Bronchiolitis is the most widespread serious respiratory infection among children under one year of age and the one that causes the most hospitalizations.
Before 12 months of life, 75% of children are infected with the respiratory syncytial virus (RSV), the main virus that causes this disease.
It was like that before the pandemic, but this year it is becoming more noticeable: on the one hand, its impact on hospitals had been forgotten after two years of displacement due to the spread of the covid;
on the other, it has been more than a month ahead of its normal time and has coincided with a flu epidemic.
At the beginning of this winter, RSV has once again been the main pathogen with which children from zero to four years of age are infected: in the first weeks of November of this year, it caused four times more infections than the influenza virus or the from covid.
In Catalonia, of the few places where data can be compared, the incidence of RSV has reached a higher peak of cases this winter than in 2019.
RSV and the other viruses that cause bronchiolitis also affect adults, but they usually remain a simple cold that does not pass through the nose.
In babies, the infection can reach the bronchi and bronchioles (in the lower respiratory tract, closest to the lungs) and can develop its worst symptom: respiratory failure.
It is key for parents to recognize when the baby is having difficulty breathing.
As seen in this image, it is clearly distinguished from when the baby breathes well: you have to pay attention to its thorax, abdomen and nose.
Motion
quick of
fins of
nose
external symptoms
of a baby with
bronchiolitis
Motion
constant
of the abdomen
ribs are marked
on each inhalation
movement is observed
quick nostrils
constant motion
of the abdomen
external symptoms
of a baby with
bronchiolitis
ribs are marked
on each inhalation
It is also important to listen to your breathing: when you have bronchiolitis, it is usually accelerated and with slight wheezing, as can be seen
in this recording
captured by a stethoscope.
The sound heard when listening to
a healthy baby
is very different .
The first symptoms may resemble those of other viruses: persistent cough, runny nose, sneezing.
In any case, it is advisable to keep the child sitting up to help him breathe better (even tilting the crib about 30 degrees at night), practice nasal washings with saline solution, avoid smoky environments and offer more smaller amounts of food, since it may cost you more to eat.
See your doctor if you start to have difficulty breathing or, even with mild symptoms, if you have risk factors such as being premature, heart disease, or lung disease.
Why does RSV hit children so hard?
The advance of the virus in babies responds, on the one hand, to the lesser development of their immune systems, which are not yet equipped to defend themselves against RSV.
As of early December, the hospitalization rate for this condition for the general population was 6.2 per 100,000 population.
Among children from zero to four years old it amounted to 145.
A baby has a respiratory system
smaller and less stable than the
of an adult.
The pharynx and larynx
are shorter, reducing
the space between the entrance
air and lungs
Are more
glands that
produce mucus,
that obstructs
the tracks
Bronchioles
The lung weighs less than
half that of an adult
but works a lot: a baby
healthy breathes between 20 and 40 times
per minute
The diameter of the trachea is half
than that of an adult.
trachea of an adult
8-10mm
trachea of a baby
4-5mm
the same diameter
than a sewing needle
The trachea and bronchi are shorter and of smaller caliber.
The bronchus is
flimsier and
facilitates collapse
Bronchioles
A baby has a more respiratory system
small and less stable than that of a
adult.
The pharynx and larynx
are shorter, reducing
the space between the entrance
air and lungs
have more glands
that produce mucus,
that obstructs the roads
Bronchioles
The lung weighs less than
half that of an adult
but works a lot: a baby
healthy breathes between 20 and 40 times
per minute
The diameter of the trachea is half that
that of an adult.
trachea of an adult
8-10mm
trachea of a baby
4-5mm
the same diameter
than a sewing needle
The trachea and bronchi are shorter and of smaller caliber.
The bronchus is
flimsier and
facilitates collapse
Bronchioles
A baby has a smaller and less stable respiratory system than an adult.
The diameter of the trachea is half that of an adult.
trachea of an adult
The pharynx and larynx
are shorter, reducing
the space between the entrance
air and lungs
8-10mm
have more glands
that produce mucus,
that obstructs the roads
trachea of a baby
4-5mm
the same diameter
than a sewing needle
Bronchioles
The lung weighs less than
half that of an adult
but works a lot: a baby
healthy breathes between 20 and 40 times
per minute
The trachea and bronchi are shorter and of smaller caliber.
The bronchus is
flimsier and
facilitates collapse
Bronchioles
A baby has a smaller and less stable respiratory system than an adult.
The diameter of the trachea is half that of an adult.
trachea of an adult
The pharynx and larynx
are shorter, reducing
the space between the entrance
air and lungs
8-10mm
They have more glands than
produce mucus, which
obstructs the tracks
trachea of a baby
4-5mm
the same diameter
than a sewing needle
Bronchioles
The lung weighs less than half that
that of an adult, but works a lot: a baby
healthy breathes between 20 and 40 times per minute
The trachea and bronchi are shorter and of smaller caliber.
