A naturopathic approach to treating respiratory syncytial virus (RSV bronchiolitis)

Dr. Emily Lesnak is a Naturopathic Doctor practicing at West Seattle Natural Medicine.She specializes in pediatrics and sees children of all ages for well visits, ADHD, gastrointestinal issues and behavioral disorders.Schedule with Dr. Emily at West Seattle Natural MedicineLatest posts by Emily Lesnak (see all)

What is respiratory syncytial virus (RSV)?

This mouthful of a name is the most common source of lower lung infections in young children. RSV has the potential to lead to bronchiolitis, which is inflammation of the smallest air passages of the lungs, the bronchioles.

What are the symptoms of RSV bronchiolitis?

RSV generally starts with mild cold-like symptoms (think congestion and mild cough), but in some children it can cause a more serious lung infection. Often children and babies with bronchiolitis will have a fever, moderate cough, lots of congestion, and wheezing.

More severe signs and symptoms can include fast or troubled breathing, gasping for breath, flaring of the nostrils, caving in of the chest muscles when breathing. If you notice any of these signs it is really important that your child be seen by a doctor because they are working extra hard to breath.  For more information check out our article: My child has a cough – when do I call 911?

Is my child at risk for RSV? And how can it be prevented?

RSV is most common from fall to spring, depending on the climate of your location. This virus spreads VERY easily and is VERY common. It is so common that by the age of 2 almost every child has had an RSV infection of one form or another.

Babies that are born premature are at a higher risk for RSV infection because they were born before their lungs could fully develop. If a baby has congenital heart or lung disease they will also be at increased risk for RSV.

RSV can be spread by coughing or sneezing near your baby or child. Keeping in mind basic hygiene can be really important in preventing RSV infection: washing your hands and having others wash their hands before touching your baby and washing your baby’s and child’s toys on a frequent basis can all go a long way in preventing RSV.

How does my doctor know if my child has RSV bronchiolitis?

If your doctor suspects that your child has RSV bronchiolitis they will do a physical exam and listen to your child’s lungs and check for congestion. Wheezing is often heard on the lung exam and sometimes other abnormal lung sounds. Your doctor will also get a temperature reading and check your child’s oxygen level and make sure that your baby is not working too hard to breathe. Your baby’s ears and mouth will also be examined to make sure there are not any other causes for concern. The diagnosis for RSV bronchiolitis can be made in your doctor’s office, but sometimes if the infection is serious enough or your baby is working hard to breath they might be send your child to the local children’s hospital for further evaluation. Often times, babies and children can be managed at home if the infection is not severe.

How can RSV be treated?

RSV bronchiolitis is that it can be hard to treat because the extra congestion and mucus production makes it hard to breath and contributes to the cough. Antibiotics are not recommended since RSV is a virus and not bacteria; antibiotics are only used to treat bacteria. Bronchodilators (work by opening up the lower breathing tubes) and steroids (decrease inflammation and swelling in the lungs) are medications that are used in breathing issues like asthma, but they are not found to be helpful for RSV. So, there is not recommended medication that is routinely used to treat bronchiolitis. Sometimes these medications can be used in certain instances if a child needs to be hospitalized for RSV if their breathing cannot be managed at home or your doctor’s office.

So, what is a family to do?

There are a few treatments that I will recommend once I have diagnosed their baby or child with bronchiolitis.

Nasal suctioning:

Since babies and children with RSV often have lots of nasal congestion, at home nose suctioning can be a big help. Infants are “obligate nose breathers” meaning that they prefer to breathe just through their nose, so any little bit of congestion or mucus that is trapped in their nasal passages will make it more difficult for them to breathe.

Bulb syringes can be used, but make sure that the end tip is placed right at the entrance to the nose. If the tip is inserted too far it can cause swelling of the nose passages, which creates more mucus production – this is what we are trying to treat and prevent! (For more information check out our article 2 simple tricks to ease your baby’s nasal congestion) The NoseFrida is another suctioning tool that works a little better than the bulb syringe, but this one requires that a caregiver sucks out the snot, but don’t worry, there is a filter that prevents baby’s snot from going in the caregiver’s nose!

I always recommend that families use nasal saline (salt and water mix) drops along with suctioning because this helps to further break up mucus. Saline mixes can be found at your local drug store. The saline drops just go right in your child’s nose.

Anti-viral support:

I will often use a couple of anti-viral herbs and nutrients to treat RSV bronchiolitis. Elderberry is one of my favorite anti-viral herbs to use for kids. It works well for many viruses and is often given in syrup form so it tastes good too! I use the syrup in babies older than 6 months once they have started to introduce solids, but always making sure that the syrup is not honey based, since honey is to be avoided under 12 months of age. If the baby is less than 6 months of age and is breast-fed, I will have Mom take the elderberry syrup so baby gets the anti-viral properties through the breast milk. There are lots of studies that support the use of elderberry for treating the flu virus and I find that it works well for RSV bronchiolitis too.

N-acetylcysteine (NAC) is an amino acid; amino acids are the building blocks of proteins. NAC has the ability to thin mucus, which is a big help in RSV bronchiolitis since congestion is the major issue. Similar to elderberry syrup, I will give NAC to babies over 6 months of age – it has a sulfur-like taste to it, so mixing an opened up capsule in foods like applesauce can be helpful. There are also dissolvable NAC tablets that work well. NAC is also a potent antioxidant, which helps support immune function, another good reason to use it in RSV bronchiolitis.

RSV bronchiolitis is very common, but can also be tough to treat. It is important to know what signs and symptoms mean that your child or baby is working extra hard to breath – they should be seen by a doctor if this is happening! Nasal suctioning, saline drops, and anti-viral support will help your child feel better and hopefully get better sooner!

References:

https://www.cdc.gov/rsv/research/us-surveillance.html

KrawitzC, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, Hain T. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011 25;11:16.

Mata M, Sarrion I, Armengot M, Carda C, Martinez I, Melero JA, Cortijo J. Respiratory syncytial virus inhibits ciliagenesis in differentiaged normal human bronchial epithelial cells: effectivenets of N-acetylcysteine. PLoS One 2012; 7(10).

Mata M, Morcillo E, Gimeno C, Cortijo J. N-acetyl-L-cysteine (NAC) inhibit mucin synthesis and pro-inflammatory mediators in alveolar type II epithelial cells infected with influenza virus A and B and with respiratory syncytial virus (RSV). Biochem Pharmacol. 2011 82(5)548-55.

Naz F, Raza AB, Ijaz I, Kazi MY. Effectiveness of nebulized N-acetylcysteine solution in children with acute bronchiolitis. J Coll Physicans Surg Pak. 2014 24(6):408-11.

Schreiber S, Ronfani L, Ghirardo S, Minen F, Taddio A, Jaber M, Rizzello E, Barbi E. Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis. Acta Paediatr 2016 105(3):292-6.

Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004 32(2):132-140.

Comforting a Child Who Has a Respiratory Illness

Topic Overview

Here are some ways you can help comfort your child who has a respiratory illness (such as respiratory syncytial virus (RSV) infection or a cold):

• Ask your doctor if your child can take acetaminophen or ibuprofen to help relieve fever (if present). Be safe with medicines. Read and follow all instructions on the label. If you give medicine to your baby, follow your doctor’s advice about what amount to give. Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome.
• Prevent dehydration. Encourage your child to drink extra fluids or suck on flavored ice pops, such as Popsicles. Let your baby breastfeed more often or give your baby extra bottles. Liquids may help thin the mucus and also reduce fever (if present). But don’t force your child to take fluids, which may cause your child to vomit.
• Let your child rest. Unless you see signs of dehydration, do not awaken your child during naps or at night to take fluids.
• Keep your child away from smoke and fumes. This includes cigarette smoke, smoke from wood-burning stoves, and fumes from gas, oil, or kerosene heaters. These irritate the breathing tubes and slow healing.
• Place extra pillows under the upper half of an older child’s body, or raise the head of the bed by putting wood blocks under the bed frame.
• Use saline nose drops and an aspirating bulb to clear your child’s nose. You may need to suction your child’s nose if he or she is unable to breathe well enough to eat or sleep.
• If your child is having trouble breathing or if symptoms are getting worse, contact a doctor.

Credits

Current as of:
May 27, 2020

Author: Healthwise Staff
Medical Review:
Susan C. Kim MD – Pediatrics
Adam Husney MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Kathleen Romito MD – Family Medicine
John Pope MD – Pediatrics

Current as of: May 27, 2020

Author:
Healthwise Staff

Medical Review:Susan C. Kim MD – Pediatrics & Adam Husney MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine & Kathleen Romito MD – Family Medicine & John Pope MD – Pediatrics

RSV in Babies: Everything You Need to Know

For the most part, RSV in babies is mild, but for some susceptible babies, it can be serious. Find out who is most susceptible and what to do in this post.

