Bronchiolitis

What is bronchiolitis?

Bronchiolitis (BRON-kee-oh-lie-tis) is a lung infection of the bronchioles. The bronchioles are tiny tubes (airways) inside your child’s lungs. These small airways become inflamed and swell, making it hard for your child to breathe. The airways become filled with fluid, mucus, and dead tissue, and muscles around them tighten, making them smaller. Bronchiolitis most often happens to children younger than 2 years old, usually in the fall, winter, or early spring. In healthy children acute bronchiolitis usually goes away on its own. Some children get a more severe (very bad) form of the disease and may become very sick. The disease usually lasts 5 to 7 days, although the coughing may continue for many weeks afterwards.

What causes bronchiolitis and how does it spread?

• Bronchiolitis is caused by different types of germs, such as viruses and bacteria. Bronchiolitis is usually caused by viruses and most often by the respiratory syncytial virus (RSV). Other germs that can cause bronchiolitis include those that also cause influenza (the flu), colds, and pneumonia. Children with a viral infection can also have a bacterial infection at the same time. Even if your child had RSV before, he can still get it again. Ask your caregiver for more information about respiratory syncytial virus (RSV).
  
  
• Your child may get infected by breathing in germs or putting germ-carrying objects (including fingers) into his mouth. RSV is a highly contagious virus that can very easily be spread to other people. An infected person may spread germs to others by coughing, sneezing, or being in close contact with others. He may leave germs on objects such as beds, tables, cribs, and toys. Your child may have more frequent contact with germs in certain situations. These include having a school-aged brother or sister, or going to crowded places such as daycare centers.

What may increase my child's risk of having bronchiolitis that is more severe?

Some of these children may also get bronchiolitis more easily:

• Age: Less than 6 to 12 weeks of age.
  
  
• Immune system problems: Having a weak immune system (part of the body that helps fight infection). This may be weakened by HIV, organ or bone marrow transplants, or certain immune system disorders.
  
  
• Other medical conditions: Having another medical condition, such as a heart or lung problem, allergy, cystic fibrosis, or Down syndrome.
  
  
• Premature or small: Babies that were born premature (less than 37 weeks in womb) or with a low weight (less than approximately five pounds).

What are the signs and symptoms of bronchiolitis?

• Initial illness: Bronchiolitis begins like a common cold. When he first gets ill, your child may have any of the following:
  
  
  • Breathing faster than usual.
    
    
  • Coughing.
    
    
  • Fever and irritable or fussy.
    
    
  • Not eating or sleeping as well as usual.
    
    
  • Runny or stuffy nose.
    
    
  • Wheezing (high-pitched whistling sound heard when breathing out).
  
  
• More severe illness: Most children do not get more sick. Those who do become more ill may have any of the following:
  
  
  • Trouble breathing:
    
    
    • Breathing very fast (60 to 70 breaths or more in one minute).
      
      
    • Grunting and increased wheezing or noisy breathing.
      
      
    • Increased coughing.
      
      
    • Nostrils (openings of your child's nose) become wider when breathing in.
      
      
    • Pale or bluish color of the skin, lips, fingernails, or toenails.
      
      
    • Pauses in breathing for at least 15 to 20 seconds.
      
      
    • Retractions (pulling in of the skin between the ribs and around the neck with each breath).
    
    
  • Other signs and symptoms:
    
    
    • Increased or fast heartbeat.
      
      
    • Loss of appetite or poor feeding.
      
      
    • More irritable or fussy than before.
      
      
    • More sleepy than usual, has trouble staying awake, or does not respond to you.
      
      
    • Pass little or no urine.
      
      
    • Vomiting (throwing up) with coughing, or diarrhea (loose, frequent bowel movement).

What problems can bronchiolitis cause?

Fast breathing may cause feeding problems. When your child eats or drinks too little, he may get dehydrated. Dehydration is when your child's body has too little water or fluid in it. Your child may also have further breathing problems, causing a decrease in oxygen inside his body. When your child's body does not get enough oxygen, his kidneys, heart, and brain can be damaged. Your child may have other problems when he is sick such as an ear infection.

How is bronchiolitis diagnosed?

Your child's caregiver will take a detailed health history of your child. He may ask you questions about your child's signs and symptoms. He will ask about how your child has been eating, drinking, sleeping, and acting. Tell your child's caregiver about your child's activities, or if he has been around any sick people. Tell him if your child has other medical problems. Your child's caregiver will listen to your child's heart and lungs using a stethoscope. He will also watch how your child is breathing and acting. Your child may need one or more of the following tests:

• Pulse oximeter: A pulse oximeter is a machine that can tell your caregiver how much oxygen is in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to the machine.
  
  
• If your child is very sick:
  
  
  • Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.
    
    
  • Chest x-ray: This is a picture of your child's lungs and heart. A chest x-ray may be used to check your child's heart, lungs, and chest wall. It can help caregivers diagnose your child's symptoms, or suggest or monitor treatment for medical conditions.
    
    
  • Culture: This is a test to grow and identify the germ that is causing your child's condition. A culture may be done using swab samples taken from your child's throat or nose.
    
    
  • Nasal wash: A nasal wash is a test to find out what is causing your child's condition. A sample of mucus from your child's nose may be taken with a suction (vacuum) tube. This sample will be put into a bottle and sent to the lab for tests.

How is bronchiolitis treated?

