Bronchiolitis: The Cough that Won’t Quit


Cough and colds plague this time of year.  At our practice bronchiolitis has been the main diagnosis the past two months.  This is an illness that comes every year.  Despite causing more deaths annually in young children and the elderly it gets less attention in the media than influenza because there isn’t a safe or cost-effective vaccine available for the general population (currently a subgroup of high risk premature infants are vaccinated for RSV only).  Terrifying right?  Yet a second grader with this illness may look like they have allergies with no fever and play normally!  If your school-age child has a runny nose this time of year please be cautious with contact with young infants.  I often hear Moms declare their child has allergies as the kid coughs their brains out spraying virus everywhere.  Just because a child doesn’t have a fever doesn’t mean they are not contagious.  To Moms of young infants keep your guard up.  Wear your babies.  Don’t let school-aged kids kiss them or touch their faces or hands.  You’re not being a jerk.  You’re acting as a part of their immune system.  To breastfeeding moms don’t wean in the winter if you can help it.  Just wait until spring when this bad boy has passed us by.  If planning a pregnancy make a summer baby!  It’s a safer time of year to be tiny.

Often what we see this time of year is a mixed picture of some typical respiratory viruses. Let’s focus on the illness called bronchiolitis.  Ie the cough that won’t quit.  It is the manifestation of one of typically three respiratory viruses (parainfluenza, respiratory syncytial virus and human metapneumovirus).  They make their way into our respiratory tracts this time of year causing few symptoms in those who have been previously inoculated (young school children, older pediatricians, teachers, Moms) and causing moderate to severe symptoms in those who have never danced or forgotten how to dance with these guys (young infants, teenagers, elderly).  Your typical second grader is a pro with this illness.  They likely will have no fever and appear to have some mild allergies.  That same viral syndrome in a young infant can result in a stay in the hospital for respiratory distress or 103+ fevers in a 3 year old.  Those prone to inflammation such as children with histories of wheezing and/or eczema are also vulnerable to more severe expression.  At baseline these children have a tendency towards the inflammatory pathways and this type of illness causes marked inflammation to the smaller airways (bronchiol-itis) which is where the name comes from.  These kids get an amplified inflammatory response which results in worse than average bronchospasm.  Also these kids have slightly thicker phlegm at baseline which can result in respiratory plugging and also make them more prone to secondary bacterial infections such as ear infections and pneumonias.  When we attempt to support a child with this illness it is all about the the phlegm.

Such a gross word right?  Phlegm.  Make it your friend.  When your child is sick with bronchiolitis/cold symptoms this is who you are working with to heal your child from the inside out.  Down in our respiratory tracts there are these fingers that are working to slowly lift gunk up and out of our lungs (cilia) via the phlegm.  Now if your secretions are like glue it makes their job a lot harder.  If the snot is thin and fluid their work is much easier.  The body will heal the cold.  My goal with my own child is to avoid antibiotics unless absolutely necessary.  Secondary bacterial pneumonia and ear infections which could require their use are more likely to form in thicker phlegm because the immune system has a harder time getting to where the bad guys are at.  Think of the native immune system rushing in with their Hummers but they get stuck in deep gooey mud.  This is how most cold medicines/antihistamines make things worse.  In an attempt to dry up the secretions they end up making it thicker and screw over our native immune response.  The body is trying to flush itself of the bad guys.  That’s what the copious snot is for!  It is also your friend.  Now if you are an adult and you HAVE to go to work feel free to keep your nose from dripping on others.  For kids, leave it alone.  In fact augment the runny mess with warm teas (no honey for friends <1 yr old).  As you sip them down your esophagus they warm and thin the phlegm in the adjacent trachea.  We use something my son calls “stink tea.”  In the winter this is actually something he drinks daily.  It is a mixture of steeped cinnamon sticks, raw honey and Gaia Kids Defense tincture.   Diffusing essential oils such as Breathe (Respiratory Blend) by DoTerra will help to loosen the secretions and even has some antimicrobial benefits as well.  My patients all use and swear by Vicks.  I don’t fight it but suggest to use it only on the soles of the feet with socks over top.  Even with expensive EOs it is better to avoid sensitive skin areas on children.  The soles of the feet are a great place to start.  Humidifiers, nasal saline/Nose Frida suction, warm baths/showers, less dairy/gluten, chicken noodle soup, avoid sweets…do you see the common denominator to what your grandma was thinking?  That’s right it’s phlegm maintenance.  There are many natural anti virals as well but they deserve their own blog!  More coming I promise.

For most kids this phlegm based approach will get them through.  Fever will break usually in <72hrs however the cough with this illness can be severe and last over 2 weeks! No they will not sleep well.  Occasionally they will cough until they vomit.  Don’t panic it will go away eventually.  Also remember to remind your sleep-deprived self next year will be better with this new hard-earned immunity!  Remember though there are the subgroups that do poorly no matter what a parent does.  If your child is having difficulty breathing, fever >72hrs, issues with feeding seek immediate care.  If your child has a history of asthma hope for the best but prepare for the worst.  Have your emergency medicines filled and ready.  Good luck out there.  Be well.

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