No amount of hand-washing can keep all germs at bay. Eventually baby will get his first cold. And, unfortunately, sometimes that case of the sniffles can turn into something more serious, like RSV.

What is RSV in Babies?

Respiratory Syncytial Virus, commonly referred to as RSV, is a respiratory virus spread among humans, typically during cold season (November through April). There are two strains, A and B, which can effect the severity of illness.

RSV causes cold-like symptoms that can be especially uncomfortable for infants, since they cannot clear mucus from their lungs and noses as effectively as older children and adults can. It’s important to take the proper steps to monitor and treat baby’s symptoms, as RSV can be serious in infants, especially those under 6 months.

RSV Symptoms in Infants and Babies

• The RSV virus causes cold-like symptoms that last 1-2 weeks.
• Symptoms usually appear three to five days after infection.

If you notice any of the following signs of RSV, call your pediatrician right away:

• Coughing/wheezing that doesn’t stop
• Gasping for breath or rapid breathing
• Sunken chest when breathing
• Irritability
• Poor appetite/refusal to feed
• Signs of dehydration (lack of tears or sunken soft spot)
• Lethargy
• Interrupted sleep
• Blue color of mouth or fingernails
• Cough producing yellow, green, or gray mucus
• Fever

Get free updates on baby’s first year! – Free Updates on First Year [In-article]

Sign me up!

How is RSV Diagnosed?

Since RSV is so similar to the common cold, it’s difficult to diagnose without a test. A doctor can diagnose RSV by:

• Taking a rapid RSV test (your provider will take a nasal swab, so a lab can test your mucus for the virus)
• Or, taking a chest X-ray

If baby’s breathing seems labored…

Because RSV can make it difficult for your child to get enough oxygen, your pediatrician may also use a pulse oximeter to test blood oxygen saturation levels. If the test indicates baby isn’t getting enough oxygen, they may administer oxygen support. In severe cases, hospitalization may be required to ensure baby receives enough oxygen and stays hydrated.

Note: Because RSV usually runs its course on its own, your child’s doctor may not perform a formal test unless baby is particularly at-risk for complications (born premature or younger than six months, for example).

RSV Treatment

Antibiotics are not necessary or helpful since RSV is a virus, not a bacterial infection. (If RSV causes bronchiolitis or bacterial pneumonia, antibiotics may be prescribed.)

Home treatment (and a careful watch for complications) is suitable for treating mild to very moderate symptoms (even in babies). Here are some home remedies you can try, with your doctor’s approval:

• Cool mist humidifier: This helps moisten, soothe, and decongest airways.
• Nose Frida: Baby can’t effectively clear his/her own nose and lungs. This tool uses your own lung power to remove mucus from baby’s nose. Note: You can place a few drops of saline solution in each nostril to loosen things up first.
• Hydrate: Hydration is key! Breastfeeding mamas should continue to breastfeed as often as possible. For babies older than six months, bone broth or this natural electrolyte drink may help.
• Thyme tea: Purchase organic dried thyme at your grocery store, put 1 Tablespoon of the herb in a tea ball, soak in hot water, and put in bath water. Repeat up to six times per day. Studies suggest thyme helps expel phlegm and relieve congestion.
• Epsom salt: You can also add up to 1 Tablespoon of Epsom salt to bath water to relax the muscles in the chest cavity and further break up mucus. (source)
• Maty’s All Natural Baby Chest Rub: This lavender, eucalyptus, and chamomile rub is specially formulated to soothe cough and congestion. For young babies, rub it on the soles of their feet. For older children, rub directly on their chest and feet.
• Garlic oil: Garlic has long been used as a remedy for illness. Studies suggest a compound in garlic called allicin that boosts immune function. Rub garlic oil on baby’s feet. For older children, rub garlic oil directly on the chest.
• Raw onions: This old wives tale hasn’t been substantiated with research, but it’s one many parents swear by. Chop up raw onions, cook them in water, allow to cool and then wrap in paper towels. Place the warm towels on baby’s feet for 10-15 minutes. For older children, you can place this directly onto the chest. You can also chop up raw onion and place in same room where baby sleeps.
• Coldcalm Baby: This infant-safe Coldcalm comes in single-use liquid doses to temporarily relieve sneezing, runny nose, and nasal congestion.
• Vitamin D: To help boost baby’s immune system, administer 400 IUs of vitamin D drops per day. Try this brand.
• Baby probiotics: Look for an infant probiotic with B. bifidum, B. infantis, and L. reuteri to help support baby’s immune system. This is one of my favorites. Read all about baby probiotics here.
• XLEAR: This helps thin mucus and support the nasal microbiome. Administer prior to using the Nose Frida. You can alternate with saline.

Additional treatment options for the breastfeeding mama

A breastfeeding mom can help baby fight the virus by taking a variety of supplements herself, since beneficial properties will pass through breastmilk:

• Vitamin C: Proven to boost the immune system and because it’s water soluble, it passes through to milk. You can get with camu camu powder or another food-based vitamin C supplement.
• Vitamin D: To ensure your breast milk has am adequate amount of vitamin D, studies suggest taking 5,000-6,000 IU of vitamin D per day. (source) Try taking three capsules of this brand per day.
• Probiotics: I like this brand, but I’ve also tried Dr. Ohhira and Bio-K. You can also eat fermented foods, like kombucha, yogurt, kefir, sauerkraut, and kimchi.
• Elderberry syrup: I don’t recommend taking elderberry syrup every day (it can send your immune system into overdrive), but it has been proven to reduce the severity and duration of colds. (source). Take 1-2 TB per day until baby feels better.

How to Treat Post-Coughing Vomiting

With RSV, congestion can be bad and mucus production is immense. As a result, babies can cough so hard that they throw up. For post-coughing vomiting, look into homeopathic remedies, like Ipecacuanha 30C, that can help when dissolved in breast milk and administered. Always talk to healthcare provider before giving baby any homeopathic remedies!

To help post-coughing vomiting, you can also try to minimize the passage of mucus by:

• Holding baby upright while nursing or feeding
• Placing baby to sleep in a reclined or more upright position whenever possible

Is RSV Contagious?

This virus is very contagious and can be easily spread by infected droplets (from sneezing, coughing, or talking) that get into the eyes, nose, or mouth.

• RSV can live on hands for 30 minutes or on contaminated objects (think supermarket carts and toys) for hours.
• RSV is typically contagious for 3 to 8 days.

How to Prevent RSV in Babies and Infants

Prevention is key in keeping RSV out of your home and is especially important if you have a high-risk child.

Here are some things you can do to minimize the risk:

• Wash hands frequently
• Minimize contact with older siblings, particularly if they’re sick (You can ask older kids to kiss or touch baby’s feet, rather than face. )
• Don’t allow utensil or food sharing
• Disinfect surfaces with thieves spray
• Wash bedding/toys often
• Avoid crowds or exposure to people who are sick
• Continue to breastfeed if you already are. Take vitamin D, probiotics, and elderberry syrup to impart the benefits to baby through your milk.
• Give baby vitamin D drops and probiotics regularly (older children can also take elderberry syrup)

Unfortunately, a child can get RSV multiple times in the same season. There is one bit of good news, though: It’s usually more mild the second or third time.

When RSV Gets Really Serious…

For most babies and children, RSV causes a mild cold. But in severe cases, babies may need more conventional treatment, including:

• A nebulizer: If, despite treatment, baby is having trouble breathing, a nebulizer may be necessary to provide oxygen support. A nebulizer converts a medicine to a mist that baby inhales.

In very severe cases of RSV in babies, hospitalization may be necessary. In the hospital, doctors may administer oxygen treatment, IV fluids, and/or a ventilator to help with breathing. This is usually only necessary for a few days.

Those most at risk for these complications are:

• Babies born prematurely: Premature infants often have lower lung function, making respiratory illness particularly dangerous.
• Children younger than 2 born with heart or lung disease: Babies with congenital heart disease who contract RSV are 24 times more likely to die than those who don’t contract the disease.
• Infants and young children whose immune systems are weakened: Certain conditions or procedures (chemo or a transplant, for example) can make babies more susceptible to RSV.
• Babies under 8 to 10 weeks old: At such a young age, babies systems aren’t mature enough to adequately fight off infection and viruses.

Though RSV generally runs its course with proper symptom management, babies are particularly sensitive—their symptoms can escalate quickly.

Keep a close eye on baby and stay in touch with your child’s pediatrician.

