Bronchiolitis in Children

Bronchiolitis is an infection of the lungs. It’s when your child has swelling in the smaller airways (bronchioles) of the lung. This swelling blocks air in the smaller airways. Bronchiolitis is different than bronchitis. Bronchitis is an infection of the larger airways.

Bronchiolitis often happens in the winter and early spring. It most often affects children younger than 2 years old.

The most common cause of bronchiolitis is a virus. At first, the virus causes an infection in the upper respiratory tract. This includes the nose, mouth, and throat. It then spreads down into the windpipe (trachea) and lungs (lower respiratory tract). The virus causes inflammation and even death of the cells inside the respiratory tract. This blocks airflow in and out of the child’s lungs.

Bronchiolitis is most often caused by the respiratory syncytial virus. But these other viruses can also cause it:

• Rhinovirus
• Parainfluenza virus
• Adenovirus
• Influenza
• Human metapneumovirus

In rare cases, bronchiolitis may be caused by bacteria.

All young children are at risk for bronchiolitis. The illness can spread easily through droplets in the air from coughing, sneezing, and talking. But some children have a higher chance of developing it. These are children who:

• Were born too early (premature)
• Have been exposed to tobacco smoke
• Go to daycare
• Have other serious health conditions
• Have older children in the home
• Are not breastfed

Bronchiolitis may at first be mistaken for a common cold. It starts out with many of the same symptoms. But your child may have a cough and other breathing problems that get worse over time. Below are the most common symptoms of bronchiolitis:

• Runny nose
• Congestion
• Fever
• Cough
• Fast or hard breathing
• Wheezing
• Loss of appetite
• Irritability
• Vomiting

These symptoms often last about a week. They may look like other health problems. Make sure your child sees their healthcare provider for a diagnosis.

Your child’s healthcare provider can diagnose bronchiolitis with a health history and physical exam of your child. In some cases, your child may need tests to rule out other diseases, such as pneumonia or asthma. These tests include:

• Chest X-rays. This test makes images of internal tissues, bones, and organs.
• Blood tests or blood gases. A blood test may help see if the infection is caused by a virus or bacteria.
• Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To get this measurement, the healthcare provider puts a small sensor (like a bandage) on your child's finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless, and the red light doesn't get hot.
• Swab of the nose and throat (nasopharyngeal swab). This test can quickly spot RSV and other viruses.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Most cases are mild and can be treated at home. There is no cure for the illness. So the goal of treatment is to ease symptoms and wait for the body's immune system to fight off the virus. Antibiotics aren't used unless your child has a bacterial infection.

Some babies with severe breathing problems are treated in the hospital. While they are in the hospital, treatment may include:

• IV (intravenous) fluids if your child can't drink well
• Extra oxygen and a breathing machine (ventilator) to help with breathing
• Frequent suctioning of your child’s nose and mouth to help get rid of thick mucus
• Breathing treatments, as ordered by your child’s healthcare provider

If your child is at home, the following treatment may be helpful:

• Rest
• Drinking lots of fluids
• Suctioning your child’s nose and mouth with a bulb syringe to help get rid of thick mucus, especially before feedings
• Giving acetaminophen or ibuprofen (if your baby is older than 6 months) for fever, if directed by your child's healthcare provider.
• Use a cool-mist vaporizer in your child's room at night

Talk with your child’s healthcare provider before giving over-the-counter cough and cold medicine to your child. The American Academy of Pediatrics does not advise giving these medicines to children younger than 4 years old because they may cause harmful side effects. For children between ages 4 and 6, only use over-the-counter products when advised by your child's healthcare provider. In most cases, also don’t give antihistamines. They can dry up the secretions. That can make the cough worse.

Don’t give aspirin or medicine that contains aspirin to a child younger than age 19 unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder. It most often affects the brain and the liver.

Note: Always talk with your child's healthcare provider before giving any medicine to them, especially for the first time.

Most children who have bronchiolitis will get well without any problems. But those born early or who have other health problems are more likely to have complications from the condition. These may include:

• Pauses in breathing (apnea)
• Breathing failure

You can help prevent the spread of bronchiolitis.

• Wash your hands or use an alcohol-based hand cleaner before and after touching your child. Also help your child wash their hands.
• Keep your child away from others who are sick. While your child has symptoms, keep them away from other children.

• Keep your child up-to-date on all vaccines.

• Teach your child to cover their nose and mouth when coughing or sneezing.

Your child may also need a palivizumab shot to help prevent infection with RSV. This medicine belongs to a group of medicines known as immunizing agents. It works by giving your child's body antibodies to protect it against RSV infection. During RSV season, these shots are advised for high-risk babies. High-risk babies include those born early or those with lung, heart, or immune system diseases. Talk with your child’s healthcare provider to see if the shot is right for your child.

Call 911 if your child:

• Has trouble breathing
• Turns blue in color, especially the lips and fingertips
• Is breathing very fast

Call your child’s healthcare provider right away if your child’s symptoms get worse, or if they:

• Can't keep liquids down
• Aren't eating or drinking
• Aren't having wet diapers

• Bronchiolitis is an infection of the airways in the lungs.
• It’s often caused by a virus, often the respiratory syncytial virus (RSV).
• The first symptoms may look like a common cold. But a child develops a cough, wheezing, and breathing problems.
• Most cases are mild and can be treated at home. Children with severe breathing problems are often treated in the hospital.
• Bronchiolitis can be prevented with correct handwashing and staying away from people who are sick. Your child may get a palivizumab shot if they are at high risk for an RSV infection.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.