Definition: Bronchiolitis is an infection of the lower respiratory tract (smallest airways of lung, called "bronchioles") usually occurring in children less than two years of age.

Symptoms: The following symptoms often accompany bronchiolitis:

• wheezing — a high-pitched whistling noise produced during expiration (breathing out);

• rapid breathing with a rate of >40 breaths per minute;

• tight breathing or difficulty moving air out. This is often accompanied by retractions (pulling in and out of muscles at the rib cage or stomach);

• cough with thick mucous;

• fever and runny nose preceding lung symptoms;

• difficulty drinking or loss of appetite;

• increased fussiness.

Cause: The virus that causes bronchiolitis in 85% to 90% of patients is respiratory syncytial virus (RSV). It occurs in epidemics with a peak incidence from December to April. RSV causes inflammation of the bronchioles (small airways), which in turn leads to wheezing, difficulty breathing, and an oxygen requirement. Whereas children less than two years old develop bronchiolitis, older children may simply develop cold symptoms. Wheezing and breathing difficulties may be worse for two to three days, but then gradually improve. Wheezing can persist for seven days and cough for about 14 days. Twenty percent of children may develop ear infections. One to two percent of children with RSV are hospitalized because they need oxygen or intravenous fluids.

Home Treatment

Albuterol: Approximately one-third of children with bronchiolitis respond to albuterol, a medicine also used to treat asthma. Your doctor will order this if it is beneficial to your child. The dose is ____________ by nebulizer every _____ hours.

Fever medicines: Acetaminophen every four to six hours or ibuprofen every six to eight hours may help suppress fevers and keep your child more comfortable.

Humidified air: Warm or cool moist air humidifiers may help loosen the thick mucous and break up secretions that may be gagging your child. New ultrasonic humidifiers are quiet and may also kill molds and bacteria that may contaminate the water.

Nasal suction: Suctioning of the nose will make your child more comfortable and allow him/her to drink easier. Suction with a soft rubber bulb syringe alone cannot remove dry secretions. Warm tap water or nasal saline drops will help loosen the mucous. Place three drops in each nostril. After one minute, use a suction bulb to suck it out. You can repeat the procedure several times until your child breathes easier.

Fluids: Encourage fluid intake. You may need to offer smaller volumes at more frequent intervals, as eating can be exhausting. If your child vomits after a coughing spasm, feed them again.

Smoking: Tobacco smoking aggravates coughing. Do not smoke around your child, as wheezing is exacerbated in children with RSV who are exposed to passive smoke. Do not allow anyone to smoke inside your home or car.

Oxygen: Oxygen is a medication ordered by your doctor. Do not take your child off oxygen unless instructed to do so. Do not travel to the mountains or above 6,000 feet without your doctor's permission.

Your doctor has ordered a liter flow of ________ per minute to be given by nasal cannula.

Precautions: Oxygen itself is nonflammable but will increase the rate of burning of a material such as clothing. For example, a spark that lands on clothing will normally only smolder and cause a small burn hole, but with oxygen in use it will cause the clothing to ignite. For this reason, avoid toys with friction motors and ones that emit sparks. If you have a wood stove or fireplace in your home, be sure the firebox is enclosed or a spark screen is in use.

The oxygen source and your child should be kept 4-6 feet away from any heat source.

Do not smoke in the house and absolutely no smoking in the car when your child is present. Sparks from cigarettes are impossible to control, and your child should never be exposed to second-hand smoke.

Do not use any oil, grease, or petroleum-based products on any of your equipment or

near your child. These materials are highly flammable and, with supplemental oxygen present, will burn readily. For this reason, avoid any petroleum-based lotions or creams (i.e., Vaseline) on the face or upper chest. Check the listing of contents on products before purchasing. If moisturizing is necessary, we recommend nonpetrolatum products or aloe vera products as substitutes. In addition, we recommend that the child not be in the kitchen if you are frying foods, as the combination of oxygen, heat, and splattering of oil and grease can be a potential problem. If the child's presence is unavoidable, maintain the same 4-to-6-foot distance as with a fireplace.