How about you?

Have you, your baby or a loved one had RSV? How was it treated? Share with us in comments below!

Respiratory Syncytial Virus (RSV): Symptoms, Treatment, Relief

Overview

RSV in Infants and Children

What is respiratory syncytial virus (RSV)?

Respiratory syncytial virus (RSV) is a common respiratory virus. It affects the lungs and its bronchioles (smaller passageways that carry air to the lung). RSV is one of the most common causes of childhood illness, infecting most children by two years of age. RSV can also infect adults.

Most healthy children and older adults who get RSV will get a mild case with cold-like symptoms. Only self-care or “comfort care” is usually needed.

Severe infection with RSV can lead to pneumonia (an infection in the lungs) and bronchiolitis (inflammation of the small airways in the lungs) and may require hospital care. People at greatest risk of severe infection are the very young (those less than six months old), those over the age of 65 and those of any age who have heart or lung conditions or a weakened immune system. RSV can also make existing heart and lung problems worse.

Is respiratory syncytial virus (RSV) contagious? How is it spread? How long does it last?

Yes, RSV is highly contagious — particularly during the three- to seven-day period a person has symptoms. Some infants and people with weakened immune systems may remain contagious for as long as four weeks.

The virus is spread through close contact, when an infected person sneezes or coughs and the virus becomes airborne and gets into your body through your eyes, nose or mouth. It’s also spread by touching objects that the virus has landed on and then touching your face. RSV can live on hard surfaces for many hours.

It takes between two to eight days from the time a person is exposed to the RSV to show symptoms. Symptoms generally last three to seven days. Most children and adults recover fully in one to two weeks.

How common is respiratory syncytial virus (RSV)?

Most children get RSV before two years of age. Infection is easily spread in young children because of their close contact with other children who may be infected, through the sharing of their toys and constant touching of objects that may be contaminated with the virus. Some 57,000 children under age five require hospital care due to RSV each year in the U.S.

Among adults, about 177,000 older adults are hospitalized each year for RSV. Some 14,000 adults die due to this infection each year.

Is respiratory syncytial virus (RSV) a seasonal illness?

Yes, like the flu, RSV is a seasonal illness. It occurs in most areas of the U.S., starting in late fall and lasting through early spring.

Who gets respiratory syncytial virus (RSV) infection?

RSV infects almost all children at least once before they are two years old. Most of the time, this virus only causes minor cold-like symptoms. However, for some babies and certain adults, the infection can be more dangerous.

Infants and adults at highest risk of severe or life-threatening RSV infection are:

• Premature infants (because their lungs are underdeveloped).
• Infants under 6 months of age.
• Infants born with heart or lung disease.
• Children and adults with weakened immune systems, including those who have received an organ transplant or those undergoing chemotherapy.
• Children who have difficulty swallowing or can’t clear mucous.
• Adults 65 years of age and older.
• Adults with heart and lung diseases, such as congestive heart failure, chronic obstructive pulmonary disease or asthma.

Symptoms and Causes

What are the signs and symptoms of respiratory syncytial virus (RSV) in infants?

Common symptoms of RSV in infants include:

• Runny nose.
• Decrease in appetite.
• Sneezing and coughing.
• Fever (temperature above 100 degrees Fahrenheit). Fever may not always be present.

Symptoms in the youngest infants include:

• Fussiness/irritability.
• Decreased activity/more tired than usual.
• Decreased appetite.
• Pauses in breathing.

Symptoms of severe RSV in infants include:

• Short, shallow and rapid breathing.
• Flaring (spreading out) of nostrils with every breath.
• Belly breathing (look for a “caving in” of the chest in the form of an upside-down “V” starting under the neck).
• Bluish coloring of lips, mouth and fingernails.
• Wheezing (This can be a sign of pneumonia or bronchiolitis.)
• Poor appetite.

What are the symptoms of respiratory syncytial virus (RSV) in older children and adults?

Many older children and adults have no symptoms or very mild symptoms. Common symptoms of RSV in those who do get symptoms are similar to the common cold and include:

• Runny nose.
• Congestion.
• Mild headache.
• Sore throat.
• Fever.
• Cough.
• Tiredness.

What serious conditions can respiratory syncytial virus (RSV) lead to?

Serious conditions that can arise from RSV include:

• Pneumonia or bronchiolitis.
• Worsening symptoms in people with such conditions as chronic obstructive pulmonary disease, asthma and congestive heart failure.

Diagnosis and Tests

How is respiratory syncytial virus (RSV) diagnosed?

Your healthcare provider will take your or your child’s medical history and ask about symptoms. The physical exam will include listening to your or your child’s lungs and checking oxygen level in a simple finger monitoring test (pulse oximetry). They may order blood testing to check for signs of infection (such as a higher than normal white blood cell count) or take a nose swab to test for viruses.

If more severe illness is suspected, your healthcare provider will order imaging tests (X-rays, CT scan) to check your or your child’s lungs.

Management and Treatment

How is respiratory syncytial virus (RSV) treated?

If you or your child has mild symptoms, prescription treatment is usually not needed. RSV goes away on its own in one to two weeks. Antibiotics are not used to treat viral infections, including those caused by RSV. (Antibiotics may be prescribed, however, if testing shows you or your child has bacterial pneumonia or other infection.)

Some young children who develop bronchiolitis may have to be hospitalized to receive oxygen treatment. If your child is unable to drink because of rapid breathing, he or she may need to receive intravenous fluids to stay hydrated. On rare occasions, infected babies will need a respirator to help them breathe. Only about 3% of children with RSV require a hospital stay. Most children are able to go home from the hospital in two or three days.

If you are an older adult and especially if you have a weakened immune system, you may need to be hospitalized if the RSV is severe. While in the hospital, you may receive oxygen or be put on a breathing machine (ventilator) to help your breathe or receive IV fluids to help with dehydration.

Is a vaccine available to prevent respiratory syncytial virus (RSV)?

No vaccine is available to treat RSV yet. Scientists are working on developing one.

Is there a cure for respiratory syncytial virus (RSV)?

Currently, there is no cure for RSV. However, scientists continue to learn about the virus and look for ways to prevent the infection or better manage severe illness.

What is palivizumab (Synagis®)?

Pavlivimab is a drug approved to prevent severe RSV in certain infants and children at high risk for severe disease. The drug doesn’t cure RSV, is not used to treat children who already have severe RSV and can’t prevent RSV infection. It is given as monthly injections during the RSV season. Ask your healthcare provider if pavlivimab is an appropriate drug to prevent RSV infection in your child.

If I or my child gets respiratory syncytial virus (RSV) once, can we get it again?

People who contract certain viruses can sometimes build an immunity to a virus. This means that they will not become infected again for some length of time or even forever. This is not the case for RSV. It’s possible for you or your child to get RSV more than once over your life and even more than once during a single RSV season.

The good news is that repeated infections tend to be less severe than the original infection. However, if you are an older adult or an adult with a weakened immune system or long-term heart or lung disease, RSV infection may be more serious if you are infected again.

Prevention

What can I do to prevent getting respiratory syncytial virus (RSV) or prevent spreading RSV if infected?

You can follow the same precautions that one follows if they have the cold, flu or any other contagious disease:

• Wash your hands often. Wash for 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. (Alcohol-based rubs work well for young children who don’t have the coordination or attention span for proper hand washing technique.)
• Avoid touching your eyes, nose and mouth to prevent the spread of viruses from your hands.
• Cover your mouth and nose with a tissue when sneezing and coughing or sneeze and cough into your elbow. Throw the tissue in the trash. Wash your hands afterward. Never cough or sneeze into your hands!
• Avoid close contact (within 6 feet) with those who have known RSV, coughs, colds or are sick. Stay home if you are sick.
• Don’t share cups, toys or bottles, or any objects. Viruses may be able to live on such surfaces for hours (and be transmitted to your hands).
• If you are prone to sickness or have a weakened immune system, stay away from large crowds of people.
• Clean frequently used surfaces (such as doorknobs and counter tops) with a virus-killing disinfectant.

Additional tips for children:

• Keeping your children home from day care when they or other children become ill.
• If you have a child at high risk of developing severe RSV, try to limit time at child care centers or gatherings of large number of children during the RSV season.
• Wash toys frequently.

How can I make my child with respiratory syncytial virus (RSV) feel better at home?

