Bronchiolitis is a common lung infection in young children and infants. It causes inflammation and congestion in the small airways (bronchioles) of the lung. Bronchiolitis is almost always caused by a virus. Typically, the peak time for bronchiolitis is during the winter months.
Bronchiolitis starts out with symptoms similar to those of a common cold but then progresses to coughing, wheezing and sometimes difficulty breathing. Symptoms of bronchiolitis can last for several days to weeks, even a month.
Most children get better with care at home. A very small percentage of children require hospitalization.
For the first few days, the signs and symptoms of bronchiolitis are similar to those of a cold:
- Runny nose
- Stuffy nose
- Slight fever (not always present)
After this, there may be a week or more of difficulty breathing or a whistling noise when the child breathes out (wheezing).
Many infants will also have an ear infection (otitis media).
When to see a doctor
If it's difficult to get your child to eat or drink and his or her breathing becomes more rapid or labored, call your child's doctor. This is especially important if your child is younger than 12 weeks old or has other risk factors for bronchiolitis — including premature birth or a heart or lung condition.
The following signs and symptoms are reasons to seek prompt medical attention:
- Audible wheezing sounds
- Breathing very fast — more than 60 breaths a minute (tachypnea) — and shallowly
- Labored breathing — the ribs seem to suck inward when infant inhales
- Sluggish or lethargic appearance
- Refusal to drink enough, or breathing too fast to eat or drink
- Skin turning blue, especially the lips and fingernails (cyanosis)
Bronchiolitis occurs when a virus infects the bronchioles, which are the smallest airways in your lungs. The infection makes the bronchioles swell and become inflamed. Mucus collects in these airways, which makes it difficult for air to flow freely in and out of the lungs.
Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by the age of 2. Outbreaks of the RSV infection occur every winter. Bronchiolitis can also be caused by other viruses, including those that cause the flu or the common cold. Infants can be reinfected with RSV because at least two strains exist.
The viruses that cause bronchiolitis are easily spread. You can contract them through droplets in the air when someone who is sick coughs, sneezes or talks. You can also get them by touching shared objects — such as utensils, towels or toys — and then touching your eyes, nose or mouth.
Infants younger than 3 months of age are at greatest risk of getting bronchiolitis because their lungs and immune systems aren't yet fully developed.
Other factors that are associated with an increased risk of bronchiolitis in infants, or more severe illness due to bronchiolitis, include:
- Premature birth
- An underlying heart or lung condition
- A depressed immune system
- Exposure to tobacco smoke
- Never having been breast-fed — breast-fed babies receive immune benefits from the mother
- Contact with multiple children, such as in a child care setting
- Living in a crowded environment
- Having siblings who attend school or child care and bring home the infection
Complications of severe bronchiolitis may include:
- Blue lips or skin (cyanosis). Cyanosis is caused by lack of oxygen.
- Pauses in breathing (apnea). Apnea is most likely to occur in premature infants and in infants within the first two months of life.
- Low oxygen levels and respiratory failure.
If these occur, your child may need hospitalization. Severe respiratory failure may require that a tube be inserted into the trachea to help the child's breathing until the infection has run its course.
If your baby was born prematurely, has a heart or lung condition, or has a compromised immune system, watch closely for beginning signs of bronchiolitis. The infection can quickly become severe. In such cases, your child will usually need hospitalization.
Tests and X-rays are not usually needed to diagnose bronchiolitis. The doctor can usually identify the problem by observing your child and listening to his or her lungs with a stethoscope. However, it may take more than one or two visits to distinguish the condition from a cold or the flu.
If your child is at risk of severe bronchiolitis, if symptoms are worsening or if another problem is suspected, your doctor may order tests, including:
- Chest X-ray. Your doctor may request a chest X-ray to look for signs of pneumonia.
- Viral testing. Your doctor may collect a sample of mucus from your child to test for the virus causing bronchiolitis. This is done using a swab that's gently inserted into the nose.
- Blood tests. Occasionally, blood tests might be used to check your child's white blood cell count. An increase in white blood cells is usually a sign that the body is fighting an infection. A blood test can also determine whether the level of oxygen has decreased in your child's bloodstream.
Your doctor may also ask you about signs of dehydration, especially if your child has been refusing to drink or eat or has been vomiting. Signs of dehydration include sunken eyes, dry mouth and skin, sluggishness, and little or no urination.
Bronchiolitis typically lasts for two to three weeks. The majority of children with bronchiolitis can be cared for at home with supportive care. It's important to be alert for changes in breathing difficulty, such as struggling for each breath, being unable to speak or cry because of difficulty breathing, or making grunting noises with each breath.
Because viruses cause bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — aren't effective against it. If your child has an associated bacterial infection, such as pneumonia, your doctor may prescribe an antibiotic for that.
