October 23, 2017
Winter is coming! This is the time of year when we see lots of wheezing children present to clinic with a disease called bronchiolitis. Bronchiolitis is a viral associated illness that causes significant lung inflammation in children under the age of two years old. It is a leading cause of hospitalization in this group. This illness is usually benign, but it can be scary as some children will present with cough, fever, wheezing and further respiratory compromise over time. Some high risk individuals need to be aware of this disease, including: premature or low birth weight newborns, children with immune system defects/cardiac disease/chronic lung disease/severe neurological disease.
Respiratory syncytial virus (RSV), rhinovirus, parainfluenza, influenza, adenovirus and metapneumovirus are the major pathogens that cause this disease. RSV is the most common and serious player in this group.
The tricky part of diagnosing this illness is realizing that it starts as a common cold and then progresses to a lower respiratory tract disease with wheezing and shortness of breath as the hallmark worsening symptoms. Paying close attention for these signs of lower respiratory illness can save a life.
These viral diseases are spread via droplets of a cough or nasal secretions. Quarantining young ones and effective hand washing are very important in the prevention of disease.
If your child does get ill, bring them to your provider as soon as they show signs of lower tract disease with wheezing, shortness of breath, tugging in their ribs, nasal flaring or fast breathing rate.
Your doctor will likely provide a breathing treatment with a medicine called albuterol which can help in a minority of cases that are asthma related. Children with a family history of asthma are likely to benefit from this medicine and warrant a trial. Other medicines like steroids and antibiotics have no place in treating viral disease and should not be used as the recent scientific literature has proven.
It is clear that vitamin D is important in the prevention of disease. As with all immune related diseases, vitamin D is critical in maintaining a robust and normal immune response to disease. Maintaining normal vitamin D levels in a newborn's body is critical. To that end, it is recommended that all breast fed babies receive 400IU of vitamin D daily. We also encourage 15 minutes of direct sun exposure as well for all children with increasing time in the sun for children with darker skin tones as directed by your provider.
Exclusive breastfeeding is also critical in order to provide passive antibodies that can prevent illness in the first place.
Aside from the risk of death from this disease, there are some other interesting risks post illness. Children with low vitamin D levels and/or a family history of allergic type diseases are at higher risk for developing later asthma. We also know from the Amish study that children that have little exposure to natural animal based bacteria are at higher risk for allergic type disease.
Take home points:
1) Exclusively breastfeed
2) Maintain adequate vitamin D levels
3) Get exposed to animal dust of farms/farm houses and household pets
4) Wash hands and avoid people with viral colds when your children are young to prevent sensitization
5) After 6 months of age, children should eat as healthily as possible to keep all micro nutrient levels normal
6) Seek immediate medical help if your child is wheezing, having difficulty breathing, is short of breath or has you concerned
7) Avoid smoke and other airborne pollutants that can reduce immunity and inflame the lung tissue
8) Keep your child hydrated with adequate volumes of breastmilk or supplemental water when older
9) Run a vaporizer with sterile normal saline for mucous thinning and cough reduction