• Do not allow anyone to smoke around your child or in the home. This can complicate breathing.
• Try using a cool mist vaporizer to soothe dry breathing passages if recommended by your doctor. Hot-air vaporizers should be avoided because of the risk for scald burns.
• Make sure your child gets plenty of fluids, such as breast milk or formula for infants, or milk, juices, and water for older children. Breast milk contains antibodies that can help fight infections.
• For fever, give your child (older than 6 months) medicine such as acetaminophen (Children’s Tylenol®) or ibuprofen. Never give your child aspirin, as aspirin could cause Reye’s syndrome.
• Apply saline nasal drops to help loosen mucus in the nose.
• Blow little noses frequently (or gently suction your infants’ nose).
• Allow your child plenty of rest, as needed.
• Give all medicines as instructed by your child’s doctor.

Outlook / Prognosis

What can be expected if I or my child develop respiratory syncytial virus (RSV)?

Most cases of RSV are mild and cause cold-like symptoms. Almost all children under two years of age will be infected with RSV.

Most cases of RSV in adults and healthy children will not require treatment. Infants and older adults at greatest risk of severe RSV can develop pneumonia or bronchiolitis or experience a worsening of their existing heart and lung conditions and may require hospitalization.

You can help prevent the spread of RSV by following good common sense hygiene / cleanliness tips.

Always contact your healthcare provider or go to the emergency department if you have breathing problems, high fever or are concerned about any of your or your child’s symptoms.

Living With

When should I call my healthcare provider?

Call your healthcare provider if you or your child has these symptoms:

• Fever (temperature above 100 degrees Fahrenheit).
• Fever lasting more than two days.
• Grey or blue tint to tongue, lips or skin.
• Difficulty breathing.
• Cold symptoms that have become severe.

Additional symptoms to watch for in young children include:

• Extreme fussiness, decreased alertness.
• Dehydration (Signs include less than one wet diaper every 8 hours, dry mouth and crying without tears).
• Coughing continues day and night.
• Poor appetite.

Coughs: Meds or Home Remedies?

Medicines (OTC)

Over-the-Counter (OTC) cough and cold medicines can cause side effects. These side effects can be serious in young children. The risks of using these medicines outweigh any benefits. In 2008, the Food and Drug Administration (FDA) looked at this issue in children. They recommended these medicines never be used in young children. After age 6, the medicines are safe to use, if you follow the package instructions. But, it’s easy to treat coughs and colds without these medicines.

Home Remedies:

A good home remedy is safe, cheap, and as helpful as OTC medicines. They are also found in nearly every home. Here are some simple but helpful home treatments.

1. Runny Nose: Just suction it or blow it. Teach your child how to blow the nose at age 2 or 3. When your child’s nose runs like a faucet, it’s getting rid of viruses. Allergy medicines (such as Benadryl) do not help the average cold. They are useful only if your child has nasal allergies (hay fever).

2. Blocked Nose: Use nasal saline.

• Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don’t have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
• Step 1: Put 3 drops in each nostril. If age under 1 year old, use 1 drop.
• Step 2: Blow (or suction) each nostril separately, while closing off the other nostril. Then do other side.
• Step 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
• How Often: Do nasal saline rinses when your child can’t breathe through the nose. Limit: If under 1 year old, no more than 4 times per day or before every feeding.
• Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
• Saline nose drops can also be made at home. Use ½ teaspoon (2 ml) of table salt. Stir the salt into 1 cup (8 ounces or 240 ml) of warm water. Use bottled water or boiled water to make saline nose drops.
• Reason for nose drops: Suction or blowing alone can’t remove dried or sticky mucus. Also, babies can’t nurse or drink from a bottle unless the nose is open.
• Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow (or suction) each nostril.
• For young children, can also use a wet cotton swab to remove sticky mucus.
• Medicines. There are no drugs that can remove dried mucus from the nose.

3. Coughing: Use homemade cough medicines.

• Age 3 months to 1 year. Give warm clear fluids (such as apple juice or lemonade). Dose: 1-3 teaspoons (5-15 ml) four times per day when coughing. Under 3 months, see your child’s doctor. Caution: Do not use honey until 1 year old.
• Age 1 year and older. Use Honey ½ to 1 teaspoon (2 to 5 ml) as needed. It thins the secretions and loosens the cough. If you don’t have honey, you can use corn syrup. Research shows that honey works better than cough syrups to reduce nighttime coughing.
• Age 6 years and older. Use Cough Drops to decrease the tickle in the throat. If you don’t have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
• Coughing fits. The warm mist from a shower can help.

4. Fluids: Help your child drink lots of fluids. Staying well hydrated thins the body’s secretions. That makes it easier to cough and blow the nose.

5. Humidity: If the air in your home is dry, use a humidifier. Moist air keeps the nose and airway from drying out. Run a warm shower for a while to help put moisture in the air.

Treatment is Not Always Needed:

• If symptoms aren’t bothering your child, they don’t need medicine or any treatment. Many children with a cough or cold are happy, play fine and sleep well.
• Only treat symptoms if they cause discomfort or wake your child up. Treat a cough if it’s hacking and really bothers your child.
• Fevers are helpful. Only treat them if they slow your child down or cause some discomfort. That does not occur until 102° F (39° C) or higher. Acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be given. Use to treat higher fever or pain. See Dose tables.

Summary

If coughs or colds need treatment, home remedies may work better than medicines.

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Last Reviewed: 10/12/2021

Last Revised: 03/11/2021

Copyright 2000-2021 Schmitt Pediatric Guidelines LLC.

Respiratory Syncytial Virus (RSV) Infection | CS Mott Children’s Hospital

Topic Overview

What is respiratory syncytial virus infection?

Respiratory syncytial virus infection, usually called RSV, is a lot like a bad cold. It causes the same symptoms. And like a cold, it is very common and very contagious. Most children have had it at least once by age 2.

RSV is usually not something to worry about. But it can lead to pneumonia or other problems in some people, especially babies. So it’s important to watch the symptoms and call your doctor if they get worse.

What causes RSV infection?

A virus causes RSV infection. Like a cold virus, RSV attacks your nose, eyes, throat, and lungs. It spreads like a cold too, when you cough, sneeze, or share food or drinks.

There are many kinds of RSV, so your body never becomes immune to it. You can get it again and again throughout your life, sometimes during the same season.

What are the symptoms?

RSV usually causes the same symptoms as a bad cold, such as:

• A cough.
• A stuffy or runny nose.
• A mild sore throat.
• An earache.
• A fever.

Babies with RSV may also:

• Have no energy.
• Act fussy or cranky.
• Be less hungry than usual.

Some children have more serious symptoms, like wheezing. Call your doctor if your child is wheezing or having trouble breathing.

How is RSV diagnosed?

Doctors usually diagnose RSV by asking about your or your child’s symptoms and by knowing whether there is an outbreak of the infection in your area.

There are tests for RSV, but they aren’t usually needed. Your doctor may want to do testing if you or your child may be likely to have other problems. The most common test uses a sample of the drainage from your nose.

How is it treated?

RSV usually goes away on its own. For most people, home treatment is all that is needed. If your child has RSV:

• Prop up your child’s head to make it easier to breathe and sleep.
• Suction your baby’s nose if he or she can’t breathe well enough to eat or sleep.
• Relieve fever with acetaminophen or ibuprofen, if needed. Be safe with medicines. Read and follow all instructions on the label. Never give aspirin to someone younger than 20 years, because it can cause Reye syndrome, a serious but rare problem.

When a person with RSV is otherwise healthy, symptoms usually get better in a week or two.

RSV can be serious when the symptoms are very bad or when it leads to other problems, like pneumonia. Certain people are more likely to have problems with RSV:

• Babies younger than 6 months, especially those born early (prematurely)
• People with immune system problems
• People with heart or lung problems
• Adults older than 65

These people sometimes need treatment in a hospital. So it’s important to watch the symptoms and call your doctor if they get worse.

Can you prevent RSV infection?

It’s very hard to keep from catching RSV, just like it’s hard to keep from catching a cold. But you can lower the chances by practicing good health habits. Wash your hands often, and teach your child to do the same. See that your child gets all the vaccines your doctor recommends.

Medicines to prevent RSV may be given to babies and children who are more likely to have problems with the infection. Sometimes these medicines don’t prevent RSV, but they may keep symptoms from getting serious.

Cause

Respiratory syncytial virus (RSV) is highly contagious, meaning it spreads easily from person to person. There are two main types of RSV and many subtypes (strains). For this reason, you cannot have full immunity to the virus. And you may have many RSV infections throughout life.

People with RSV infection may spread the virus through their secretions (saliva or mucus) when they cough, sneeze, or talk. You can catch the virus by:

• Touching an object or surface contaminated with the virus and then touching your nose, eyes, or mouth without first washing your hands. The virus can survive for more than 6 hours on countertops and other hard surfaces, such as doorknobs, and for 30 minutes on hands, clothing, or tissue.
• Close contact. If an infected person coughs or sneezes near you, you could breathe in RSV that’s in his or her saliva or mucus.

