How do I know if my child has bronchiolitis

Bronchiolitis etymologically means inflammation of the small bronchi (bronchioles) and surrounding tissue. It is the first episode of obstructive respiratory distress (exceptionally the second since, by consensus, successive episodes in the same patient are labeled as bronchitis) that occurs in infants less than 12 months of age, although in the United States it is accepted up to 24 months of age.

Initially the patient presents with symptoms compatible with a viral infection, such as fever, nasal catarrh and cough.
Subsequently, respiratory distress, restlessness and refusal of food appear. Pulmonary auscultation detects wheezing and/or rales.

What to do if bronchiolitis is suspected?

Diagnostic tests are not required to detect bronchiolitis, since it depends on the patient’s symptoms on the one hand, and on the findings of the pediatric specialist in the examination of the patient on the other.

However, in some cases, a sample may be taken from the rhinopharynx. Although it is not always indicated, its application is on the rise, since it is very useful to differentiate between the two major producers of bronchiolitis: Respiratory Syncytial Virus (RSV) and Rhinovirus (RV). It is important to distinguish between them because these types of viruses have different prognosis and treatment. That is why in my practice we can perform this test if the patient’s condition makes it advisable.
Another fundamental aspect of bronchiolitis is to check the patient’s oxygen saturation by means of pulse oximetry (taking oxygen from the finger), because if it is below 95%, it indicates a more important affectation.

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In severe cases, a chest X-ray may also be performed, although it is advisable to replace it with an ultrasound, since children are 4 times more sensitive than adults to X-rays.

What is bronchiolitis ultrasound?

Ultrasonography is the exploration by ultrasound, in this case, of the lungs, both posterior, anterior and lateral of both lungs.
It is not painful and can be performed in the arms of the parents. Another advantage is that it is innocuous, as it does not emit radiation, and can be repeated as many times as necessary.
In addition, ultrasound is capable of detecting abnormalities that are not visible on radiography, such as the presence of small subpleural condensations.

Ultrasound scoring systems are available to assess the severity of bronchiolitis, which can also be done in series to check the patient’s evolution.

As an innocuous examination, ultrasound can be applied to all patients with bronchiolitis. With this tool, we can have more data than those provided during simple pulmonary auscultation and, by virtue of the above, we routinely practice it in all our patients.