The bronchus is
flimsier and
facilitates collapse
Bronchioles
Without antibodies to fight it, the infection also reaches much deeper respiratory tracts than those of an adult: everything spreads very easily to the lower airways, which, congested by mucus and inflammation, complicate the passage of air.
In the case of children under one month, the risk is greater: “They not only have respiratory distress: they can apnea.
They stop breathing ”, warns Mirella Gaboli, from the Spanish Society of Pediatric Pneumology.
How is it contagious?
El VRS se transmite en las gotitas que una persona infectada produce al estornudar o toser y sobrevive bastantes horas en superficies duras, como mesas y juguetes de madera o plástico. Por su naturaleza, los más pequeños interactúan, se llevan objetos a la boca y no guardan distancias: cuando se juntan en el mismo lugar cerrado, es muy fácil que se transmitan virus y bacterias. A su pesar, las guarderías se convierten así en un escenario perfecto para la propagación de la enfermedad.
Riesgos de contagio en una
guardería o zona de cuidado
infantil
Los niños comparten el mismo espacio
durante horas y se intercambian
objetos, lo que facilita la transmisión de
los virus.
El movimiento reflejo de
llevarse las manos y los
objetos a la boca es el
principal riesgo de contagio
Los objetos que entran en
contacto con las mucosas son
compartidos, multiplicando los
riesgos de contagio
Los niños pequeños no pueden
llevar mascarilla. La tos y los
estornudos que tienen generan
gotitas que transmiten el virus por el aire
Según la normativa, cada niño debe
tener al menos 2m² de espacio, pero,
en la práctica, es imposible garantizar
que mantengan la distancia
La poca ventilación y los
espacios reducidos facilitan que
el virus perdure en el aire
Riesgos de contagio en una
guardería o zona de cuidado infantil
Los niños comparten el mismo espacio
durante horas y se intercambian objetos, lo
que facilita la transmisión de los virus.
El movimiento reflejo de
llevarse las manos y los
objetos a la boca es el
principal riesgo de contagio
Los objetos que entran en
contacto con las mucosas son
compartidos, multiplicando los
riesgos de contagio
Los niños pequeños no pueden
llevar mascarilla. La tos y los
estornudos que tienen generan
gotitas que transmiten el virus por el aire
Según la normativa, cada niño debe
tener al menos 2m² de espacio, pero,
en la práctica, es imposible garantizar
que mantengan la distancia
La poca ventilación y los
espacios reducidos facilitan que
el virus perdure en el aire
Riesgos de contagio en una guardería o zona de cuidado
infantil
La poca ventilación y los
espacios reducidos facilitan
que el virus perdure en el aire
El movimiento reflejo de
llevarse las manos y los
objetos a la boca es el
principal riesgo de contagio
Según la normativa, cada
niño debe tener al menos
2m² de espacio, pero, en la
práctica, es imposible
garantizar que mantengan
la distancia
Los niños pequeños no pueden
llevar mascarilla. La tos y los
estornudos que tienen generan
gotitas que transmiten el virus por
el aire
Los objetos que entran en
contacto con las mucosas son
compartidos, multiplicando los
riesgos de contagio
Riesgos de contagio en una guardería o zona de cuidado infantil
La poca ventilación y los
espacios reducidos facilitan
que el virus perdure en el aire
El movimiento reflejo de
llevarse las manos y los
objetos a la boca es el
principal riesgo de contagio
Según la normativa, cada
niño debe tener al menos
2m² de espacio, pero, en la
práctica, es imposible
garantizar que mantengan
la distancia
Los niños pequeños no pueden
llevar mascarilla. La tos y los
estornudos que tienen generan
gotitas que transmiten el virus por el aire
Los objetos que entran en
contacto con las mucosas son
compartidos, multiplicando los
riesgos de contagio
Como recuerda Cristina Calvo Rey, de la Asociación Española de Pediatría, “los lactantes en ningún caso pueden llevar mascarillas, que podría protegerles, y se contagian incluso antes de haber empezado a tener síntomas”. Lo normal es que un par de días antes de empezar con tos y mocos ya puedan contagiar, y sigan haciéndolo entre tres y ocho días más.
Por esto, higiene de manos, ventilación frecuente de las estancias y evitar el contacto estrecho serían las otras medidas de prevención que proponen los expertos. Pero en una clase donde, normalmente, hay un solo adulto para gestionar entre seis y ocho niños pequeños, son especialmente difíciles de aplicar.
Outside of educational centers, contagion is usually fostered by contacts with older siblings or other adults at family gatherings.
The Spanish Society of Pediatric Pulmonology recommends avoiding visits to children under three months of age if any type of symptom occurs and, in the event that there may be a contagion at home, wearing a mask and washing hands before touching the baby.
Jacob V. López
has contributed to this story
You can follow
EL PAÍS Salud y Bienestar
on
,
and
.