Feeding your baby with RSV / Bronchitis

Bronchiolitis is a common infection of the lower respiratory tract that affects babies and young children under 2 years old.

It is almost always caused by a viral infection. In most cases, the respiratory syncytial virus (RSV) is responsible.

Unfortunately your infant can get it more than and almost all children are infected with it by the time they’re 2 years old. This may result in an admission to the Children’s unit – where your baby may need to receive oxygen to help with their breathing and extra help with their feeding.

This year we have seen cases of (RSV) much earlier than the winter months.

Symptoms include:

• a rasping and persistent dry cough
• rapid or noisy breathing (wheezing)
• brief pauses in their breathing
• feeding less/fussy feeding 
• fewer wet nappies 
• vomiting after feeding
• being unsettled

One of the symptoms of RSV is that your baby maybe feeding less, if your baby is not feeding as much and is not having as many wet nappies you must seek medical advice.

During this time your baby may not tolerate feeds (breast or bottle) and your baby may need a tube placing into their nose down into their tummy which will help them to rest more, but take in food. Too much activity like feeding may tire them out and make it more difficult for them to breathe.

Saline nasal drops can helps when baby is snuffly, as can keeping them upright as much as possible.

Seek medical advice if you think your baby may need help with their breathing.

Comforting your baby 

During this time there are things you can do to comfort your baby, such as being with them and keeping them close, stroking their hands / feet, cuddling your baby or having skin to skin (this may require the nurses to help you),  they will be happy to do this for you if your baby is well enough.

Stroking your baby gently or having skin to skin / or cuddles will help both you and your baby feel relaxed by releasing hormones called oxytocin (the love hormone).

Breastfeeding / protection of breast milk supply 

If you are breastfeeding and your baby is being fed by tube to help with their breathing it is very important you protect your milk supply until breastfeeding resumes.

To do this you will need a double electric breast pump which the Children’s ward can supply.

At this point it is a good idea to double pump rather than to single pump.

This may be the first time you have expressed, and you will probably be feeling quite stressed yourself, so do not be alarmed if it takes a while to see milk coming out of the pump. Massaging your breasts, looking at your baby, being near your baby, or talking to or being with your partner will all help release the milk and drain your breasts.

Top tips to maximise your breast milk include:- 

(If you don’t pump/express and your baby is being temporarily tube fed this can result in a slowing down of your milk production)

• Ask a member of staff to loan a breast pump
• Ask a member of staff to help you set the pump up correctly
• Aim to double pump (both breasts at the same time)
• Make sure the funnel flange fits well around your nipple i.e not too small so it hurts, or too big so it does not pump effectively
• Aim to pump at least 8-10 in 24 hours to mimic your babies usual feeding pattern
• Try gentle nipple stimulation first and gentle massage of your breasts
• Express in cycles of 5 mins for a total of 15 – 20 mins (stimulate breasts and nipple, express for 4-5 minutes, back to stimulation then express and repeat – this will help with letting the milk down)
• Encourage oxytocin – this hormone helps with your let down (release of milk).  Many mothers find relaxation techniques helps, also massage of the breast and warmth to the breast, nice calming thoughts, deep breaths, talking about your concerns to a member of staff or looking at baby or photos of baby.
• Ask a member of staff how to clean the pump equipment and store your breast milk safely
• If baby is well enough when being fed by the tube, hold them near to your breast or nipple whilst they have their feed.
• Keep hydrated and eat well to keep you energised and feeling well in order to best look after your baby

When baby is feeling better and able to breastfeed, baby may feed little and often – you may still have to express.

Once your baby is getting better, sometimes they can have small amounts of milk through a feeding tube before starting breastfeeds again.  Every baby is different, and each baby will do this in different amounts of time.  Providing your breastmilk for your baby will help them whilst ill with immunity but also nutrition and comfort.

Further information available here.

• Keep baby close – Look out for early feeding cues
• Lots of skin to skin contact
• Don’t go too long without breastfeeding or expressing (remember supply and demand)
• Keep night breastfeeds to help stimulate your milk (prolactin is the milk-making hormone and this generally peaks between midnight to 5am)
• Observe nappies for signs baby is receiving enough milk
• Access infant feeding support from NCT 

Your baby may have to stop bottle feeding and have a tube inserted into their tummy to conserve energy to help with breathing.

If you are giving expressed breast milk see above for top tips.

Also, see tips above on comforting your baby.

If you are giving baby formula milk it is advisable to stick with stage 1 formula.

Top tips for when baby returns to bottle feeding:-

• Your baby may now feed little and often
• Keep baby close and feed on feeding cues
• Hold baby in a semi upright position with the bottle slightly tipped and horizontal
• Only fill the hole covering the teat with milk (not the whole of the teat)
• Gently rub the teat against your baby’s top lip to encourage them to open their mouth
• Pace the feed by watching baby for full up cues – these could be turning away, spitting out, stopping sucking
• Limit the amount of people who feed your baby so the main carer understands babies cues and this will help with bonding too
• Baby does not have to finish a full feed, this can cause discomfort
• Observe nappies for signs baby is receiving enough milk

You may find that your baby is more unsettled after and between feeds following RSV.

If you are breastfeeding and baby is unsettled during feeding, access help and ask for someone to look at how baby attaches to the breast.

If you are bottle feeding, returning to normal feeding can take some babies longer than others, little and often and taking it slowly can help, it maybe that you baby just wants to be held a little more, and be more settled in your arms. Accessing support and talking with your health visitor can help you identify what is going on for your baby and what may help.

You may see a change in your babies stooling (poo) pattern, they may change in frequency, colour or consistency – this is usually temporary.

If you are breastfeeding there is no need to stop – the antibodies that baby receives through breastmilk have never been more important.  Access support and ask for someone to look at how baby attaches to the breast.

If  you are bottle feeding, this can be a very normal response to illness or antibiotics, there is no need to change the milk you baby is receiving, chat with your Health Visitor for more support and information.

Breastfeeding your baby reduces the risk and severity of respiratory infections, the longer your baby has breastmilk/breastfeeds, the greater the protection is, if you would like more support with breastfeeding or to increase your breast milk supply or start breastfeeding again (re-lactation) please contact your Health Visitor.