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Bronchiolitis in children

Published by Bupa's health information team, February 2008.

This factsheet is for parents of children who have bronchiolitis, or for people who would like more information about it.

Bronchiolitis is an infection of the bronchioles and is caused by a virus. It's the most common infection of the lower breathing system in young infants. Around one in three infants will develop bronchiolitis in their first year of life. It's most common during the winter months.

About bronchiolitis
Symptoms
Complications
Causes
Diagnosis
Treatment
Prevention
Questions and answers
Related topics
Sources

About bronchiolitis

The bronchioles are the small tubes inside your lungs. When you breathe in, air flows into your windpipe and down into your lungs via a series of branching tubes called bronchi. Inside your lungs, the bronchi branch into the smaller bronchioles, which end in millions of tiny air sacs (alveoli). When the air enters the alveoli, oxygen from the air is transferred to your blood, which is then transported around your body.

When your child has bronchiolitis, the bronchioles become inflamed and lined with mucus which can make it difficult for him/her to breathe.

Bronchiolitis can be caused by various different viruses. Most commonly it's caused by respiratory syncytial virus (RSV), particularly during the winter months when infection most often occurs. Bronchiolitis isn't usually serious and your child will normally get better on his/her own with over-the-counter treatments.

Symptoms

Your child's symptoms may include:

a fever (a temperature higher than 37.5^oC)
a runny or blocked nose
a cough
difficulty feeding
breathing quicker than usual
finding it harder than usual to breathe
wheezing
stopping breathing for very brief periods of time (known as apnoea)

For most children, bronchiolitis isn't serious and your child will get better on his/her own, being looked after at home. If you are at all worried or see any changes in their symptoms, you should take your child to see their GP.

Some children can develop severe bronchiolitis and may have more serious symptoms. In particular, watch closely for the following symptoms and seek urgent medical attention if your child:

is feeding less than half the amount he/she usually does
appears to be very tired or lethargic
has symptoms of dehydration like a dry nappy for three hours or a sunken fontanelle (soft spot on the top of the head)
is breathing faster than one breath per second
is flaring his/her nostrils or making grunting noises when breathing
is having difficulty breathing - you may see the muscles under your child's ribs or the skin between the ribs sucking in with each breath
begins to have a bluish skin colour (known as cyanosis)
has repeated episodes of apnoea

If your child was born with lung or heart problems, was born prematurely or has a suppressed immune system (for example due to HIV infection), he/she is more at risk of getting severe bronchiolitis.

Complications

Rarely, children can get another infection (known as a secondary infection) in addition to the virus causing their bronchiolitis. This can cause pneumonia, for example.

In the longer term, bronchiolitis may increase the chance that your child develops asthma later in life. However, there is mixed evidence about if and why this happens.

Causes

Bronchiolitis is an infection caused by one of a number of different viruses. Respiratory syncytial virus (RSV) is usually the cause.

The viruses that cause bronchiolitis can easily spread from one person to another. They can be transferred through the air by coughing and sneezing or by direct contact (in person or through materials that have been in contact with an infected person).

Your child is more likely to get bronchiolitis if he/she:

is younger than six months old
was born prematurely (before 37 weeks into the pregnancy)
is exposed to cigarette smoke
has never been breastfed
lives in crowded living conditions

Diagnosis

The doctor will ask about your child's symptoms and medical history. The doctor will also examine your child by listening to his/her chest with a stethoscope.

Sometimes, your doctor will do further tests to find out if your child has bronchiolitis. These are usually only done when your child is showing symptoms of severe bronchiolitis. These tests include:

taking a sample of fluid from your child's nose, which will be sent to a laboratory to identify which virus is causing the bronchiolitis
taking an X-ray of your child's chest
a blood test to check the levels of oxygen in your child's blood

Treatment

Many children get bronchiolitis. Most don't get seriously ill and the infection usually clears up on its own in around a week. There are, however, a number of treatments you can give your child at home to help ease their symptoms.

Liquid paracetamol can help to lower a fever and ease any pain. You can get liquid paracetamol without prescription from your pharmacist. Always read the patient information leaflet that comes with the medicine. Never give your child aspirin.
Make sure your child has plenty of fluids to prevent them from becoming dehydrated.
Although there is little scientific evidence, some parents find that running hot water in the shower or bath to steam up the bathroom and sitting in there with their child helps to ease congestion.
Saline nose drops available from a pharmacy can help a blocked nose.
Sometimes keeping your child upright, for instance in their baby car seat, might help them breathe more easily. Take care not to let his/her head roll forward.

Some children with bronchiolitis will need to go to hospital for treatment, particularly if they are showing the symptoms of severe bronchiolitis, have other medical problems or were born prematurely.

In hospital, your child may be given one or more of the following treatments.

Fluids may be given through a tube in the stomach (either via the nose or mouth) or through a drip into your child's vein.
Mucus causing congestion in your child's nose can be suctioned out.
Extra oxygen can be given through a mask or tube in your child's nose.
A bronchiolator medication which expands the air passages in the lungs may be given. However, there is mixed scientific evidence as to whether this is an effective treatment.
Occasionally antiviral medication is given.

Prevention

It's not easy to prevent your child from getting bronchiolitis because the viruses which cause it are common. At present there is no vaccine for RSV, the virus that most commonly causes bronchiolitis.

However, there are measures you can take to reduce the chance that your child will get bronchiolitis. Or, if your child is already infected, you can minimise the chance of it spreading to others.

Make sure everyone in your household washes their hands frequently.
Keep your child home from childcare or school until their fever has gone down, their cough is almost gone and they feel well enough to attend.
Keep your child away from people who have a cold or flu.
Teach your child to cover his or her mouth, or if he/she is too young to do this, do it for him/her.
Use disposable tissues and throw them away immediately after use.
Don't smoke near to your child.