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Bronchiolitis

Topic Overview

What is bronchiolitis?

Bronchiolitis is an infection caused by a virus. It affects the lower part of the lungs. Bronchiolitis is common in babies, but it can happen in children up to age 2 years.
Bronchiolitis makes the small airways that carry air to the lungs (bronchioles) swell and make more mucous. The bronchioles become narrow, which causes wheezing, lots of coughing, and trouble breathing.

What causes bronchiolitis?

The most common virus that causes bronchiolitis is RSV (respiratory syncytial virus). RSV infections tend to happen between November and April each year, with a peak in January and February. Your child can get an RSV infection more than once. In older children and adults, RSV causes a common cold rather than bronchiolitis.

What are the symptoms?

At first, your child may have common cold symptoms, including:

  • Runny nose.
  • Mild cough.
  • Fever.
  • Low energy.
  • Eating less than normal.

About 1 to 3 days after cold symptoms start, the infection can cause bronchiolitis symptoms such as:

  • A cough that’s getting worse.
  • Lots of coughing.
  • Wheezing.
  • Fast breathing.
  • Indrawing (when the skin gets sucked in at the neck, collarbones, or between the ribs with each breath).
  • Throwing up after coughing.
  • Trouble feeding (breast or bottle), especially for babies younger than 6 months.
  • Fewer wet diapers.

Bronchiolitis can be more serious in some children, especially if they:

  • Were born early (premature, before 34 weeks).
  • Are younger than 3 months.
  • Have a history of asthma or lung problems.
  • Have a history of heart problems.

Take your child to a doctor if they have any symptoms of bronchiolitis.

How is bronchiolitis diagnosed?

A doctor may diagnose bronchiolitis by asking your child's medical history and checking their symptoms. Your child probably won’t need tests if they have typical bronchiolitis symptoms.

How is it treated?

Bronchiolitis happens the same way in most children. Symptoms tend to get worse until day 4 or 5, and then they slowly get better. Most children feel better in 1 to 2 weeks. But some children have a cough that lasts a few weeks.
If your child has bronchiolitis, you can usually take care of them at home. There is no medicine for bronchiolitis. Antibiotics do not work because bronchiolitis is caused by a virus.

Care at Home:
Coughing

  • Keep your child sitting or propped up instead of lying down, because it’s easier to breathe in this position. A cool-mist humidifier in your child's room can help with their cough. Follow the directions for using the humidifier, and keep it out of reach of children.
  • Cough medicine isn’t good for young children. Do not give cough medicine to children younger than 6 years.

Stuffy nose:

  • Clean out your child’s nose to make breathing and feeding easier.
  • Try saltwater nose sprays (like Hydrasense) to help loosen mucous in the nose. Spray or drop salt water into each nostril. Then suck out the mucous with a nasal aspirator. Talk to your pharmacist to find the right products for your child. Don’t make your own saltwater solution at home.
  • Clean your child’s nose before feeds and bedtime, and as often as they need during the day.

Eating and drinking:

  • Encourage your child to drink fluids. Your child may not want to drink like they usually do, but keep offering small amounts of fluids throughout the day so they stay hydrated (so their body has enough water).
  • Babies younger than 6 months should continue to feed (breast or bottle) as usual. Keep track of how many wet diapers they make.
  • Your child may not want to eat food when they’re sick, and that’s OK.


Fever and discomfort:

  • You may give acetaminophen (like Tylenol or Tempra) or ibuprofen (like Advil or Motrin) to keep your child comfortable. Follow the directions on the package or the directions from your healthcare provider.
  • Do not give aspirin to anyone younger than 18 years because of the risk of Reye syndrome, a serious illness.

In Hospital
When bronchiolitis is very bad, your child may need to stay in the hospital for a few days. Doctors and nurses will do many things to help your child breathe and keep them comfortable, including:

  • Keeping your child calm and sitting upright to make breathing easier.
  • Listening to your child’s lungs and watching their breathing.
  • Gently suctioning your child’s nose and using nasal saltwater drops.
  • Giving your child extra oxygen.
  • Giving your child extra nutrition with a feeding tube or fluids with an intravenous (IV), if needed.

How can you prevent bronchiolitis?

Bronchiolitis spreads easily (it’s very contagious) through close contact with someone who’s sick and is coughing or sneezing around you. Touching toys or sharing food with someone who’s sick can spread the virus. Children with bronchiolitis are contagious for almost a week after they first get sick. Keep your child at home if they’re coughing a lot.

To prevent bronchiolitis:

  • If your child has bronchiolitis, keep them at home until they feel better.
  • Keep a child with bronchiolitis away from young babies (under 3 months) as much as possible.
  • Wash your hands often to stop the virus from spreading. Teach your child to wash their hands before and after eating, coughing, or sneezing.
  • Don't smoke, use other tobacco products, or vape around your child. Second-hand smoke can put children at higher risk of infections.

Palivizumab (Synagis) is a medicine that can help prevent bronchiolitis and other problems in children with a high risk of getting very sick from RSV. Ask your doctor about this medicine if your child:

  • Was born early (premature).
  • Has heart or lung disease.
  • Has other health problems.

Where can you learn more about bronchiolitis?

To learn more about bronchiolitis, see the following resources:

References

Other Works Consulted

  • Bourke T, Shields M (2011). Bronchiolitis, search date July 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
  • Federico MJ, et al. (2011). Respiratory tract and mediastinum. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 487–535. New York: McGraw-Hill.
  • Gadomski AM, Brower M (2010). Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews (12).
  • Ralston S, et al. (2014). Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5): e1474–e1502. DOI: 10.1542/peds.2014-2742. Accessed October 28, 2014.
  • Seiden JA (2009). Bronchiolitis: An evidence-based approach to management. Clinical Pediatric Emergency Medicine, 10(2): 75–81.
  • Welliver RC (2009). Bronchiolitis and infectious asthma. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 277–288. Philadelphia: Saunders Elsevier.
  • Zore JJ, Hall CB (2010). Bronchiolitis: Recent evidence on diagnosis and management. Pediatrics, 125(2): 342–349.

Credits

Adaptation Date: 9/13/2021

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

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