Cases of RSV bronchiolitis are on the rise, which tends to happen every year around this time.1
What is RSV and What Problems Does It Cause?
RSV (fancy name: Respiratory Syncytial Virus) is a virus that circulates in our communities from the fall through late spring. It’s notorious for causing “bronchiolitis” in young kids (especially in those under 2 years old) and in the elderly.
Bronchiolitis is an infection of the small airways of the lower lungs. While several viruses can cause bronchiolitis, RSV is the most common and well-known culprit.
Doctors worry about bronchiolitis because it can cause major breathing problems in children, especially in premature babies and infants with lung disease or heart conditions. It can also hit the elderly population fairly hard and those with weakened immune systems.
How is RSV Spread?
It’s spread by touching surfaces with the virus on them and through close contact with mouth or nose secretions (think: spit and snot).
What are the Symptoms of RSV Bronchiolitis?
Common Symptoms Include:
- Cold-Like Symptoms: A runny nose and a cough.
- Fussiness.
- Wheezing (in Some Kids).
- Trouble Breathing.
Signs of Respiratory Distress Include:- Fast breathing.
- Nasal flaring (when the nostrils go in and out with each breath).
- Retractions (when the spaces between the ribs get sucked in with each breath).
- Grunting noises at the end of each breath.
- Head Bobbing (i.e. when a child’s head moves up and down with each breath because they’re using their neck muscles to assist with breathing).
Other Possible Symptoms:
- Ear Infections: Kids with RSV bronchiolitis are at a higher risk of developing ear infections.
- Poor Feeding: Babies with bronchiolitis tend to “pop off” the breast or bottle frequently.
Why? Because they have trouble coordinating their feeding and breathing when they’re congested. This is especially true for babies under 2 months of age, who are “obligate nasal breathers” (meaning they tend to breathe through their noses, rather than through their mouths).
PediaTip: If your baby has bronchiolitis, feed them smaller amounts more frequently and take extra breaks during feeding to prevent them from getting tuckered out. In addition, keep track of your little one’s wet diapers to make sure they’re staying hydrated (FYI: they should have at least 3+ wet diapers per day).
Insider Info: RSV Bronchiolitis Can Be Sneaky
- RSV Bronchiolitis symptoms peak around Day 4 or 5 of the illness, whereas most colds peak around Days 2-3. So, just when you think you’re out of the woods with RSV, it gets worse. Thanks a lot RSV!
- Studies show that children who contract RSV before age 1 are 2-4 times more likely to develop asthma later in life compared to the general population.2
How Would My Child’s Doctor Diagnose RSV Bronchiolitis?
- Doctors diagnose RSV bronchiolitis primarily based on a child’s symptoms and physical exam.
- If RSV is suspected, your child’s doctor may perform a a rapid RSV test, which involves collecting a sample from deep inside the nose using a swab. The test is quick and can be done right in the office, with results available in 10-15 minutes.
Reality Check: The RSV rapid test isn’t the most fun test in the world to get. It involves sticking a big Q-tip deep into your child’s nose.
The Silver Lining: The discomfort only lasts a few seconds, and the test helps guide the doctor’s next steps.
If the RSV test is positive, your doctor will monitor your little one closely since RSV bronchiolitis often worsens before it improves.
How Is Bronchiolitis (Both RSV Bronchiolitis and Bronchiolitis Caused by Other Viruses) Treated?
Since bronchiolitis is caused by a virus, antibiotics won’t help. Instead, treatment focuses on supportive care—keeping your child comfortable while the virus runs its course.
Supportive Care Includes:
- Offering your child plenty of fluids.
- Slowing down their feeds (if you’re bottle feeding or breastfeeding).
- Keeping an eye on their breathing.
- Using non-medicated saline nose drops to help with the congestion.
For More Severe Cases:
Young children with respiratory distress and/or poor feeding may need extra support in the hospital. In the hospital, doctors can give kids supplemental (extra) oxygen and/or IV fluids. Some children who wheeze with RSV bronchiolitis respond to asthma medications that help open up the airways (think: albuterol). The doctor may, therefore, do a “trial of albuterol” to see if it helps.
Do Doctors Have Any Tools to Help Prevent RSV Bronchiolitis in Kids?
Yes! Two new preventive measures have been approved to combat RSV this year:
1. Pfizer’s Abrysvo Vaccine:
- Purpose: This vaccine is given to expectant moms during pregnancy to protect their babies from RSV during the first 6 months of life.
- Significance: It’s the FIRST vaccine approved for the prevention of RSV infections in newborns (and in adults 60+ years).3
- Mechanism: When administered late in pregnancy, protective antibodies are passed to the baby through the placenta before birth.
- Safety Update: The FDA recently issued a warning for Pfizer’s Abrysvo RSV vaccine after a small number of cases of Guillain-Barré Syndrome (GBS) were reported in pregnant individuals who received the vaccine.4 GBS is a rare neurological condition that’s often reversible, although recovery can take weeks to months. Per the Centers for Disease Control & Prevention (the CDC), the overall risk of this side effect remains very low, and the vaccine is still considered safe and recommended for most expectant mothers. If you have any concerns, though, talk to your doctor about whether the vaccine is right for you.
2. The Beyfortus Monoclonal Antibody Injection (Nirsevimab)
- Purpose: Provides direct antibodies against RSV.
- Approved For:
- ALL infants under 8 months who are entering their first RSV season.
- Certain high-risk children ages 9-18 months (such as those with heart or lung conditions).
Are These Tools Helping?
It’s still too early to determine the full impact of these preventive measures on RSV cases this year compared to last year. RSV activity is currently increasing, particularly in the southeastern U.S. and especially among young children. However, this pattern was also observed last year and is not unexpected.5
The Bottom Line
Although RSV cases are on the rise, the introduction of Abrysvo and Beyfortus provides promising options to reduce severe outcomes. Consult with your doctor to determine if these preventive tools are right for you or your baby.