The virus spreads easily in crowded settings, such as child care facilities, preschools, and nursing homes. Children attending school often spread the virus to their parents and siblings. The incubation period—the time from exposure to RSV until you have symptoms—ranges from 2 to 8 days but usually is 4 to 6 days. ^{footnote 1}

You are most likely to spread the virus within the first several days after symptoms of RSV infection begin. You remain contagious for up to 8 days. Babies and young children may spread the virus for at least 3 to 4 weeks.

Many different viruses can cause lower respiratory tract infections in children. These viruses can cause symptoms that are similar to an RSV infection.

Symptoms

When a respiratory syncytial virus (RSV) infection affects the nose and throat (upper respiratory system), symptoms are usually mild and resemble those of the common cold. They include:

• Cough.
• Stuffy or runny nose.
• Mild sore throat.
• Earache.
• Fever, usually at the beginning of the illness. A high fever does not mean the illness is more severe.

Babies may have additional symptoms, including:

• A decreased interest in their surroundings.
• Listlessness and sleepiness.
• Fretfulness (irritability) and not sleeping well.
• Poor feeding.
• Apnea, where breathing stops for about 15 to 20 seconds. This usually occurs only in babies who were born prematurely and who also have a history of apnea.

It is hard to distinguish between a common cold and RSV infection. But unless you or your child has an increased risk of complications from RSV, it usually is not important to know which virus causes symptoms.

RSV infection sometimes leads to bronchiolitis or pneumonia or both.

Symptoms of these complications include:

• Difficulty breathing, which may include breathing more rapidly than normal.
• Wheezing.
• Coughing that is getting worse. A child may choke or vomit from intense coughing.
• Lethargy, increased tiredness, decreased interest in surroundings, or loss of interest in food.

What Happens

In healthy children, respiratory syncytial virus (RSV) infections tend to be mild and resemble a cold. Children who have only upper respiratory system symptoms, such as a sore throat or a runny nose, usually recover in about 10 to 14 days.

Two different types and many different subtypes (strains) of RSV exist. For this reason, you cannot have full immunity to the virus and may have many RSV infections throughout your life. A child’s first RSV infection, which almost always occurs by age 2, usually is the most severe. Certain babies and children have an increased risk of complications from an RSV infection because of a health condition or another problem. Also, babies have narrow breathing tubes that can clog easily, making breathing hard. The most common complications for young children are bronchiolitis and pneumonia, which are lower respiratory tract infections.

Adults older than 65 have an increased risk of complications following infection with RSV. Pneumonia is a particular risk, especially if other health problems exist, such as chronic obstructive pulmonary disease (COPD) or heart failure.

It may take older adults longer to recover from RSV infection and its complications than people in other age groups.

What Increases Your Risk

Respiratory syncytial virus (RSV) infects almost all children by the age of 2, and reinfection throughout life is common. The virus spreads easily and is extremely difficult to completely avoid. Babies and young children who are in day care centers or frequently in public places are most likely to become infected, especially during the peak season.

Older brothers and sisters in school often become infected with the virus and spread it to other household members, including babies and preschoolers. Sharing food, touching objects that are contaminated with the virus, and not washing hands can lead to RSV infection. Older adults living in nursing homes or other group environments also have a higher risk of becoming infected with RSV.

Babies ages 2 to 7 months of age have the highest incidence of RSV infection affecting the lower respiratory tract. Reinfection with another type or strain of RSV can occur within weeks. But later infections are usually less severe.

With RSV infections, there is an increased risk of having complications, especially in certain babies and young children and adults older than 65.

When should you call your doctor?

Call
911
or other emergency services right away if:

See your doctor right away if your baby or child has moderate trouble breathing.

Call a doctor if your child:

• Breathes slightly faster than normal and seems to be getting worse. Most healthy children breathe less than 40 times a minute.
• Has cold symptoms that become severe.
• Has shallow coughing, which continues throughout the day and night.
• Has poor appetite or decreased activity level.
• Has any trouble breathing.

Watchful waiting

For an otherwise healthy child who has symptoms of an upper respiratory infection, such as a cough or runny nose, home treatment usually is all that is needed. But it is important to watch for signs and symptoms of complications, such as dehydration.

Watchful waiting may not be appropriate when your child with an upper respiratory infection has an increased risk for complications. Watch your child closely if he or she has symptoms of an upper respiratory infection. If symptoms get worse or new symptoms develop, see a doctor right away.

Who to see

Respiratory syncytial virus (RSV) infection can be diagnosed and treated by a health professional such as a:

Exams and Tests

In otherwise healthy people, it is not usually necessary to distinguish respiratory syncytial virus (RSV) infection from a common cold. A doctor may suspect RSV infection as the cause of symptoms when there is evidence of a recent community outbreak. It is generally not necessary to confirm RSV infection with lab tests. But a medical history and physical exam may be done to evaluate symptoms.

A viral detection test may be done to confirm a diagnosis of RSV in symptomatic children and adults older than 65 who are at an increased risk for a severe infection or for complications. The test involves lab analysis of nasal drainage, obtained with a cotton swab or nasal wash. Testing may also be recommended for people who are hospitalized if the cause of symptoms has not already been determined and they have a high risk of developing complications.

The results of viral detection tests help determine whether precautions are needed to prevent the spread of infection. For children who are at risk for getting severe infections or complications of RSV infections, the results of these tests may help guide treatment, such as the need for medicines.

Certain tests may be needed if RSV symptoms do not improve or become worse or if complications such as bronchiolitis or pneumonia are suspected. These tests may include:

Treatment Overview

Respiratory syncytial virus (RSV) infections are usually mild and seem like a common cold. In most cases, RSV infections go away on their own in about 10 to 14 days. Home treatment to ease symptoms and prevent complications is usually all that is needed.

• Watch for signs of dehydration. Signs of dehydration include being thirstier than usual and having darker urine than usual. Make sure to replace fluids lost through rapid breathing, fever, diarrhea, or vomiting. Encourage more frequent breast- or bottle-feeding. Avoid giving your baby sports drinks, soft drinks, undiluted fruit juice, or water. These beverages may contain too much sugar, contain too few calories, or lack the proper balance of essential minerals (electrolytes).
• Make your child more comfortable by helping relieve his or her symptoms. Sometimes a child may get some relief from medicine, such as acetaminophen or ibuprofen, or from being kept in an upright position, which makes breathing easier. Be safe with medicines. Read and follow all instructions on the label. You can suction your baby’s nose if he or she can’t breathe well enough to eat or sleep.
• Make sure you understand whether and when antibiotics are needed. Antibiotics are not usually given for RSV infections. But if your child develops complications, such as an ear infection, your doctor may prescribe an antibiotic. Do not stop giving antibiotic medicine when your child starts to feel better. The entire prescription must be taken to completely kill the bacteria. If you do not give your child all the medicine, the bacterial infection may return.
• Take care of yourself. Caring for a sick child can be very tiring physically and emotionally. You can best help your child when you are rested and feeling well.

Treatment for severe infection or complications

Children who develop lower respiratory infections, especially bronchiolitis, may need medicines in addition to home treatment. Antibiotics may be used to treat a bacterial infection (such as pneumonia) that develops as a complication. But antibiotics don’t treat RSV or any other viral infection.

When complications develop in otherwise healthy children, corticosteroid medicines sometimes are used. But more study is needed before corticosteroids are routinely recommended for this purpose.

A child who is having difficulty breathing or is dehydrated may need to be cared for in a hospital. The child may need respiratory and other medical treatments. In very rare cases, some children receive the antiviral medicine ribavirin while they are in the hospital.

• Pregnant women should avoid contact with a child who is receiving ribavirin.
• If your child is in the hospital for RSV, there are extra measures you can take to make his or her stay comfortable.

Prevention

Respiratory syncytial virus (RSV) infection is easy to catch (highly contagious). It is common for children to get viral infections such as RSV if they are often exposed to infected people and have not built up immunity. There is no sure way to prevent respiratory illnesses in babies and children.

Sometimes medicines are used to help prevent RSV infection in babies and children who are at risk for complications from RSV. Even if RSV infection develops, use of these medicines may result in a less severe infection.

Monoclonal antibodies, such as palivizumab (Synagis), may be used to help prevent or reduce the severity of RSV infection.

