Four Seasons Pediatrics

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RSV Bronchiolitis Here; Norovirus Coming

Four Seasons Pediatrics began to see a significant number of children with RSV (RSV is the most common virus that causes this illness.  It stands for Respiratory Syncytial Virus) Bronchiolitis this week.   Bronchiolitis generally occurs in children 2 years or less.  It is a virus that causes significant wheezing.  Premature infants are at a higher risk of complications from RSV.


  • Your child is wheezing. This means that when your child breathes out he or she makes a high-pitched whistling sound.
  • Your child is breathing rapidly at a rate of over 40 breaths per minute.
  • Your child has to push the air out (tight breathing).
  • Your child has a cough and may cough up very sticky mucus.
  • Often a fever and a runny nose precede the breathing problems and cough.

The symptoms are similar to asthma.  The average age of children who get Bronchiolitis is 6 months.  They are usually not older than 2 years.

The wheezing is caused by a narrowing of the smallest airways in the lung (bronchioles). This narrowing results from inflammation (swelling) caused by a virus, usually the respiratory syncytial virus (RSV). RSV occurs in epidemics almost every winter. While infants with RSV develop Bronchiolitis, children over age 2 years and adults just develop cold symptoms.  The virus is found in nasal secretions of infected people. It is spread by an infected person who sneezes or coughs less than 6 feet away from someone else or by his or her hands after touching the nose or eyes.  People do not develop permanent immunity to the virus, which means that they can be infected by it many times.

Expected Course
Wheezing and tight breathing (difficulty breathing out) become worse for 2 or 3 days and then begin to improve. Overall, the wheezing lasts approximately 7 days and the cough about 14 days.  The most common complication of bronchiolitis is an ear infection, occurring in some 20% of infants.  Bacterial pneumonia is an uncommon complication. Only 1% or 2% of children with bronchiolitis are hospitalized because they need oxygen or intravenous fluids.  In the long run, approximately 30% of the children who develop bronchiolitis later develop asthma.  Recurrences of wheezing (asthma) occur mainly in children who have close relatives with asthma and may be as high as 70% if asthma, eczema or allergies closely run in the family.  Asthma is easily treated with medications.

1. Medicines
Some children with bronchiolitis respond to asthma-type medicines, but most do not.  In addition, you can give your child acetaminophen every 4 to 6 hours or ibuprofen every 6 to 8 hours if the fever is over 102°F (39°C).

2. Warm fluids for coughing spasms
Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer warm apple juice if your child is over 4 months old.  In addition, breathing warm moist air helps to loosen up the sticky mucus that may be choking your child. You can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.

3. Humidity
Dry air tends to make coughs worse. Use a humidifier in your child’s bedroom. The new ultrasonic humidifiers are very quiet and they kill molds and most bacteria that might be in the water.  If possible, use distilled water instead of tap water in the humidifier.

4. Suction of a blocked nose
If the nose is blocked up, your child will not be able to drink from a bottle or to breast-feed. Most stuffy noses are blocked by dry or sticky mucus. Suction alone cannot remove dry secretions.  Warm tap-water or saline nose drops are better than any medicine you can buy for loosening up mucus. Place three drops of warm water or saline in each nostril. After about one minute, use a soft rubber suction bulb to suck out the mucus. You can repeat this procedure several times until your child’s breathing through the nose becomes quiet and easy.

5. Feedings
Encourage your child to drink enough fluids.  Eating is often tiring, so offer your child formula, breast milk, or regular milk (if he is over 1 year old) in smaller amounts at more frequent intervals. If your child vomits during a coughing spasm, feed him or her again.

6. No smoking
Tobacco smoke aggravates coughing. Children who have an RSV infection are much more likely to wheeze if they are exposed to tobacco smoke. Don’t let anyone smoke around your child. In fact, try not to let anybody smoke inside your home.

Call Us Immediately If:

  • Breathing becomes labored or difficult.
  • The wheezing becomes severe (tight).
  • Breathing becomes faster than 60 breaths per minute (when your child is not crying).

Call us within 24 Hours If:

  • Any fever lasts more than 3 days.
  • The cough lasts more than 3 weeks.
  • Your child is not urinating at least once every 6-8 hours
  • A fever returns after resolving for 48 hours.

Norovirus Cases Increasing

Norovirus is the most common cause of gastroenteritis (stomach bugs) in the United States.  A new strain of the virus was discovered in 2012.  It is unclear whether the new strain will cause more causes than usual, but the number of cases in the U.S. has been rising recently.  Each year Norovirus causes 21 million cases and about 800 deaths.  Anyone can be infected with norovirus and get sick.  Also, you can have norovirus illness many times in your life. Norovirus illness can be serious, especially for young children and older adults.


Norovirus causes nausea, vomiting, diarrhea, cramps, fever and headache.   Most people are better in 1-3 days.  It can cause severe vomiting and diarrhea.  The primary concern is dehydration.  This may show up as a dry mouth, less tears and less urination. 


Norovirus is highly contagious.  Anyone can get infected with norovirus and get sick. Also, you can get norovirus illness many times in your life. One reason for this is that there are many different types of noroviruses. Being infected with one type of norovirus may not protect you against other types.

Norovirus can be found in your stool (feces) even before you start feeling sick. The virus can stay in your stool for 2 weeks or more after you feel better.  You are most contagious when you are sick and for about 3 days after you recover.   It spreads quickly in those who are in confined spaces such as daycares, schools, cruise ships etc.  The virus is more likely to stay for prolonged time on surfaces.  It is also less likely to be killed by sanitizer gels.  Washing with soapy water is more likely to be effective if done properly.    Try using an alternating approach of gels and handwashing.   After vomiting or diarrhea, surfaces should be cleansed with 1/2 to 1 cup of bleach per gallon of water. 


If your child develops a gastroenteritis from Norovirus, the most important approach is fluid management.  Advance fluids slowly, giving a smaller amount (as little as 1/2 ounce) every 15 minutes.  After an hour you may increase this amount.  If vomiting returns, go back to the amount that was tolerated in the previous hour.  If diarrhea is the main symptom, and vomiting is not an issue (or no longer an issue), try the BRAT diet.  These are foods that are more constipating (Bananas, Rice, Applesauce, Toast).  You may also give culturelle (1/2 capsule daily if less than 1 years old, 1 capsule daily if more than 1 years of age).  This has been shown to reduce the amount of diarrhea.  Monitor for dehydration.   Urination should occur at least once every 8 hours.  If it is not, please call us.

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