What should you know about infant RSV bronchiolitis?

RSV is a virus that can inflame the smallest breathing tubes in an infant’s lungs. Bronchiolitis often begins like a cold, then breathing may become faster, wheezy, or visibly effortful. A baby may pause more often during feeds because breathing and sucking are harder to coordinate.

Symptoms can change over the course of an illness. A clinician assesses breathing effort, oxygenation when needed, hydration, alertness, and feeding rather than relying on the sound of the cough alone. Antibiotics do not treat RSV, and medicines are chosen according to the examination.

Keep the baby comfortably upright while awake and offer smaller, more frequent feeds if tiredness makes normal feeds difficult. Clear visible nasal mucus gently before feeds, avoid smoke and strong scents, and monitor wet nappies and alertness. Keep hands clean and avoid close contact with vulnerable people while the baby is unwell.

A nebuliser is not automatically needed for RSV bronchiolitis. If a clinician recommends nebuliser treatment or another therapy, use it only as directed. Do not give cough medicines or leftover prescriptions without a child-health assessment.

Seek emergency help if the baby has pauses in breathing, blue or grey lips, severe chest pulling-in, grunting, extreme sleepiness, or cannot feed. Urgent assessment is also needed when wet nappies become much less frequent or breathing is steadily worsening.

Arrange prompt Child Health Consultation for persistent wheezing, fever in a very young infant, repeated vomiting with feeds, or a baby who is taking much less than usual. Bring a record of feeds and breathing changes.

How hard is my baby working to breathe? Is feeding and hydration adequate? What signs should make us return urgently, and would any inhaled treatment help this particular examination?