The following may help reduce your child’s risk of respiratory problems:

• Wash your hands frequently, and teach your children to do the same. Also, make sure people who care for your child wash their hands and understand the importance of this habit in preventing the spread of infection.
• See that your child gets all of his or her vaccines. Diphtheria, tetanus, and pertussis (DTaP), Haemophilus influenzae type b (Hib), and pneumococcal vaccines are especially important.
• Breastfeed your baby for at least the first 6 months after birth, if possible. Breast milk seems to offer some protection against RSV infection, but more study is needed.^{footnote 2} Breast milk does not prevent RSV infection.
• Separate a child diagnosed with RSV from others in the home as much as possible.
• If you smoke, quit. If you cannot quit, do not smoke in the house or car. Secondhand smoke irritates the mucous membranes in your child’s nose, sinuses, and lungs, making him or her more susceptible to infections.

Outbreaks of RSV often occur between late fall and early spring. To keep from catching the virus during this time, limit your exposure to RSV. This is most critical for babies and children who are at risk for serious RSV infections. Try to avoid:

• Sharing items such as cups, glasses, and utensils with others.
• People who have upper respiratory infections, such as colds.
• Child care centers, malls, movie theaters, and other places where many people are in an enclosed area.
• Visiting children who are in the hospital.

Home Treatment

When to use home treatment

Most mild to moderate respiratory syncytial virus (RSV) infections in otherwise healthy people are like the common cold and can be treated at home. If your child is older than 12 months of age and is not at risk for complications from RSV infection, try home treatment. But RSV infections in people with an increased risk of complications need close monitoring.

People who have impaired immune systems need to see a doctor for cold symptoms because of the increased risk for complications. Also, babies and children—and older adults—who have health problems and other risk factors should see a doctor at the first sign of RSV.

How to help your child with RSV infection

• Watch for signs of dehydration. Make sure to replace fluids lost through rapid breathing, fever, diarrhea, or vomiting. Encourage more frequent breast- or bottle-feeding. Avoid giving your baby sports drinks, soft drinks, undiluted fruit juice, or water. These beverages may contain too much sugar, contain too few calories, or lack the proper balance of essential minerals (electrolytes).
• Make your child more comfortable by helping relieve his or her symptoms. Sometimes a child may get some relief from medicine, such as acetaminophen or ibuprofen, or from being kept in an upright position, which makes breathing easier. Be safe with medicines. Read and follow all instructions on the label. Never give aspirin to someone younger than 20 years, because it can cause Reye syndrome, a serious but rare problem. For more information, see Quick Tips: Giving Over-the-Counter Medicines to Children.
• Antibiotics are not usually given for viral infections. But if your child develops complications of RSV, such as an ear infection, your doctor may prescribe an antibiotic. Do not stop giving antibiotic medicine when your child starts to feel better. The entire prescription must be taken to completely kill the bacteria. If you do not give your child all the medicine, the bacterial infection may return.
• Take care of yourself. Caring for a sick child can be very tiring physically and emotionally. You can best help your child when you are rested and feeling well.

Medications

Most respiratory syncytial viral (RSV) infections do not require prescription medicines. But medicines may be recommended for certain people to help:

• Prevent RSV infection.
• Treat RSV infection and its complications.

Medicine choices

A medicine may be given to infants and children at high risk for complications of RSV to prevent the infection or reduce its severity. Monoclonal antibodies, such as palivizumab (Synagis), are usually given in monthly doses for up to 5 months. This medicine can stop RSV from multiplying.

Medicines to help treat complications of RSV infection include:

• Corticosteroids. These medicines may be used if a child has an RSV infection and also has asthma or an allergic-type breathing problem. But corticosteroids are typically not used.
• Antibiotics. Antibiotics help the body destroy bacteria and may be used to help treat or prevent complications that can occur from RSV.
• Bronchodilators. They relax the muscle layer that surrounds the breathing tubes in the lung, allowing them to expand and move air more easily. This may help to reduce wheezing in some infants and toddlers.

What to think about

• Ribavirin (Virazole) is an antiviral medicine that is very rarely used to treat people with RSV infections who have a high risk of developing complications. Studies so far have provided conflicting evidence regarding its effectiveness. The doctor will consider the particular circumstances of the person being treated before making a recommendation about ribavirin.
• Bronchodilators are typically not used, but they may be tried for babies who are having trouble breathing. The medicine can be continued if it helps.

References

Citations

1. American Academy of Pediatrics (2015). Respiratory syncytial virus. In DW Kimberlin et al., eds., Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed., pp. 667–676. Elk Grove Village, IL: America Academy of Pediatrics.
2. Hall CB, Walsh EE (2009). Respiratory syncytial virus. In RD Feigin et al., eds., Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2462–2487. Philadelphia: Saunders Elsevier.

Other Works Consulted

• Committee on Infectious Diseases, Bronchiolitis Guidelines Committee (2014). Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics, published online July 28, 2014. DOI: 10.1542/peds.2014-1666. Accessed August 1, 2014.
• Honegger JR, Brady MT (2011). Viral respiratory infections including influenza. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 961–970. New York: McGraw-Hill.
• Levin M, et al. (2014). Infections: Viral and rickettsial. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 22nd ed. , pp. 1227–1270. New York: McGraw-Hill.

Credits

Current as of:
May 27, 2020

Author: Healthwise Staff
Medical Review:
John Pope MD – Pediatrics
Kathleen Romito MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Susan C. Kim MD – Pediatrics

Bronchiolitis (for Parents) – Nemours Kidshealth

What Is Bronchiolitis?

Bronchiolitis (brong-kee-oh-LYE-tiss) is an infection of the respiratory tract. It happens when tiny airways called bronchioles (BRONG-kee-olz) get infected with a virus. They swell and fill with mucus, which can make breathing hard.

Bronchiolitis is more common during the winter months. Most cases can be managed at home.

What Are the Signs & Symptoms of Bronchiolitis?

The first symptoms of bronchiolitis are usually the same as those of a cold:

Usually, symptoms get better on their own. But sometimes the cough might get worse and a child may start wheezing or have noisy breathing.

Who Gets Bronchiolitis?

Bronchiolitis:

• most often affects infants and young children because their small airways can easily get blocked
• is most common during the first 2 years of life, especially in very young babies
• is more common in premature babies, children with lung or heart problems, and kids with weak immune systems

Kids who go to childcare, have siblings in school, or are around secondhand smoke have a higher risk for bronchiolitis. Older kids and adults can get bronchiolitis, but the infection usually is mild.

What Causes Bronchiolitis?

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. Sometimes, the common cold and the flu also can cause it.

How Is Bronchiolitis Diagnosed?

When they suspect bronchiolitis, doctors listen to the child’s chest and check oxygen levels with a pulse oximeter.

Usually, no tests are needed. The doctor may use a swab to get a sample of mucus from the nose for testing. This helps with identifying the type of virus causing the problem.

A chest X-ray might be done if the child’s oxygen level is low or the doctor suspects pneumonia.

How Is Bronchiolitis Treated?

Most cases of bronchiolitis are mild and don’t need specific medical treatment. Antibiotics can’t help because viruses cause bronchiolitis. Antibiotics work only against bacterial infections.

Treatment focuses on easing symptoms. Kids with bronchiolitis need time to recover and plenty of fluids. Make sure your child gets enough to drink by offering fluids in small amounts often.

You can use a cool-mist vaporizer or humidifier in your child’s room to help loosen mucus in the airway and relieve cough and congestion. Clean it as recommended to prevent buildup of mold or bacteria. Avoid hot-water and steam humidifiers, which can cause scalding.

To clear nasal congestion, try a nasal aspirator and saline (saltwater) nose drops. This can be especially helpful before feeding and sleeping.

Talk to the doctor before giving your child any medicine. For babies who are old enough, you may be able to give medicine to help with fever and make your child more comfortable. Follow the package directions about how much to give and how often. But cough and cold medicines should not be given to any babies or young kids. When in doubt, call your doctor.

Babies who have trouble breathing, are dehydrated, or seem very tired should be checked by a doctor. Those with serious symptoms may need care in a hospital to get fluids and, sometimes, help with breathing.

Is Bronchiolitis Contagious?

Viruses that cause bronchiolitis spread easily through the air when someone coughs or sneezes. Germs can stay on hands, toys, doorknobs, tissues, and other surfaces. People can be contagious for several days or even weeks.

How Long Does Bronchiolitis Last?

Bronchiolitis usually lasts about 1–2 weeks. Sometimes it can take several weeks for symptoms to go away.

When Should I Call the Doctor?

Bronchiolitis often is a mild illness. But sometimes it can cause severe symptoms. When it does, kids need treatment in a hospital.

