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

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.

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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.

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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.

 

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Emily Lesnak
Emily Lesnak
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 Medicine

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