Bronchiolitis is a common chest infection in babies and young children. It is usually caused by a virus, such as respiratory syncytial virus (RSV). This virus spreads when someone coughs or sneezes.
Bronchiolitis usually affects babies and young children under age 2, especially babies under 6 months.
Most cases are mild and clear up within 2 to 3 weeks without treatment. In some cases, it can be more serious. Some children may need to be cared for in a hospital.
RSV immunisation is recommended for your baby. This is very effective in preventing RSV infection.
Symptoms
Bronchiolitis usually begins like a cold.
Your child might have a:
- runny nose
- blocked nose
- fever (temperature of 38 degrees Celsius or higher)
- slight cough
Further symptoms may develop over the next few days, including:
- a dry and persistent cough
- rapid or noisy breathing (wheezing or grunting)
- feeding less
- fewer wet nappies
- vomiting after feeding
- being irritable
When to get medical help
Most children with bronchiolitis can be cared for at home.
But keep a close eye on your child. Symptoms can get worse quickly. Your child may need hospital treatment.
Emergency action required: Call 112 or 999 or go to your nearest emergency department if your child:
- is having difficulty breathing - you may notice their nostrils are getting wider as they breathe, or their ribs are sucking in
- has gone blue on their lips or tongue
- will not stay awake or wake up
- has long gaps in breathing (more than 10 seconds at a time, or regular short gaps in breathing of 5 to 10 seconds)
- is breathing a lot faster than usual (more than 60 breaths per minute)
- is pale and sweaty
- has a dry nappy for 12 hours or more
Urgent advice: Go to a GP or emergency department (ED) urgently if
your child has symptoms and:
- was premature (born before 37 weeks)
- is less than 3 months old
- has heart or lung disease
- has an immune deficiency (weakened immune system)
Non-urgent advice: Contact your GP if:
- you're worried about your child
- your baby had fewer than 3 to 4 wet nappies in a 24-hour period
- your baby has gone 12 hours without having a wet nappy
- your baby has no energy to breastfeed, is refusing to feed or is too breathless to attach to your breast
- you are bottle feeding and you notice your baby is taking less than half of what they would normally take
- your child has a high temperature (38C or higher) for more than 3 days or is getting worse
- your child seems breathless
- your child is listless or irritable
Diagnosis
Your GP will usually make a diagnosis by:
- asking about your child's symptoms and how long they've had them
- using a stethoscope to listen to your child's breathing and check for any crackling or high-pitched wheezing
Checking for dehydration
Your GP might look for signs of dehydration if your child has not been feeding well or has been vomiting.
Signs of dehydration can include:
- dry mouth and skin
- drowsiness
- producing little or no pee
- the soft spot on their head (fontanelle) looks like it has sunk inwards (sunken fontanelle)
Dehydration in babies and children
When your child might be admitted to hospital
Your GP may refer your child to hospital if they are:
- not feeding properly
- dehydrated
- having problems breathing
Your GP may refer your child to an emergency department. This is if they feel that your child needs support for breathing or feeding.
Treat your child at home
You can usually care for your child at home if they have mild, cold-like symptoms and are recovering well.
There's no specific treatment for bronchiolitis. It usually clears up on its own after 2 to 3 weeks.
Antibiotics are not needed and will not help to treat it.
Do the following for your child as part of your at-home care:
Do
-
check on them often, day and night
-
contact your GP if their symptoms get worse
-
give them as much chance to rest as possible
-
keep them upright to help them breathe and feed
-
offer your child their usual milk feeds - they may need to take smaller amounts more often
-
give your child extra water or milk to stop them getting dehydrated
-
keep the air moist - making your home too warm will dry out the air
Avoid smoking around your child
Smoke from cigarettes or other tobacco products will make your child's symptoms worse.
Do not let anyone smoke around your child.
If anyone in the household is a smoker, they should:
- only smoke outside
- wear a jacket that they can remove when entering the home
Sign up for a Quit Plan to get free help to stop smoking
Keep your child away from small children
The virus that causes bronchiolitis can spread to other children.
Keep your child at home until:
- their symptoms have improved
- their temperature goes back to normal and stays that way without taking paracetamol and ibuprofen
Feed your child little and often
Babies with bronchiolitis can become very tired when feeding.
You should:
- offer breastfeeds frequently (if you're breastfeeding)
- give smaller feeds more often (if you're bottle feeding)
Provide milk feeds and plenty to drink if your child is older than 6 months. Do not worry if they do not want to eat. The most important thing is that they are drinking.
You may need to give toddlers extra fluids to stop them becoming dehydrated.
Use nasal drops
You can use saline drops or saline nasal spray on your baby before each feed.
Place a couple of drops of saline in your child's nose before they feed to help relieve a blocked nose.
Your pharmacist will tell you which drops are suitable for your baby.
Dealing with fever
If your child is uncomfortable with their high temperature, you can give them medicine to help reduce their temperature.
If your child is age 2 months or older they can usually have paracetamol.
If they are older than 3 months and weigh at least 5kg they can usually have ibuprofen for children.
Ask your pharmacist for advice. Always read the label to make sure the medicine is suitable for your child. Talk to a pharmacist or doctor if you are not sure.
Do not underdress or overdress your child. Comfortable, loose clothing is best.
Do not sponge them or bathe them in cool or lukewarm water.
High temperature - fever in children
Look after yourself
Babies and small children with bronchiolitis often do not sleep well at night. The cough can seem to get worse at night.
Ask friends or family to help you so that you can get some rest.
Reduce the risk of bronchiolitis
You cannot prevent bronchiolitis. But you can reduce the risk of infection and stop germs from spreading.
Do
-
keep young babies and children away from people who are sick with coughs and colds as much as possible
-
ask people not to visit if they have cold or flu symptoms, even if they do not feel unwell
-
cover your child's nose and mouth when they cough or sneeze
-
throw tissues away when they've been used
-
clean your hands and your child's hands often - ask anyone in contact with your child to clean their hands first
-
wash and dry forks, knives and spoons after use
-
keep infected children at home until symptoms have improved
-
wash or wipe toys and surfaces often
Don't
-
do not smoke around your child
-
do not let others smoke around your child
-
do not wear clothes you have been smoking in around your child
RSV immunisation
RSV immunisation has been introduced for newborn babies. This will help protect them from RSV over winter months.
Breastfeeding and bronchiolitis
Breastfeeding your baby may also help prevent them from getting bronchiolitis. This is because babies get special proteins called antibodies from breastmilk.
Antibodies can protect your child from infection.
Helping children at high risk of severe bronchiolitis
Children with existing health problems or who were born premature are at high risk of severe bronchiolitis.
They are highly recommended to have RSV immunisation. This will reduce the severity of an infection.
Long-term effects
Bronchiolitis does not usually cause long-term breathing problems. But it can damage cells in your child's airways.
This can last for 3 to 4 months and cause ongoing wheezing and coughing.
There may be a link between bronchiolitis and respiratory conditions in later life.
Content supplied by the NHS and adapted for Ireland by the HSE