Get medical care right away if a baby:

• has fast, shallow breathing and you can see the belly moving up and down quickly
• has labored breathing, when the areas below the ribs, between the ribs, and/or in the neck sink in as a child breathes in
• has flaring nostrils
• is very fussy and can’t be comforted
• is very tired or won’t wake up for feedings
• has a poor appetite or isn’t feeding well
• fewer wet diapers or peeing less than usual
• has a blue color to the lips, tongue, or nails

You know your child best. Call your doctor right away if something doesn’t seem right.

Can Bronchiolitis Be Prevented?

Washing hands well and often is the best way to prevent the spread of viruses that can cause bronchiolitis and other infections.

Also:

• Keep infants away from anyone who has a cold or cough.
• Keep kids away from secondhand smoke.
• Keep toys and surfaces clean.

90,000 7 Proven Ways To Deal With Anxiety

Contents of article

Feel a rapid heartbeat, trembling in your hands and knees, twists your stomach, your cheeks turn red, slight nausea and shortness of breath – these are signs of intense anxiety and panic. This happens exactly at the moment when it is necessary to demonstrate calmness and resilience. We’ve put together 10 effective ways to help you manage stress and calm down quickly. Choose one of the methods and apply at the right time.

Wash your hands in cold water

During intense excitement, a person seems to cease to control himself, his emotions and actions. Shaking hands and fever intensify panic. To calm your body, you need to wash your hands in cold water, or even better, wash your face. Cold water will bring you to your senses and help you distract from worries.

Clench your fists

If you are unable to get up and walk around, try the next method. Sit on a chair, put your hands on your knees and clench your fists with all your strength, take a deep breath and exhale slightly loosen your fingers.Then inhale again and open your fists a little more as you exhale. And so repeat several times.

Take online courses for free
and discover new opportunities
Start learning

Scroll the same phrase

Breathe in and out through your nose and silently say “everything will be fine” several times, like a spell. You can say a funny phrase from the cartoon “Calm, only calm!” in the voice of Carlson. Your task is to distract yourself from frightening thoughts.

Confess your excitement

It often happens that the more we try to hide our excitement, the more it manifests itself. In this case, allow yourself to be worried, tell a loved one that you are in a great panic and it will immediately become easier for you.

Unleash your emotions

Irritation, nervous tension may be the result of an unresolved internal problem. To get rid of this state, you need to give free rein to emotions. Cry when you feel like it, don’t suppress your emotions.

Convert

This method is suitable in cases where you need to go through an unpleasant procedure, an exam, a job interview, or speaking in front of an audience.At this moment, it is important to catch your eye on some object in the room, for example, a tile on the wall, and start counting them. This will distract yourself from your thoughts and help you calm down.

Meet Fear

The best way to overcome your fears is to face them. For example, you are afraid to ask for a promotion at work, so you constantly postpone this conversation. But you do not know for sure how this conversation will end in the end. Therefore, take the first step yourself and conquer your fear.

Each of us periodically experiences anxiety and even panic, but this can and should be fought. To make your life easier and learn how to control your emotions, take the free online course “Stress Management”. In just 45 minutes, you will learn really working techniques to help you quickly deal with stress in the moment.

90,000 Rational and Irrational Thinking: Features, Methods and Development Tips

You often make deliberate decisions or are guided by intuition, or maybe you use two methods at once.Let’s see what the difference is between rational and irrational thinking, and what type of thinking is better to develop. Rational thinking is based on a logical principle, blocking the influence of emotions, moods, all subjective forms. Irrational thinking, on the contrary, refers primarily to feelings, emotions and experiences, without limiting thoughts to any framework.

Rational and irrational thinking are opposite sides of one whole. Many people prefer to stick to a rational approach without further developing other abilities.But these two types of thinking can perfectly complement each other. By learning the methods of opposing thinking, you will be able to navigate faster in various unknown situations.

Take online courses for free
and discover new opportunities
Start learning

Methods of Rational Thinking

People with developed rational thinking rely on facts, logic, clear reasoning. They are not in a hurry, even slow in making decisions. They carefully consider each step, analyzing and comparing the available data.Such people have the following skills:

• Analyze the problem. In order to make a decision, they first mentally decompose the situation into parts, details, in order to understand the relationship.
• Synthesize details. Separate parts of the problem are combined into a coherent whole to see the whole picture.
• Compare the facts. Comparing the differences between different events, they determine something in common that contributed to what is happening.
• Abstracts from unnecessary details. To get to the bottom of the truth and see the root of the problem, they discard unnecessary elements.
• Organize information. The obtained facts are combined into a single whole. Everything in the world is interconnected, there is no such phenomenon that would exist separately from each other.

All these techniques can be used both in scientific activity and in everyday life. Rational thinking is more developed among those who are fond of the exact or natural sciences: mathematics, chemistry, physics, biology.

Methods of irrational thinking

Irrational thinking is based on impulsive decision making, formed on emotions, self-awareness and feelings.Consider the principles of irrational thinking:

• Intuition. This is a kind of premonition, a feeling, not supported by any facts and logic. You just need to act in this situation as the heart says, and not otherwise.
• Illumination. Sudden awareness of the right decision, the instant appearance of the right thought. Illumination can come, for example, in a dream, in the morning at breakfast, or in a conversation with a friend.
• Imagination. It is the ability of a person to model a situation and solve a problem without using practical skills.Think over the missing elements and restore the general picture of what happened.

This is the basis of irrational thinking, you can also add emotional reactions, spiritual insights, meditation, subconsciousness, contemplation and others. Irrational thinking is more developed among those who are fond of art, creativity, believe in miracles.

It is possible to develop both types of thinking at any age. This is an ongoing process that requires constant work on yourself. There are various exercises that can help shape the thinking of both the adult and the student.If you want to improve your skills, develop your weaknesses, then take the online course “Emotional Intelligence”. Learn how to improve your personal performance, learn to work with your motivation, habits, perception and emotional state.

HLW Veterans Council

Infection prevention – together

Wash your hands

The best way to prevent infections is to wash your hands frequently with soap and water.You can also use an alcohol-based hand sanitizer. When performing medical procedures, healthcare professionals and caregivers must carefully practice hand hygiene.

Follow the rules of personal hygiene carefully.

Simple daily self-care is essential to prevent infections. This includes brushing your teeth and taking good care of your oral cavity, doing daily watering, protecting your skin, and following guidelines for wound and catheter care.

Keep the rooms where the patient is located

clean

For some immunocompromised children, even microbes living in dust and dirt can be dangerous. Routine cleaning of floors and surfaces can reduce the risk of infection. Particular attention should be paid to the areas in which the child undergoes medical procedures. Germs can be found on toys and other objects used by children. Wipe down toys and electronics regularly. Wash stuffed animals, blankets, and bedding in hot water.Change your bedding often.

Avoid contacts

Stay away from sick people. For patients with weak immunity, even a common cold can be dangerous. Some patients may need a special mask to filter the air that may contain germs. Family members who are ill may wear masks to reduce the risk of transmitting germs to the patient.

Get vaccinated

Caregivers and family members should follow vaccination guidelines, including getting flu and whooping cough shots.Vaccination of the patient is carried out on the recommendation of a doctor. Some immunocompromised patients should not be given certain vaccinations, and live vaccines are especially dangerous. This is why it is so important that people around them are vaccinated.

Watch the chair

Diarrhea in cancer patients may be associated with chemotherapy, radiation therapy, or infection. Wash your hands and disinfect surfaces. Change diapers with gloves.

Be careful

For children with weak immunity, even familiar things can become a source of infection.Talk to your doctor about the possible risks:

• Fresh Flowers: Flowers and plants may contain potentially harmful bacteria and fungi.
• Domestic and Wildlife: Avoid contact with wild animals. Pets must be vaccinated and healthy; they should be washed regularly.
• Dirt and Soil: Some patients may be affected by Aspergillus and other microbes living in dust and dirt.
• Crowded areas and swimming pools: Some children need to avoid these areas to reduce their risk of illness.

Think Food Safety

Wash your hands before preparing and eating food and keep the food preparation area clean. Store and prepare food properly. Wash fruits and vegetables before eating. Talk with your doctor about which foods to avoid and follow diet directions.

