RSV Infection (Bronchiolitis)

Front view of respiratory system. Inset shows bronchiole.

Bronchiolitis is a viral infection. It affects the small air tubes in the lung (bronchioles). It's usually caused by the respiratory syncytial virus (RSV). It occurs mostly in babies under 2 years old. Older children and adults can get this virus, but it generally feels just like a common cold to them.

The virus is contagious during the first few days. It's spread through the air by coughing or sneezing. It's also spread by direct contact. This might be by touching your sick child, then touching your own eyes, nose, or mouth. Washing your hands often will lower the risk of spreading it to others.

This illness usually starts like a cold, with fever and nasal congestion. After a few days, the virus spreads into the bronchioles. This causes mild wheezing and rapid breathing for up to 7 days. The congestion and cough may last up to 2 weeks. Antibiotic medicines are usually not needed for this illness. They might be prescribed if your child gets a bacterial infection such as pneumonia or an ear infection. Medicines used to treat lung or a breathing condition such as bronchopulmonary dysplasia (BPD) or asthma can help ease RSV symptoms. Treatment for RSV infection offer support. The main goals are to keep good oxygen levels and make sure the child has enough fluids and nutrition.

Home care

Follow these guidelines when caring for your child at home:

  • Your child’s healthcare provider may prescribe medicines to treat wheezing. Follow all instructions for giving these medicines to your child.

  • Use children’s acetaminophen for fever, fussiness, or discomfort, unless another medicine was prescribed. In babies over 6 months of age, you may use children’s ibuprofen or acetaminophen. If your child has chronic liver or kidney disease, talk with your child's provider before using these medicines. Also talk with the provider if your child has had a stomach ulcer or digestive bleeding Never give aspirin to anyone younger than 18 years of age who is ill with a viral infection or fever. It may cause a serious condition called Reyes syndrome. It can cause severe liver or brain damage.

  • Wash your hands well with soap and clean, running water before and after caring for your child. This will help prevent spreading the infection.

  • Give your child plenty of time to rest. 

    • Children 1 year and older: Use extra pillows to prop your child’s head and upper body upright while lying down. This may make breathing easier. Talk with your healthcare provider about how far to raise your child's head.

    • Babies younger than 12 months: Never use pillows or put your baby to sleep on their stomach or side. Babies younger than 12 months should sleep on a flat surface on their back. Don't use car seats, strollers, swings, baby carriers, and baby slings for sleep. If your baby falls asleep in one of these, move them to a flat, firm surface as soon as you can.

  • Help your older child blow their nose well. Your child’s healthcare provider may advise saline nose drops to help thin and remove nasal secretions. Saline nose drops are available without a prescription. You may put 2 to 3 drops of saline nose drops in each nostril before your child blows their nose. Always wash your hands after touching used tissues.

  • For younger children, suction mucus from the nose with saline nose drops and a small bulb syringe. Talk with your child’s healthcare provider or pharmacist if you don’t know how to use a bulb syringe. Always wash your hands after using a bulb syringe or touching used tissues.

  • To prevent dehydration and help loosen lung secretions in toddlers and older children, have your child drink plenty of liquids. Children may prefer cold drinks, frozen desserts, or ice pops. They may also like warm soup or drinks with lemon and honey. Don’t give honey to a child younger than 1 year old.

  • To prevent dehydration and help loosen lung secretions in babies under 1 year old, have your child drink plenty of liquids. Use a medicine dropper, if needed, to give small amounts of breastmilk, formula, or oral rehydration solution to your baby. Give 1 to 2 teaspoons every 10 to 15 minutes. A baby may only be able to feed for short amounts of time. If you are breastfeeding, pump and store milk to use later. Give your child oral rehydration solution between feedings. This is available from grocery stores and drugstores without a prescription.

  • To make breathing easier during sleep, use a cool-mist humidifier in your child’s bedroom. Clean and dry the humidifier daily to prevent bacteria and mold growth. Don’t use a hot-water vaporizer. It can cause burns. Your child may also feel more comfortable sitting in a steamy bathroom for up to 10 minutes.

  • Don't give over-the-counter cough and cold medicines to children under 6 years unless your healthcare provider has specifically advised you to do so. These medicines can cause serious side effects, especially in babies under 2 years of age. And these medicines don't help ease symptoms.

  • Keep your child away from cigarette smoke. Tobacco smoke can make your child’s symptoms worse.

Follow-up care

Follow up with your healthcare provider as advised.

If your child had an X-ray, it will be reviewed by a doctor. You will be told of any new findings that may affect your child's care.

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

  • Fever (see Fever and children, below)

  • Your child loses their appetite or feeds poorly

  • Your child has an earache, sinus pain, a stiff or painful neck, headache, repeated diarrhea, or vomiting

  • A new rash appears

Call 911

Call 911 if any of these occur:

  • Increasing trouble breathing

  • Fast breathing, as follows:

    • Birth to 6 weeks: over 60 breaths per minute.

    • 6 weeks to 2 years: over 45 breaths per minute.

    • 3 to 6 years: over 35 breaths per minute.

    • 7 to 10 years: over 30 breaths per minute.

    • Older than 10 years: over 25 breaths per minute.

  • Blue, purple, or gray tint to the lips or fingernails

  • Signs of dehydration. These include dry mouth, crying with no tears, urinating less than normal, or no wet diapers for 8 hours in babies

  • Unusual fussiness, drowsiness, or confusion

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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