Friday, March 30, 2012

Babies Coughing and Wheezing: Does Your Baby Have RSV?

It's late.  Your baby is coughing and wheezing.  Everything seems worse in the middle of the night.  What kind of cough is it?  What is going around this time of year?  What should you do?

A common virus has really taken off in the last month or two.  You have probably heard of it:  RSV.
RSV stands for Respiratory Syncytial Virus.  For older kids and adults it usually just causes a bad cold.  However, infants and toddlers can be hit hard by this virus.  RSV causes a lot of mucous drainage.  This is hard for babies because they greatly prefer to breathe out of their noses.  The infection causes wheezing and congestion in the lungs of small children.  RSV can cause a fever and may lead to ear infections and prolonged cough.

Sometimes I have called this "baby bronchitis."  Although that comparison helps people understand the condition a little better, bronchiolitis is not actually the same thing as bronchitis.  Bronchitis affects the larger airways in the lungs (the "bronchi") and leads to a significant productive cough.  Bronchiolitis affects the smaller airways, deeper in the lungs.  These flexible, narrow airways are called bronchioles.  They collect mucous and then tend to tighten up with each breath.  This leads to wheezing and a painful sounding, tight cough.

Here are some examples of the symptoms of bronchiolitis.  You will hear wheezing (both with inhale and exhale) and see retractions.  When the skin sucks in above the sternum (breastbone) or between the ribs with each breath, these are retractions. 

This video shows a baby with bronchiolitis who has retractions in her neck (called suprasternal retractions), wheezing with inhaling and exhaling, nostrils flaring with each breath, and a tight little cough (at the end of the video).  Although the dad mentions during the video that she has croup, actually this is a better video of bronchiolitis.

The next video shows a baby with head bobbing.  It is a sign of difficulty breathing in young infants.  Because he is using his neck muscles to help him breathe it pulls his head forward with each breath.

Here is a pretty good example of a bronchiolitis cough.  It starts about 20 seconds into the video.  You might also notice that the baby seems to cough up mucous into her mouth, which she then chews on for a while before she swallows it.  Sometimes babies with bronchiolitis gag on the phlegm and actually throw up after coughing.

RSV bronchiolitis can be mild, moderate, or severe.  Mild bronchiolitis causes wheezing and coughing, but babies can still smile, laugh, drink, and eat.  More severe bronchiolitis can cause rapid breathing, significant retractions, pale or bluish skin tone, prolonged coughing spells, gagging and vomiting with cough.

In another blog post I will discuss some home treatment for RSV bronchiolitis, and what can be done for a child in the office, emergency room, or hospital.  Please remember that my blog is not intended to substitute for the advice of your own personal pediatrician!  Words on a page cannot replace your own observations, or those of the doctor who knows your child.

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