Bronchiolitis

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.

  1. Bronchiolitis is a common illness in the lungs. It causes breathing problems in babies.
  2. Bronchiolitis is very easy to catch.
  3. Breastfeeding and a smokefree environment give the best protection against bronchiolitis.
  4. Bronchiolitis is usually a mild illness but some sicker babies need to go to hospital.
  5. There is no medicine that makes bronchiolitis better.
  6. 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.

(British Lung Foundation, 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.

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

  1. Starship Children's Health Clinicians. Starship Children's Health clinical guideline – bronchiolitis Starship Children's Health, NZ, 2019
  2. Paediatric Society of NZ. Best practice evidence-based guideline – wheeze and chest infection in infants under 1 year Paediatric Society of New Zealand, 2005 
  3. 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