Bronchiolitis

Overview
Clinicians
Clinicians

Bronchiolitis is a chest condition that causes breathing problems in babies. It's caused by a virus - often respiratory syncytial virus (RSV) or rhinovirus. Bronchiolitis is very easy to catch so wash your hands before and after handling your baby.

Key points about bronchiolitis

Breastfeeding and a smoke-free environment give the best protection against bronchiolitis.

Bronchiolitis is a common illness in the lungs. It causes breathing problems in babies.
Bronchiolitis is very easy to catch.
Breastfeeding and a smokefree environment give the best protection against bronchiolitis.
Bronchiolitis is usually a mild illness but some sicker babies need to go to hospital.
There is no medicine that makes bronchiolitis better.
If your baby with bronchiolitis is under 3 months old, you should always see a doctor.

If your baby has bronchiolitis, keep them at home and away from other babies and children, to stop bronchiolitis spreading.

(Asthma + Lung UK, 2022)

What is bronchiolitis?

Bronchiolitis is a common illness usually caused by a virus. The most common are RSV (respiratory syncytial virus) and rhinovirus but there are many viruses that can cause bronchiolitis. Bronchiolitis affects the smallest airways (called bronchioles) throughout the lungs.

Image: Asthma and Respiratory Foundation NZ

Can you catch bronchiolitis?

Yes, bronchiolitis is very easy to catch – it can spread easily between children or from adults to children. It is most common in winter and spring.

Who gets bronchiolitis?

Bronchiolitis usually affects babies under the age of 1.
Babies who are around people who smoke are more likely to get bronchiolitis.
Severe bronchiolitis is more common in premature babies or babies with heart or lung problems.

What are the signs and symptoms of bronchiolitis?

Bronchiolitis often starts as a cold, with a runny nose.

Babies with bronchiolitis:

may have a fever
start to cough
breathe fast
put a lot of extra effort into breathing
have noisy breathing (wheeze)

The second or third day of the chesty part of the illness is usually the worst. Bronchiolitis can last for several days. The cough often lasts for 10–14 days but it may last as long as a month.

When should I seek help for bronchiolitis?

See these signs that a child is struggling to breath.

When do I need to see a doctor?

You should see your family doctor or go to an after-hours medical centre urgently if your baby:
is under 3 months old is breathing fast, has noisy breathing and is having to use extra effort to breathe looks pale and unwell is taking less than half of their normal feeds is vomiting has not had a wet nappy for 6 hours. You should also see a doctor if you are worried about your baby. Even if you've already seen your doctor, if your baby's breathing difficulties get worse or if you are worried, take your baby back for checking.

You should see your family doctor or go to an after-hours medical centre urgently if your baby:

is under 3 months old
is breathing fast, has noisy breathing and is having to use extra effort to breathe
looks pale and unwell
is taking less than half of their normal feeds
is vomiting
has not had a wet nappy for 6 hours.

You should also see a doctor if you are worried about your baby.

Even if you've already seen your doctor, if your baby's breathing difficulties get worse or if you are worried, take your baby back for checking.

Call 111 and ask for an ambulance or go to the nearest hospital if your child:
has blue lips and tongue has severe difficulty breathing is becoming very sleepy and not easy to wake up is very pale is floppy has breathing that isn't regular, or pauses in breathing.

What is the treatment for bronchiolitis?

Most babies get better by themselves

Most babies with bronchiolitis get better by themselves without any special medical treatment.

Antibiotics and antivirals do not help babies with bronchiolitis.
Asthma puffers or inhalers don't help babies with bronchiolitis.
Using blue reliever asthma puffers or inhalers in babies less than 12 months of age may make their breathing worse.
Steroid medicine by mouth or inhaler does not help babies with bronchiolitis.
In babies over 12 months of age, it may be hard to tell if the problem is bronchiolitis or viral wheeze – your doctor may try asthma puffers or inhalers.

