Bronchiolitis

Bronchiolitis is a respiratory viral infection in a young child (usually less than 2 years). What is different from the congestion and cough seen in typical upper respiratory infections (nose and mouth) is there is inflammation and mucous is also in the lower airways (lungs).

  • wheezing (making a high-pitched whistling sound when breathing out)
  • breathing rapidly at a rate of over 40 breaths per minute
  • tight breathing (having to push the air out)
  • coughing (may cough up very sticky mucus)
  • a fever and a runny nose that precede the breathing problems and cough.

The symptoms are similar to asthma.

What is the cause?

The wheezing is caused by a narrowing and swelling inside the smallest airways in the lung (bronchioles). This narrowing results from inflammation (swelling) caused by a virus, usually the respiratory syncytial virus (RSV). RSV occurs in epidemics almost every winter. While infants with RSV develop bronchiolitis, children over age 2 years and adults just develop cold symptoms.

RSV and similar viruses are very common in the winter months. All children will have “colds” caused by these viruses some time in their first few years. How bad the symptoms are varies widely depending on the age of the patient and other risk factors.

The youngest infants are at highest risk for developing difficulties, especially if born early (premature) or have other heart or lung disease. The difficulties that can cause a child to be hospitalized is requiring extra oxygen or labored breathing severe enough to interfere with feeding.

How long does it last?

Wheezing and tight breathing (difficulty breathing out) become worse for 2 or 3 days and to slowly improve. Overall, the wheezing lasts approximately 7 days and the cough about 14 days.

Bronchiolitis is a VIRAL infection. Antibiotics will not help the cough or mucous. Ear infections are a common complication of bronchiolitis and do often require antibiotics in the young child.

Recurrences of wheezing (asthma) occur more often in children who have close relatives with asthma or who have had wheezing problems themselves previously. Asthma is easily treated with medications.

How can I take care of my child?

Medicines

Less than 1/3 of children with bronchiolitis are helped by asthma-type medicines. Your health care provider may prescribe medicine for your child. Your child is more likely to benefit from asthma-type medicines if there is a strong history in the family of asthma or the child has themselves had wheezing difficulties in the past. In addition, you can give your child acetaminophen (Tylenol®) every 4 to 6 hours or ibuprofen every 6 to 8 hours for fever or discomfort.

Humidity

Dry air tends to make coughs worse. Use a humidifier in your child’s bedroom to thin out secretions and make it easier for your child to cough.

Suction of a blocked nose

If the nose is blocked, your child will not be able to drink from a bottle or to breast-feed. Most stuffy noses are blocked by dry or sticky mucus. Suction alone cannot remove dry secretions. Warm tap-water or saline nosedrops are better than any medicine you can buy for loosening up mucus. Place three drops of warm water or saline in each nostril. After about one minute, use a soft rubber suction bulb to suck out the mucus. You can repeat this procedure several times until your child’s breathing through the nose becomes quiet and easy.

Feedings

Encourage your child to drink enough fluids. Eating is often tiring, so offer your child formula, breast milk, or regular milk (if he is over 1 year old) in smaller amounts at more frequent intervals. If your child vomits during a coughing spasm, feed him or her again.

No smoking

Tobacco smoke aggravates coughing. Children who have an RSV infection are much more likely to wheeze if they are exposed to tobacco smoke. Don’t let anyone smoke around your child. In fact, try not to let anybody smoke inside your home.

When should I call my child’s health care provider?

Call IMMEDIATELY if:

  • Breathing becomes labored or difficult.
  • The wheezing becomes severe (tight).
  • Breathing becomes faster than 60 breaths per minute (when your child is not crying).
  • Your child is having difficulties taking liquids.

Call within 24 hours if:

  • Any fever lasts more than 3 days.
  • The cough lasts more than 3 weeks.
  • You have other questions or concerns.