Bronchiolitis
I want to say something, just to put it out there. No matter how controversial it is. Here it is: I don’t like when kids are sick. I especially don’t like when little kids are sick, and I really don’t like when kids under 6 months are sick. But the one thing that really irks me is kids 6 months or younger sick with respiratory syncytial virus (RSV) bronchiolitis.
RSV in older children and adults amounts to a moderate cold. But for some reason in younger kids and infants, the usual nose cold presentation is not what we see. This virus goes to the lungs and makes sooooo much sticky mucus. When we get sticky mucus stuck in tiny babies’ lungs, that is never a good combination. The majority of kids 2 years and younger that get RSV will have about 5 days of cold and cough symptoms +/- fever. Usually the first 2 days are not so bad, but then somewhere around Day 3, symptoms get way worse before they start getting better on Day 4 and 5. Older kids are able to cough out this mucus well and recover nicely. But younger kiddos who can’t due to lack of muscle strength or know-how have a tough time getting this sticky mucus out. That is where you as a parent come in. You are going to be your kiddo’s cough. How, you ask? Well, by sucking as much snot out of their nose as possible to help keep the mucus train moving out of the body. With the help of some nasal saline drops and a good nose sucker like the NoseFrida or bulb suction, we can get quite an amazing amount of snot and mucus out of little kiddos to help them recover from RSV.
Even with these efforts, a good number of kids end up in the emergency room or hospital for extra help. The extra help is from wall suction, meaning a suction device hooked up to a centralized vacuum that can suck out way more snot from deeper in the lungs than we can at home. Unfortunately, there are no medicines that have been shown to consistently help with bronchiolitis. There used to be just one medicine that is used for RSV, an injection of antibodies against RSV given monthly during cough and cold season to extremely premature kids for their first 1-2 years of life or to babies with heart and lung problems under 1-2 years of age that hit certain criteria. The reason for the criteria is that it really only helps this subset of kids, and it is super hard to make and super expensive, like 10s of 1000s of dollars. So you can imagine how much insurance companies love paying for it. The criteria change every year, depending on cardiology, pulmonary, and infectious disease society recommendations. Your pediatric provider will often reach out to families that meet these criteria before the cough and cold season because the process of getting and administering these medicines is quite cumbersome.
But luckily as of 2023/2024 we have a new injection for babies up to 8 months of age called Beyfortus which is a longer acting and cheaper version of the previous injection that has been shown to help prevent and protect babies and young infants from RSV. Your pediatrician should discuss this medicine with you if you have an infant during RSV season and baby’s mom did not already get the RSV vaccine for pregnancy.
The other reason why I hate RSV is that if you are 6 months or under and you get it (or sometimes if you are 2 and under with the right family history), it could lead to asthma-like symptoms with subsequent coughs and colds. We are not 100% sure why this happens, but we think that the insult to the lungs is so memorable after getting RSV when you are little that your lungs are worried, and at the first sign of another unrelated cold, they go on hyperalert thinking they are helping the situation, when in fact they are not. If your pediatrician notices this pattern, they may discuss a daily inhaler medicine during cough and cold season for your kiddo to help prevent this reaction or maybe just the use of this inhaler at the first sign of a new cough and cold. The one bit of good news with this, though, is that this type of viral-induced asthma is the most likely for kids to grow out of once their lungs are bigger with most kids not needing this asthma-type medicine by elementary school time.
So there I said it, RSV bronchiolitis, not a fan. Would not recommend—0 stars.