Bronchiolitis is an infection of the small breathing tubes (bronchioles) in the lungs, the "lower" part of our breathing system. Bronchiolitis is caused by different viruses. The common virus is respiratory syncytial virus (RSV), which spreads from person to person through direct contact. For example, a child can be exposed to a virus when he plays with an infected child or when he is splashed by the tiny droplets that come out when an infected person sneezes or coughs. Once a child is exposed, the virus usually enters his body through the eyes or nose.
In its early stages, bronchiolitis looks like a mild cold, with sneezing and runny nose. However, over the course of two to three days, symptoms may become more serious, with lots of runny nose, a "tight" or harsh-sounding cough, wheezing, and fast breathing (tachypnea). Breathing may become so difficult that the child's nostrils flare and the chest muscles pull in (retract), or the child makes grunting or whistling noises with each breath. Parents sometimes say they can feel "rattling" in the chest. Many infants with bronchiolitis become irritable, look anxious and uncomfortable, and have a hard time eating or drinking.
Bronchiolitis tends to affect infants and children under 2, especially babies between 2 and 6 months of age. It is the most common reason for hospitalization of infants in the United States. Approximately one in five infants will get bronchiolitis each year, with 2% to 3% needing to be hospitalized. Although bronchiolitis can occur at any time of the year, it most commonly is seen during the winter months.
Bronchiolitis generally gets better within one to two weeks. However, sometimes it can turn into an infection in the ears (otitis media). Some infants who have bronchiolitis early in life may develop asthma as they get older.
Symptoms of bronchiolitis may include:
- Runny nose
- “Tight” or harsh-sounding cough
- Fever (usually mild or low grade)
- Breathing faster than usual (tachypnea)
- Difficulty breathing
- Breathing with wheezing, grunting or whistling noises
- Difficulty eating
- Not eating or drinking as much as usual (poor appetite)
- Fussiness or irritability
- Trouble sleeping
To know if your child has bronchiolitis, the doctor will:
- Check your child’s temperature, since bronchiolitis often causes a mild fever.
- Watch your child breathe. This means:
- Counting how many times your child is breathing each minute (respiratory rate). Bronchiolitis can cause him to breathe faster than normal (tachypnea).
- Checking if your child is showing signs of difficult breathing, such as using the muscles in his neck, chest or belly to help breathe (retracting), making grunting or whistling noises when breathing out, or flaring his nostrils when breathing in. Parents sometimes say they can feel "rattling" in the chest.
- Examine your child’s lungs carefully by listening to your child’s breathing with a stethoscope. Bronchiolitis can cause harsh sounds or wheezing in the lungs.
- Consider further testing.
- If available, a special device called a pulse oximeter is used to check how much oxygen is in the bloodstream. This painless test measures the oxygen using a light sensor that is placed on the end of your child’s finger or toe.
- If your child’s symptoms are severe or not what the doctor would expect, he may take a sample of mucus from your child’s nose to test for RSV or other respiratory viruses.
- A chest X-ray sometimes is necessary to check for other lung problems, such as pneumonia.
- Blood tests to look for infection in other parts of the body may be done if your child has a high fever or looks very sick.
If your child does have bronchiolitis, the doctor will:
- Not prescribe an antibiotic, since viruses cause bronchiolitis. Remember that antibiotics treat only bacteria and never viruses. If doctors use them for viral infections, when they are not needed, the antibiotics will NOT work (be resistant) in the future to treat a bacterial infection, when they are needed.
- Discuss whether any other medicines are necessary.
- Bronchodilators (for example, asthma medicines such as albuterol and epinephrine) may be used to try to make breathing easier by helping to open the breathing tubes. However, they often do not help, do not make the illness go away any faster, and are expensive.
- Steroids, taken by mouth, given directly into the bloodstream or muscle, or breathed in (inhaled), are used with asthma to decrease the swelling in the lower airways. Although steroids may be given to some children with bronchiolitis, in general, they have not been shown to help that much, can have unwanted side effects, and are expensive.
