Bronchiolitis

What is bronchiolitis?

Bronchiolitis (say: BRON-kee-oh-LIE-tis) is a common infection of the lungs caused by a virus. The infection makes the tiny airways in the lungs swell. These small airways are called bronchioles (say: BRON-kee-oles). The swelling makes the airways narrower, which makes it harder for your child to breathe.

Respiratory System
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Most cases of bronchiolitis are caused by a virus called respiratory syncytial virus (RSV). Most children will get RSV by the time they are 2 years old. The infection is most common from November to April, during the RSV season. 

Signs and symptoms of bronchioli​tis 

At first, your child may have a fever, runny nose or cough. Your child will probably cough a lot. 

Other signs can inc​lude: 

  • fast, shallow breathing 
  • high-pitched breathing sounds (wheezing) 
  • the skin sucking in (indrawing) in the chest below the rib cage, above the collarbone, between the ribs or in the neck; these are called retractions 
  • flaring of the nostrils 
  • increased irritability, crankiness or tiredness 
  • eating or drinking less 
  • trouble sleeping 

At first, your child's cough will probably be dry, short, shallow and weak. After several days, your child may start to bring up a lot of mucus when coughing. This means that your child is getting better. Your child's body is trying to get rid of the mucus and infection. 

Most children with bronchiolitis are only mildly ill with coughing or wheezing. They do not need any special medical treatment. Viral bronchiolitis usually lasts about 7 to 10 days. In some cases, children can have a cough or mild wheeze that lasts for weeks, even after the virus is gone. 

Treating bronchiolitis at hom​e 

Some helpful tips include: 

  • Place your child in a partly sitting or upright position. This makes breathing easier. 
  • Encourage your child to drink, especially clear fluids such as water or apple juice mixed with water. If your child does not want to drink, try to offer fluids in small amounts more often than usual. 
  • Babies should keep breastfeeding or drinking formula as usual. 
  • If your baby's nose is congested, saline nose drops may help to clear it. This can help your baby feed more easily. 
  • If your baby is not feeding well, try giving smaller feedings more often. This will help your baby get enough food and liquids.
  • Do not expose your child to tobacco smoke. 
  • If your child is allergic to pets or substances in the air, keep them away. These substances irritate the lungs and may make the bronchiolitis worse. 
  • Watch your child for signs of dehydration, such as dry or sunken eyes, dry sticky mouth or less urine than usual. 

Bronchiolitis can be more severe in some children 

Bronchiolitis can be more ​​severe if: 

  • your baby is less than 7 weeks old 
  • your child lives in a household with smokers 
  • your child has asthma​ or other chronic lung problems 
  • your child was born prematurely (33 weeks gestation or less) 
  • your child has certain types of congenital heart disease 
  • your child has immune system problems 

In severe cases, a child with bronchiolitis may need to go to the hospital. 

Children who have trouble breathing must go to the hospital 

Take your child to the nearest emergency department if you notice any of the following signs: 

  • Your child is breathing very fast. 
  • Your child is having trouble breathing. Look for retractions of the chest or neck, and flaring of the nostrils. These signs are more serious if your child is also wheezing. 
  • Your child’s skin looks blue or paler than usual. 
  • Your child is dehydrated . This means your child's body does not have enough fluid to work properly. This can happen when your child is not drinking enough. Your child may be dehydrated if their eyes appear to be dry or sunken or if they are urinating (peeing) less than usual. 
  • Your child is much more sleepy than usual, and does not want to play. 
  • Your child is very cranky or fussy and cannot be comforted. 
  • Your young baby is not able to feed or drink. 

Treatment in hospital for bronchiolitis 

At the hospital, your child is in a new place that may be a little scary. You can help comfort and calm your child with loving care. 

Some helpful tips include: 

  • Doctors, nurses and other health care professionals will listen often to your child’s chest with a stethoscope. The sounds they hear tell them if your child is breathing well enough. 
  • Your child will be placed in a partly sitting or upright position to make breathing easier. 
  • A member of the health care team may gently suction your child's nostrils. 
  • Your child may need to breathe extra oxygen. This helps make sure enough oxygen gets into your child's blood. 
  • To help your child breathe, the doctor may try an inhaled medicine such as salbutamol​ (Ventolin) or epinephrine. Breathing these medicines sometimes opens up a child’s airways. This helps more air get in and out of the lungs. If your child is very unwell, their doctor may ask for blood tests or a chest X-ray to be done, or for a tube to be inserted in a vein (intravenous line). Most children do not need these. 

Your child does not need medicines such as antibiotics or antivirals. These medicines will not help. Steroids usually do not help except for certains situations.

The viruses that cause bronchiolitis spread by coughing, sneezing and touching 

The viruses that cause bronchiolitis are spread through tiny droplets that come from an infected person’s nose and mouth when they cough or sneeze. They can also be passed when an infected person touches an object, such as a toy, and another person touches the same object. When children touch their own noses, eyes and mouths, they can infect themselves with the virus. Sharing toys and playing close together increases the spread of infection. 

Preventing bronchiolit​is 

Viral bronchiolitis is very common and spreads easily, but there are several ways you can reduce your child's risk of catching it. 

  • Good hand washing​ with soap and warm water is the most effective way to reduce the spread of infection. Wash hands after coming in from outside, after playing with other children’s toys and before eating. 
  • Do not expose your baby to cigarette smoke. Smoking has been associated with increased infection rates. Even second-hand smoke is harmful to your child. 
  • Try to stay away from infected people or large crowds, especially if your baby is less than 7 weeks old. 
  • Young children often place toys in their mouths. Clean toys often if they are being shared. 
  • Teach children to prevent spreading germs by learning to sneeze or cough in their sleeve or elbow. If a tissue is available, children can use it, put the used tissue in the garbage, and then wash their hands. 
  • If your child goes to day care or school, tell the caregiver which signs of illness your child has. 
  • If you can, keep your child at home until breathing is easier. 

Key points 

  • Bronchiolitis is a common viral infection of the lungs. 
  • Children with bronchiolitis may have trouble breathing. 
  • If your child has trouble breathing or seems very sick, take your child to the nearest hospital. 
  • Good hand washing will reduce the spread of infection.
​​

Katrina Newton, RN

Katherine Nash, RN

Trey Coffey, MD, FAAP, FRCPC

10/30/2013




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