By Dr. Helen Minciotti
A mother paged me several hours before our office was due to open. Her infant had been up a good part of the night breathing fast and making noise when she exhaled. The mother astutely recognized that her child was wheezing.
Not wanting to delay, I advised her to head to the closest emergency department.
Most people know someone with asthma, and they understand that asthmatics suffer from wheezing and shortness of breath when exposed to certain environmental triggers. When some infants catch bad colds, they too might wheeze, but their triggers are respiratory viruses.
This viral wheezing is known as bronchiolitis. The bronchiolitic child has a pretty classic appearance, with a clear runny nose, a frequent tight-sounding cough and an expiratory wheeze.
I remember my first bronchiolitic patient during pediatric training. The attending physician described what I would find when I listened with my stethoscope: “When he exhales,” she pointed out, “you’ll hear something that sounds just like paper being crumpled.”
These “bronchiolitic crackles” are wheezing noises made each time the sick infant exhales, and are easiest to hear with a stethoscope. When the wheezing is severe, it can even be heard with the naked ear, an “audible wheeze.” If the baby is really working hard to breathe, you might also see retractions, which are deep- sucking chest movements that cause the chest wall to outline the ribcage with each breath.
Like all wheezing, bronchiolitis can range from mild to severe. It can be life-threatening for infants younger than 6 weeks of age, premature babies and infants with congenital heart disease.
One of the more common respiratory viruses responsible for bronchiolitis is the respiratory syncytial virus, or RSV. RSV is common in the Midwest between October and May.
The American Academy of Pediatrics reports that most children have had at least one bout with RSV before age 2. A majority of these children will just have minor cold symptoms, but some will wheeze. The Academy notes that 125,000 U.S. children are hospitalized each year with RSV, and the infection is fatal in 500 of these cases.
Because bronchiolitis is not truly asthma, many of these little patients will not respond to standard asthma therapy. Then all that’s left is supportive care. Parents are instructed to keep children well-hydrated and to call if they refuse to drink, appear excessively tired or have labored breathing. If patients come into the office already exhausted, breathing hard and in need of oxygen, they will need to be admitted to the hospital for oxygen therapy and close observation.
As with other respiratory infections, the nasty viruses that cause bronchiolitis are best avoided by keeping your child away from sick people and practicing frequent hand washing. During the winter months, certain at-risk infants, such as the extremely premature, might also qualify for monthly RSV preventive shots, such as Synagis or palivizumab, a monoclonal antibody therapy.
– Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.
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