respiratory control
center is still immature.
This is because the child is going to
choose breathing over feeding every time.
This needs to be watched and managed.
The children may develop
This is a bacterial infection that
would need treatment with antibiotics,
and this is after they’ve already
cleared the viral illness.
This is a low level of oxygen that's going
to stress all of the body's organs.
This is a sign that the child's worsening,
and they may require hospitalization
for observation and management.
Rarely, children will progress
to respiratory failure,
and this can result if these
complications are not managed.