Most children with bronchiolitis can be treated at home. Children at risk for having more severe (very bad) illness may need to receive hospital treatment. Treatment may include any of the following:

• Treatment at home:
  
  
  • Encourage your child to drink: Encourage your child to drink liquids often. Liquids can be any that your child is willing to take. Liquids you should offer depend on the age of your child and include breastmilk, formula, regular milk, water, and juice.
    
    
  • Fever medicine: If your child has a temperature, ask your caregiver about what medicine you can give to your child.
    
    
  • Nasal mucus removal: Use a bulb syringe to suck out mucus out of your child's nose. Do this every time before trying to feed your child. Being able to breathe through his nose will make it easier for him to drink and eat. Ask your caregiver for information about how to use a bulb syringe. Ask your caregiver for information about using or making nose drops to thin the mucus.
  
  
• Treatment at the hospital: Most children will receive oxygen and fluid treatments. Other treatments may be given for more severe illness.
  
  
  • Fluid and nutrition: Your child may need more liquids to decrease the risk of dehydration. If your child is having trouble eating or drinking, an IV may be needed. An IV is a tube placed in your child's vein for giving liquids or medicines. A feeding tube may be passed through your child's mouth or nose and into his stomach.
    
    
  • Oxygen: Your child may need oxygen if his blood oxygen level is lower than it should be. Oxygen will help your child breathe easier. Your child may get oxygen through small tubes placed in his nostrils, or through a mask. He may instead be placed in an oxygen tent. Never take off your child's oxygen tubes or mask or remove him from the tent without asking his caregiver first.
    
    
  • Medicines:
    
    
    • Breathing medicines: Your child may need medicines, called bronchodilators, to help open the airways in his lungs. He may also need medicine, such as steroids, to decrease the swelling in his airways. These medicines may be given to help your child breathe easier.
      
      
    • Medicines to fight infection: These include antiviral and antibiotic medicines. Antivirals may help fight an RSV infection. These may be given if your child has, or is at risk of having a severe (very bad) disease. Antibiotics are bacteria-killing medicines and only used if your child has a bacterial infection.
      
      
    • Other medicines: Medicines may be given to decrease your child’s signs and symptoms. These may include medicines for fever or discomfort.
    
    
  • Breathing treatments and support:
    
    
    • Removing mucus: A small tube is placed in your child's mouth or nose and connected to suction. This tube sucks out the mucus in your child's mouth and nose to help him breathe easier. Saline drops may be put into your child's nose to loosen up some of the mucus. Your child may need to be suctioned more than once.
      
      
    • Nebulizer treatments: Your child may be given bronchodilator medicine that is nebulized (changed into a mist form) to help open the airways in his lungs. During nebulizer treatment, the medicine is mixed with air or oxygen in a machine to make the mist. The mist makes it easier for your child to breathe the medicine into his lungs. Breathing treatments are usually given through a mouthpiece or mask attached to the nebulizer (breathing treatment machine).
      
      
    • ET tube: Your child may need an endotracheal (ET) tube to help him breathe. An ET tube is put in your child's mouth or nose, and goes into the trachea (windpipe). It may be connected to a breathing machine called a ventilator. The ET tube will be taken out when your child is breathing better.

How can bronchiolitis be prevented?

• Ask if your child should receive medicine to protect against getting RSV. Your child may need to receive RSV immunoglobulin (Ig) medicine to help protect him from getting RSV. This may be needed if your child is at risk of having severe disease with RSV infection. When needed, your child will receive one dose every month for five months. The first dose is usually given in November or December. Ask your child's caregiver if your child should receive this RSV medicine.
  
  
• Avoid other people who are ill. Keep your child away from crowds or people with colds or other respiratory infections. Avoid having your child be in daycare during RSV season.
  
  
• Breastfeed your baby. Breast milk helps your baby's body fight infections, and may help prevent bronchiolitis.
  
  
• Clean toys and other objects. These include toys that are shared with other children and items touched by sick children or adults.
  
  
• Do not expose your child to smoke. This includes cigarette and other tobacco smoke. Never smoke around or allow others to smoke around your child. Do not take your child to places where a wood stove is burning. Keep your child away from chemical fumes (gas vapors) or dust.
  
  
• Wash your hands frequently. Keep your and your child's hands clean. This is the most important thing you can do to prevent spreading germs, including those that can cause bronchiolitis. Wash often with soap and water to remove germs from your hands. A germ-killing hand lotion or gel may be used when no water available.

When should I call my child's caregiver?

Call your child's caregiver if:

• Your child is not eating, or has nausea (upset stomach) or vomiting (throwing up).
  
  
• Your child is acting very tired or weak, or is sleeping more than usual.
  
  
• Your child has a fever.
  
  
• Your child is breathing fast:
  
  
  • More than 50 breaths in one minute for newborn babies up to six months of age.
    
    
  • More than 40 breaths in one minute for six months.
    
    
  • More than 30 breaths in one minute for a child at one year of age.
  
  
• You have questions or concerns about your child's condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your child has a hard time breathing, or has pauses in his breathing.
  
  
• Your child's lips or nails are bluish in color.
  
  
• Your child's symptoms do not get better, or get worse.
  
  
• Your child has signs of dehydration:
  
  
  • Crying without tears.
    
    
  • Dry mouth or cracked lips.
    
    
  • More irritable or fussy than normal.
    
    
  • More sleepy than usual.
    
    
  • Sunken soft spot on the top of the head, if your child is less than one year old.
    
    
  • Urinating less than usual, or not at all.

Where can I find more information?

Contact any of the following:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village , IL 60007-1098
  Phone: 1- 847 - 434-4000
  Web Address: http://www.aap.org
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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