Babies with more serious illness may need to go to hospital

Babies with more serious bronchiolitis may need to go to hospital. Sometimes babies need help with their breathing. This might include extra oxygen through nasal prongs (small soft plastic tubes) that fit into your child's nose.

If your baby is not drinking enough, they may need feeding through a nasogastric tube (a tube through the nose or mouth into the stomach) or fluid through an intravenous drip (into a vein).

Can I care for my child with bronchiolitis at home?

You can care for your baby at home if they are:

feeding well
do not look sick
are not working too hard with their breathing.

Suggestions for looking after your baby

Babies with bronchiolitis may not be able to feed for as long as usual – offer smaller feeds more often.
Give your baby as much rest as possible.
Don't smoke in the house or around your baby.
Keep your baby's nose clear – if it is blocked or crusty you can use saline nose drops (from a pharmacy).
Keep your baby away from other babies and children and from childcare centres to stop bronchiolitis spreading.
If your baby is miserable and upset, you can give paracetamol. You must follow the dosage instructions on the bottle – it is dangerous to give more than the recommended dose.

Remember to sleep baby on their back in their own bed and don't prop them up with pillows or blankets.

How can I prevent my child getting bronchiolitis?

Breastfeeding

Breastfeeding your baby protects them from getting bronchiolitis by boosting their infection-fighting (immune) system. Breastfeeding beyond 4 months of age offers the best protection.

Smokefree environment

Make sure your child's environment is smokefree. If you want to give up smoking:

call the free Quitline Me Mutu on 0800 778 778 or text 4006
check out the website Quitline
ask your healthcare professional.

A warm house

Keeping the house warm and well-insulated will also decrease your baby's risk of developing bronchiolitis. Read more about keeping your home warm and dry.

Stay away from people with coughs and colds

It is sensible to keep young babies away from people who have colds and coughs.

Clean hands

Make sure everyone in your family washes their hands regularly and thoroughly and dries them well, including (but not only) before preparing food and eating. This can reduce the spread of infection.

If my child has had bronchiolitis, will they get asthma?

Bronchiolitis is not the same as asthma. Most babies with bronchiolitis do not go on to have asthma. Asthma is more likely in children if there are other family members with asthma.

References

Starship Children's Health Clinicians. Starship Children's Health clinical guideline – bronchiolitis Starship Children's Health, NZ, 2019
Paediatric Society of NZ. Best practice evidence-based guideline – wheeze and chest infection in infants under 1 year Paediatric Society of New Zealand, 2005
PREDICT – Paediatric Research in Emergency Departments International Collaborative. Australasian bronchiolitis guideline 2017

	Content courtesy of KidsHealth NZ which has been created by a partnership between the Paediatric Society of New Zealand (PSNZ) and the Starship Foundation, supported and funded by the Ministry of Health
Credits

Credits: KidsHealth NZ. Last reviewed: 02 Mar 2020 Page last updated: 22 Jan 2023

Information for healthcare providers on bronchiolitis

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Bronchiolitis statistics

Childhood bronchiolitis hospitalisation rates have increased by nearly a half since 2000. Pacific rates were 3.5 times higher than non-MPA, and Māori rates 3.2 times higher. The rate for the most deprived quintile was 3.9 times the rate of the least deprived quintile. The combined effect of ethnicity and deprivation meant that Māori and Pacific children in the most deprived quintile were at least five times as likely to be hospitalised as non-MPA children in the wealthiest quintile.

There were few deaths from childhood bronchiolitis, but all 7 deaths between 2006 and 2015 were in NZDep deciles 7-10; and all were Māori and/or Pacific children.