90,000 Tracheitis – causes, symptoms and treatment

The trachea transports air during inhalation and exhalation. It is also responsible for cleaning the inhaled air from dust and dust.It is a protective function of the trachea that protects the body from bacteria that can cause infection. Tracheitis is an inflammation of the middle airways.
Symptoms of tracheitis.
The main symptom of tracheitis is a persistent and very exhausting cough. Usually dry first, then wet.
Other symptoms of tracheitis:
sore throat, shortness of breath, shortness of breath, fever, weakness and fatigue, chest pain, palpitations, hoarseness, increased discharge from the nose and nose,
Tracheitis – causes.
Tracheitis is most commonly caused by viruses (influenza, parainfluenza, rhinovirus, adenovirus and RSV). It also happens that the disease is a consequence of laryngitis and bronchitis.
Infection usually occurs by droplets. The virus is spread by sneezing and coughing. Tracheitis most commonly affects children and people exposed to cigarette smoke.
Types of tracheitis:
Acute tracheitis is very often a complication after influenza or laryngitis. This usually goes away on its own after a few days.Chronic tracheitis – accompanies chronic diseases. It also happens that this is the effect of air pollution or cigarette smoke.
How to recognize tracheitis?
Throat swab is most commonly used to diagnose tracheitis. To rule out other illnesses (such as pneumonia), the doctor may also refer the patient to a tracheal and chest x-ray.
Tracheitis – treatment.
The source of the tracheitis must first be identified. If the disease is caused by a bacterium, antibiotics must be given.It is worth remembering, however, that tracheitis is primarily caused by viruses.
In this case, analgesics, antipyretic and expectorant drugs will be sufficient. In some cases, intubation or even tracheotomy of the patient is necessary.
Home remedies for tracheitis.
Treatment of tracheitis can also be successfully supported with home remedies. First of all, do not forget about adequate hydration. The patient should consume up to 3 liters of water per day.
Other home remedies for tracheitis:
Inhalation.You can use eucalyptus oil or tea tree oil to help you breathe. The correct temperature for the patient’s room. Ideally 18-20 degrees Celsius. Adequate humidity in the room. In case we don’t have humidifiers at home, we can successfully use a wet towel hung on the radiator.
Tracheitis – complications.
Tracheitis is usually very mild and goes away on its own. In very rare cases, complications occur, which are characterized by breathing problems and shortness of breath.In this case, you should immediately consult a doctor who will rule out possible respiratory failure, which can be life-threatening. If you live in Moscow, or came to the capital for a diploma of higher education, then you have a unique opportunity – to buy a diploma in Moscow, your education will be like a Moscow university, and you can choose a diploma from any educational institution in the country!

Zero reporting of individual entrepreneurs and LLC | Submission of zero reporting (zero declaration) according to the STS and UTII

Zero declaration according to the STS, if there are no income and expenses

Zeros in the tax return can be easily explained by the lack of income.

The IRS may doubt the veracity of the information and check your bank account. If there were no receipts, questions will disappear. If you did receive money in the account, most likely, you will be sent a request for clarification. In such a situation, it is important to explain to the tax authorities what kind of money it is and why you did not show it in your tax return. For example, as part of income, you do not need to take into account the replenishment of the account with personal money or the repayment of debt.

Details about the simplified taxation system in the article “Simplified taxation system”.

6-NDFL, if employees have not been paid for the whole year

Report 6-NDFL must be submitted if individuals receive income from you – salary, dividends or an interest-free loan. The annual 6-NDFL also includes 2-NDFL certificates, which were handed over separately until 2021.

If physicists were not paid for the entire year, you do not need to report, because during the tax period you were not a tax agent. 6-NDFL can be zero.

If a person receives income from you at least once a year, you hand over 6-NDFL for the quarter in which you paid, and then until the end of the year.

For example, on April 15, 2021, your LLC issued dividends to the founder. You have to pass 6-NDFL for half a year, 9 months and a year at the end of 2021.

About reporting on personal income tax in the article “How to prepare a 6-personal income tax report”.

RSV and 4-FSS, if there are no employees

Calculation of insurance contributions to the tax and 4-FSS to the social insurance fund is handed over to individual entrepreneurs with employees and all LLCs.

If the individual entrepreneur does not have employees during the year, it is not necessary to hand over the RSV and 4-FSS.

LLC are always accountable. If there are no employees in the organization, submit zero reporting, but this may lead to claims from the state.

The fact is that an LLC is a separate organization in the interests of which the director acts. Often, in small firms, the founder himself performs the director’s job. He does not pay himself a salary and receives income in the form of dividends. But according to labor law, a director is an employee like everyone else, so he is entitled to a salary.

Supervisors are especially suspicious of firms that receive income, but hand over zeroes for employees. They may require clarification, charge additional fees and fine.

We wrote more about a director in an LLC in the article “Even if a director is a founder of an LLC, he is entitled to a salary.”

SZV-M without employees

SZV-M – monthly report to the pension fund, which contains a list of all your employees.

If you are an individual entrepreneur without employees, you do not need to take SZV-M.

And in LLC there is at least one employee – a director, and he needs to be shown in SZV-M.

There is no consensus as to whether it is necessary to take SZV-M to the director-only founder with whom an agreement has not been drawn up. The FIU itself issued two letters with opposite positions. According to a letter dated May 6, 2016, SZV-M must be taken in any case, and already in a letter dated July 27, 2016, the FIU says that there is no such obligation.

We recommend employing the director at least part-time and submitting SZV-M and other reports for him as for an ordinary employee.If an employment contract has not been signed with the director, the regulatory authorities may have questions. Read more about this in the article.

If you still do not want to employ a founder, ask your FIU whether you need to show a director without an employment contract in SZV-M – different departments may have different opinions.

If the organization has suspended business, does not receive income, and there are no hired employees, it is not necessary to take SZV-M. Such explanations are provided by the FIU on its website.

Clause: how to report after all employees have been fired

SZV-TD when there are no employees

SZV-TD – a report to the Pension Fund of the Russian Federation on personnel events.

Individual entrepreneurs without employees do not pass SZV-TD, it is not necessary to show the individual entrepreneur himself in the report. Zero report form is not provided.

If the director is employed in an organization under an employment contract, then SZV-TD must be handed over, as for any other employee. Upon acceptance and dismissal – no later than the next working day after the issuance of the order.If there were other personnel events, the report is sent by the 15th day of the next month.

If an employment contract with the founder has not been concluded, then there is no need to hand over the SZV-TD.

Article: electronic work books and SZV-TD

SZV-STAGE without employees

SZV-STAZH – an annual report to the Pension Fund of the Russian Federation on the length of service of employees.

Individual entrepreneurs who do not have employees do not submit a report. There is no zero form SZV-STAZH.

Organizations need to submit a report, even if an employment contract has not been concluded with the founder.This is stated in the Resolution of the Board of the PF RF dated 06.12.2018 No. 507P. If the sole Founding Director does not receive a salary, enter “NEOPL” in the Calculation of length of service → Additional information field.

Clause: reporting to the FIU for employees

Zero accounting LLC

Every year, all LLCs submit financial statements, which reflect the annual results of activities – money in accounts, property, debts, profit or loss.

Accounting is never zero, even if you did not run a business.Each organization has an authorized capital, the amount of which you determine when registering a business and deposit it into a bank account. It needs to be reflected in accounting records.

An article on how to conduct accounting yourself – “Accounting without an accountant: what an LLC needs to know.”

Elba has a special tariff for LLCs that submit zero reporting. Read about the details on the dedicated page.

🎁

For new individual entrepreneurs – the year of Elba as a gift

Year of online accounting at the Premium tariff for individual entrepreneurs under 3 months

Try it for free

Good to remember

The article is current on 02.02.2021

Educational platforms

ROUND is a federal-scale career guidance project.

We believe that in Russia it is necessary to introduce a larger number of systemic products for the vocational guidance of children, because:

• more than 70% of schoolchildren have no idea what they are going to do in life;

90,048 64% of the population of Russia does not work in their specialty;

$ 90,048,300 billion Russian business may be missing by 2030 due to a shortage of specialists.

In this regard, we have developed the ROUND application, which consists of an online platform and an analytics and recommendations system. The online platform allows children to post the results of their project activities, receive assignments in their area of ​​interest and find like-minded people. The analytics system tracks user activity and builds a “map of interests and success” of the child.

Using this data, the system can issue professional characteristics and set the trajectory of talent development.Those. knowing the child’s predisposition to a particular type of activity, we can give him tasks and encourage success in a particular area. The trajectories of the development of talents are formed from pedagogical recommendations, as well as the request of society (state, business) in future specialists.

Video tutorials are available in the application, as well as instructions on which children can learn various skills and professions. The mobile application and website are a global network that unites all adolescents who are passionate about project activities and creativity at any level.

The aggregator platform will become a platform for the primary selection of enthusiastic schoolchildren, who, already in the “zone of proximal development”, can be offered to participate both in online contests and attending circles in a direction that fascinates them.

Currently, there is an mvp product posted as an application on the Play Market, in which 30 professions and 300 tasks for each profession are published.