- Antiviral medicines (for example, ribavirin) are only used in the most severe RSV infections, which require hospitalization, especially admission to the intensive care unit. This most commonly is seen in infants who were born too early (premature), have problems fighting infections (for example, HIV or cancer), or have other serious medical conditions (for example, cystic fibrosis or some types of heart disease).
- Recommend ways to ease any pain or discomfort and make breathing easier.
- Discuss the things you should watch for at home.
- Tell you if your child should be seen again. Usually no follow-up visit is required if your child is feeling better.
Some over-the-counter medications may be helpful:
- For mild pain and low-grade fever, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Never use aspirin.
- Saline (salt-water) nose drops or nose sprays do not contain any medicine, so they can be used safely to clear any mucous from the nose and help keep the nasal passages open and moist. Doing this 20 minutes before feeding can help your infant drink more easily.
These over-the-counter medicines usually are not helpful:
- Cold medicines, including decongestants (pseudoephedrine), cough suppressants (dextromethorphan), and expectorants (guaifenesin), do not improve symptoms of bronchiolitis and generally are not recommended for children under 2 (unless directed by a doctor).
- Antihistamines — for example, diphenhydramine (Benadryl) — are useful for treating allergies, but have not been shown to improve symptoms of bronchiolitis.
Certain over-the-counter medications should not be used unless directed by your doctor:
- Herbal remedies (such as Echinacea or goldenseal) have not been well studied for treating bronchiolitis in children and may have unwanted side effects.
- Never give your child aspirin or any products containing aspirin because it has been associated with Reye’s syndrome, a serious illness that affects the liver and brain.
- Use a bulb syringe to remove mucus from the nose. Squeeze the bulb end of the syringe and then gently place the tip just inside your baby’s nose (not too deep). Slowly stop squeezing the bulb, so that mucus from the nose will be sucked into the bulb. Squirt out the mucous before repeating the above steps.
- To moisturize the nose and loosen more of the mucus, put a few drops of salt water (nasal saline drops) into each nostril before clearing the nose with the bulb syringe. It can be especially helpful to do this shortly before your baby feeds or goes to sleep.
- Give your child plenty of liquids — breast milk, formula, or other fluids such as broth, juice, lemonade or milk shakes — to stay well hydrated.
- Use a cool-mist vaporizer (a humidifier) in your child’s room, but make sure to clean it every few days according to the manufacturer’s instructions.
- Give your child a warm bath or sit with her for a few minutes in a steamy bathroom to help loosen congestion.
- Do not smoke around your child because it will make bronchiolitis worse.
- Is getting worse instead of better.
- Is having more trouble breathing.
- Develops blueness around the lips or on the fingernails or toenails at any time.
- Is not drinking much.
- Has not made any urine in six to eight hours.
- Seems too sleepy or tired (lethargic) at those times when he usually would be awake and active.
- Continues to have fever or difficulty breathing two to three days after having seen a doctor.
- Experiences ear pain.
Prevent other episodes of bronchiolitis by:
- Keeping your baby away from children or adults with colds.
- Making sure everyone who touches your baby always washes his or her hands first.
- Teaching your child to always wash his hands regularly and well.
- Teaching your child to cover his mouth and nose when he coughs or sneezes.
- Using disposable tissues to wipe or blow noses (use once and then throw them away).
- Not smoking around the child.
- Avoiding crowded day-care situations.
- Giving an antibody (a special substance in the blood that fights infection) against RSV is used to prevent severe RSV infections in children most at risk. Parents of children with serious medical problems should discuss their child's risk of RSV infection with their doctor as early as possible before the winter months to ask if this antibody is right for their child.
Check with your school or day care regarding specific policies about returning after illness. The viruses that cause bronchiolitis are highly contagious (spread from person to person). However, keeping children with any kind of respiratory symptoms out of school or day care may not decrease the spread of infection. Therefore, children with colds or bronchiolitis usually can go back to school or day care as soon as they have no fever for 24 hours and feel well enough to be there.
If your child needs to take a dose of medicine during the school day, it can be helpful to ask your pharmacist to put the medicine into two different labeled containers. That way you can send one to school or day care and leave the other at home. Be sure to fill out any necessary forms, including a note from your doctor, with specific instructions for giving the medicine.