Bronchiolitis

Bronchiolitis a common viral chest infection in children under 6 months of age.

undefinedBronchiolitis often starts as snuffles or a cold and after a day or two causes the small breathing tubes (bronchioles) in the lungs to become swollen and full of mucous. This can make breathing difficult and sound wheezy.

Most cases of bronchiolitis are mild and can be treated at home. Babies or children with moderate to severe cases of bronchiolitis may need to go to hospital.

When to seek urgent medical help

Dial 111 and seek urgent medical help if your child:

  • has a bluish tinge to their lips and tongue
  • has severe difficulty breathing
  • is pale and unresponsive.

These are signs that your child is not getting enough oxygen and requires immediate medical attention. 

At any stage, if you are worried about your child, don't hesitate to seek help. For free advice anytime call Healthline: 0800 611 116.

Video explaining bronchiolitis Patient UK, 2013

Key points:

  1. Bronchiolitis is very common affecting one in three babies before the age of 12 months.
  2. The main symptoms are fast breathing, cough and wheeze.
  3. Bronchiolitis is infectious so wash hands frequently to help prevent it spreading.
  4. Most cases of bronchiolitis are mild and can be treated at home with rest and plenty of fluids. Sicker children may need supportive treatment in hospital.
  5. Bronchiolitis is caused by a virus so antibiotics will not help to cure it.

Causes

Bronchiolitis is caused by a viral infection of the bronchioles inside the lungs. 

When we breathe, air enters our lungs via the wind pipe (trachea), then goes down larger branching tubes (bronchi) and finally into the smallest tubes (the bronchioles). From the bronchioles, the air passes into tiny air sacs (alveoli) in the lung from where it enters the bloodstream. When the bronchioles are infected, they become swollen and full of mucus. This restricts airflow, making it difficult to breathe.

Infection of the bronchioles is usually caused by a virus. There are many types of viruses that can cause the illness. The most common types are RSV (respiratory syncytial virus) and rhinovirus.

Risk factors

Bronchiolitis is a very common childhood illness. It affects one in three children under the age of 12 months – very young children between the age of three and six months are most commonly affected. Approximately three babies in 100 become very unwell and may need to go to hospital.

Certain factors increase your child's risk of getting bronchiolitis. These include:

  • being between the age of 3 and 6 months
  • exposure to cigarette smoke
  • living in crowded conditions
  • being bottle-fed rather than breast-fed
  • being in close contact with other infected children.

Severe bronchiolitis is more common if your child:

  • was born prematurely
  • already has a heart condition or lung disease
  • had a low birth-weight
  • has difficulty fighting infections (immune problem)
  • is less than 6 weeks old.

Symptoms 

Your child may have cold-like symptoms such as runny nose, cough and mild fever for the first few days. If  the infection spreads down the bronchioles, your child may have difficulty breathing.

Symptoms of bronchiolitis include:

  • fast breathing
  • rasping cough
  • wheezing
  • flaring of the nostrils
  • muscles between ribs may move inwards as child struggles to take a breath
  • 'crackly' sounding chest
  • difficulty feeding or drinking.

When should I seek help?

Babies or children with moderate to severe cases of bronchiolitis may need to go to hospital. This is because they may not be getting enough oxygen and/or they may not be getting enough to drink.

Dial 111 and seek urgent medical help if your child:

  • has a bluish tinge to their lips and tongue
  • has severe difficulty breathing
  • is pale and unresponsive.

These are signs that your child is not getting enough oxygen and requires immediate medical attention.

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

  • is under 3 months old
  • is breathing fast and noisily
  • is having to use extra effort to breathe
  • looks pale and unwell
  • is feeding less than half as much as usual
  • has not wet a nappy for six hours
  • is getting worse.

If your child is unwell but you are unsure if you need to see the doctor, contact Healthline (0800 611 116) for free 24 hour telephone health advice.

Diagnosis

To diagnose bronchiolitis, your child's doctor will:

  • ask you about your child's symptoms
  • check how much they are feeding
  • take your child's temperature
  • use a stethoscope to listen for wheezing or 'crackling' in the chest.

If your child has bronchiolitis, your doctor will assess your child's condition to decide whether they:

  • are well enough to be cared for at home, or
  • need to be referred to hospital to be given oxygen and/or fluids.

Treatment

Most cases of bronchiolitis are mild and can be treated at home. If your child does need to go to hospital they may be: 

  • given extra oxygen through soft nasal prongs or a mask
  • given fluids via a drip in the vein (intravenously)
  • fed through a special nose-to-tummy (nasogastric) tube.

When your child's condition has stabilised, you will be able to take them home to continue caring for them.

Caring for your child at home

Most children with bronchiolitis are not severely ill. However, it can still take several weeks before they are completely well. You can help their recovery by:

  • making sure they get as much rest as possible
  • offering them small amounts of fluids often
  • using the recommended dose of child paracetamol (pamol) if required for pain or fever
  • keeping them warm but not too hot
  • not smoking around them.

Medications unlikely to help recovery

Bronchiolitis is caused by a virus so antibiotics will not help to cure it. Antibiotics may be prescribed if your child develops a secondary bacterial infection.

Using blue asthma puffers in children younger than 6 months of age can cause symptoms to worsen. As the symptoms of bronchiolitis are similar to those of asthma, blue asthma puffers may be trialled with older children (nearer to 1 year of age). Asthma is uncommon in children under 1 year of age. 

Bronchiolitis can be passed to others

Bronchiolitis is an infectious disease. Washing your hands before and after handling your child is the best way to help prevent it spreading.

During the first few days of the illness, keep your child away from child care or other places where they may come into contact with other children. Older children and adults can also catch bronchiolitis but it is more common in younger children and babies.

Learn more

Bronchiolitis KidsHealth (NZ), March 2014
Bronchiolitis – the essentials Best Health (UK)
Bronchiolitis treatment  NHS Choices (UK), Dec 2013

References

Bronchiolitis in infants Best Practice Journal Sept 2012

Credits: Original content by Health Navigator. Reviewed By: Editorial team Last reviewed: 07 Mar 2014