Drugs that open the airways (bronchodilators) haven't been found to be routinely helpful. But your doctor may elect to try a nebulized albuterol treatment to see if it helps.
Oral corticosteroid medications and pounding on the chest to loosen mucus (chest physiotherapy) have not been shown to be effective treatments for bronchiolitis and are not recommended.
A tiny percentage of children need hospital care to manage their condition. At the hospital, your child may receive humidified oxygen to maintain sufficient oxygen in the blood, and perhaps fluids through a vein (intravenously) to prevent dehydration. In severe cases, a tube may be inserted into the windpipe (trachea) to help the child's breathing.
You're likely to start by seeing your family doctor or your child's doctor. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms your child is experiencing, including any that may seem unrelated to an upper respiratory infection, and when they started.
- Write down key personal information, such as if your child was born prematurely or if he or she has a heart or lung problem.
- Write down questions to ask your doctor.
Questions to ask your doctor
Some basic questions to ask your doctor include:
- What is likely causing my child's symptoms? Are there other possible causes?
- Does my child need any tests?
- How long do symptoms usually last?
- Is my child's infection contagious?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- Does my child need medication? If so, is there a generic alternative to the medicine you're prescribing me?
- What can I do to make my child feel better?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
Don't hesitate to ask questions during your appointment anytime that you don't understand something.
What to expect from your doctor
Be ready to answer questions your doctor may ask:
- When did your child first begin experiencing symptoms?
- Have your child's symptoms been off and on or continuous?
- How severe are your child's symptoms?
- What, if anything, seems to improve your child's symptoms?
- What, if anything, appears to worsen your child's symptoms?
What you can do in the meantime
If your child has a fever and is older than 3 months, you can give him or her acetaminophen (Tylenol, others) or ibuprofen (Children's Advil, Children's Motrin).
Never give a child under age 2 over-the-counter cough and cold products without checking with your child's doctor.
It's also important to have your child drink plenty of fluids to prevent dehydration.
Although it may not be possible to shorten the duration of your child's illness, you may be able to make your child more comfortable. Here are some tips to try:
- Humidify the air. If the air in your child's room is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds. Another way to humidify the air is to run a hot shower or bath in the bathroom and let it steam up the room. Sitting in the room holding your child for about 15 minutes may help ease a fit of coughing.
- Keep your child upright. Being in an upright position usually makes breathing easier.
- Have your child drink. To prevent dehydration, give your child plenty of clear fluids to drink, such as water or juice. Your child may drink more slowly than usual, because of the congestion.
- Try saline nose drops to ease congestion. You can purchase these drops over-the-counter (OTC). They're effective, safe and nonirritating, even for children. To use them, instill several drops into one nostril, then immediately bulb suction that nostril (but don't push the bulb too far in). Repeat the process in the other nostril. If your child is old enough, teach your child how to blow his or her nose.
- Use OTC pain relievers. OTC pain relievers such as acetaminophen (Tylenol, others) may help relieve a sore throat and improve your child's ability to drink fluids. Never give your child aspirin. It's associated with a rare but serious illness called Reye's syndrome. Don't give OTC cough and cold medicines to children younger than age 2.
- Maintain a smoke-free environment. Smoke can aggravate symptoms of respiratory infections. If a family member smokes, ask him or her to smoke outside of the house and outside of the car.
Because the viruses that cause bronchiolitis spread from person to person, one of the best ways to prevent it is to wash your hands frequently — especially before touching your baby when you have a cold or other respiratory illness. Wearing a face mask at this time is appropriate.
If your child has bronchiolitis, keep him or her at home until the illness is past to avoid spreading it to others.
Other commonsense ways to help curb infection include:
- Limit contact with people who have a fever or cold. If your child is a newborn, especially a premature newborn, avoid exposure to people with colds in the first two months of life.
- Clean and disinfect surfaces. Clean and disinfect surfaces and objects that people frequently touch, such as toys and doorknobs. This is especially important if a family member is sick.
- Cover coughs and sneezes. Cover your mouth and nose with a tissue. Then throw away the tissue and wash your hands or use alcohol hand sanitizer.
- Use your own drinking glass. Don't share glasses with others, especially if someone in your family is ill.
- Wash hands often. Frequently wash your own hands and those of your child. Keep an alcohol-based hand sanitizer handy for yourself and your child when you're away from home.
- Breast-feed. Respiratory infections are significantly less common in breast-fed babies.
Vaccines and medications
There are no vaccines for the most common causes of bronchiolitis (RSV and rhinovirus). However, an annual flu shot is recommended for everyone older than 6 months.
Infants at high risk of the RSV infection, such as those born very prematurely or with a heart-lung condition or a depressed immune system, may be given the medication palivizumab (Synagis) to decrease the likelihood of RSV infections.