Source: The impact of respiratory disease in New Zealand – 2018 update

Key practice points

Extract from Bronchiolitis – when to reassure and monitor, and when to refer BPAC, NZ, 2017

Bronchiolitis should be diagnosed clinically; blood tests, analysis of sputum, testing for the underlying virus or chest X-rays are not routinely recommended.
Bronchiolitis is managed with supportive care; there are no medicines or interventions that can be administered in primary care which are effective at reducing symptoms or the likelihood of deterioration. Ongoing research and clinical trials confirm that there is no role for bronchodilators, corticosteroids or antibiotics.
When management at home is appropriate, provide caregivers with information regarding the course of the disease, ensure they understand red flags which suggest urgent review is necessary and reinforce messages such as avoiding smoking around the infant.
Infants with symptoms of moderate severity may require referral to hospital after taking into account factors such as the time course of illness, risk factors for more severe illness and home circumstances.
Infants with severe symptoms should be sent to hospital via ambulance.

Assessment of bronchiolitis in primary care

Guidance for the assessment and treatment of bronchiolitis in children aged under 18 months.

Symptoms

Mild	Moderate	Severe
Normal respiratory rate No or subtle accessory muscle use Normal heart rate Able to feed Oxygen saturation 95%	Increased respiratory rate Minor accessory muscle use Increased heart rate Difficulty feeding Minor dehydration eg, increased thirst Crepitations Oxygen saturation 90–95%	The presence of poor respiratory effort, cyanosis or apnoea may indicate life-threatening bronchiolitis Respiratory rate >60 breaths/minute Moderate/marked accessory muscle use Nasal flare and/or grunting Markedly increased heart rate Feeding <50% of normal in preceding 24 hours Marked dehydration, eg, sunken fontanelle, sunken eyes, reduced skin turgor, low urine production, absent tears Toxic appearance Oxygen saturation 90%

Mild

Moderate

Severe

Normal respiratory rate
No or subtle accessory muscle use
Normal heart rate
Able to feed
Oxygen saturation 95%

Increased respiratory rate
Minor accessory muscle use
Increased heart rate
Difficulty feeding
Minor dehydration eg, increased thirst
Crepitations
Oxygen saturation 90–95%

The presence of poor respiratory effort, cyanosis or apnoea may indicate life-threatening bronchiolitis

Respiratory rate >60 breaths/minute
Moderate/marked accessory muscle use
Nasal flare and/or grunting
Markedly increased heart rate
Feeding <50% of normal in preceding 24 hours
Marked dehydration, eg, sunken fontanelle, sunken eyes, reduced skin turgor, low urine production, absent tears
Toxic appearance
Oxygen saturation 90%

Treatment

Mild	Moderate	Severe
Reassurance and home	Consider referring if: child is <3 months old child is not feeding sufficiently there is parental distress social circumstances are a concern.	Send to hospital by ambulance Provide oxygen if available
Encourage small frequent feeds. If nasal congestion, trial saline nasal drops. Reassure parents that improvement can be expected within 3 days, but give instructions to return if there is any concern or if symptoms become severe, eg, tell them to look for dry nappies, refusal to feed, decreased level of alertness or any breathing difficulties such as nasal flaring, use of accessory (neck) muscles.		Send to hospital by ambulance Provide oxygen if available

Clinical pathways and guidelines

Starship Children's Health clinical guideline – bronchiolitis Starship Children's Health, NZ, 2019
Starship hospital clinical guidelines for bronchiolitis Starship Children's Health, NZ, 2010
Paediatric Society of New Zealand. Best practice evidence-based guideline – wheeze and chest infection in infants under 1 year Paediatric Society NZ, 2005
PREDICT – Paediatric Research in Emergency Departments International Collaborative. Australasian bronchiolitis guideline 2017

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:

Other resources

Navigating uncertainty – managing respiratory tract infections BPAC, NZ, 2019
Bronchiolitis in infants Best Practice Journal, NZ, 2012
Bronchiolitis: when to reassure and monitor, and when to refer BPAC, NZ, 2017
Is it asthma? Assessing and managing wheeze in pre-school children BPAC, NZ, 2020
Wheeze and chest infection in infants under 1-year Paediatric Society of NZ, 2005
Te ha ora – breath of life – national respiratory strategy Asthma & Respiratory Foundation NZ, 2015

Reference

Bronchiolitis in infants BPAC, NZ, 2012