Bronchiolitis

What is bronchiolitis in children?

Bronchiolitis is a viral infection of the bronchioles (small airways) in your child's lungs. These small airways become inflamed and filled with fluid and mucus. The muscles around the airways tighten, making them smaller. This makes it hard for your child to breathe.


What causes bronchiolitis in children?

Bronchiolitis is usually caused by viruses, most often by the respiratory syncytial virus (RSV). Other bacteria and viruses that can cause bronchiolitis include those that also cause influenza (the flu), colds, and pneumonia. An infected person may spread germs by coughing, sneezing, or being in close contact with others. 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 increases my child's risk for bronchiolitis?

Bronchiolitis most often happens to children younger than 2 years old, usually in the fall, winter, or early spring. The risk for severe bronchiolitis is higher if your baby is less than 12 weeks old, has a weak immune system, or was born prematurely or at a low birth weight. The risk is also higher with medical conditions such as heart problems, allergies, or Down syndrome.

What are the signs and symptoms of bronchiolitis in children?

Bronchiolitis begins like a common cold and usually lasts 5 to 7 days. Your child may wheeze or breathe faster than usual. He may have a cough or a runny or stuffy nose. He may have a fever and be fussy or not eat or sleep as well as usual. If your child has more severe illness, his signs and symptoms will continue to get worse. You may notice that he is grunting, breathing very fast, or that there are 15 or 20 seconds in between breaths. His skin, lips, fingernails, or toenails may look pale or bluish. He may become very sleepy or stop responding to you.

How is bronchiolitis in children diagnosed?

Your child's caregiver will ask you questions about your child's health history. Tell him your child's signs and symptoms. He will ask 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. 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.

  • Blood tests: Your child may need blood tests to see if he has an infection or is dehydrated.

  • 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.

  • 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 tube. This sample will be sent to the lab for tests.

How is bronchiolitis in children treated?

Bronchiolitis usually goes away on its own in healthy children. Most children can be treated at home.

  • Acetaminophen or ibuprofen: These medicines decrease pain and lower a fever. They are available without a doctor's order. Ask your caregiver which medicine is right for your child. Ask how much to give and how often to give it. Follow directions. These medicines can cause stomach bleeding if not taken correctly. Ibuprofen can cause kidney damage. Acetaminophen can cause liver damage. 

  • Liquids: Encourage your child to drink liquids often. Liquids you should offer depend on the age of your child and include breast milk, formula, regular milk, water, and juice.

  • Remove mucus from his nose: Put several drops of saline nose drops in one nostril, then immediately suction it out with a bulb syringe. Repeat this process on the other side. Do this every time before you try to feed your child. It will be easier for him to drink and eat if he can breathe through his nose. If your child is old enough, teach him to blow his nose. Ask your caregiver how to use a bulb syringe if you do not know.

How is severe bronchiolitis in children treated?

Some children get a more severe form of the disease and need hospital treatment. This may include the following:

  • Your child may need extra oxygen if his blood oxygen level is lower than it should be. Your child may get oxygen through a mask placed over his nose and mouth or through small tubes placed in his nostrils. Ask your child's healthcare provider before you take off the mask or oxygen tubing.

  • Medicines: Your child may need bronchodilators to help open the airways in his lungs. He may also need medicine, such as steroids, to decrease the swelling in his airways. Antivirals may help fight an RSV infection. Antibiotics may be given if your child has a bacterial infection.

  • Breathing treatments and support:

    • Removing mucus: A small tube is placed in your child's mouth or nose. 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 this treatment more than once.

    • Nebulizer treatments: Bronchodilator medicine is mixed with air or oxygen in a machine called a nebulizer. This makes a mist that is easier for your child to breathe into his lungs. Breathing treatments are usually given through a mouthpiece or mask attached to the nebulizer.

    • 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.

  • Fluid and nutrition: Your child may need an IV or a feeding tube to give him liquids and nutrients.

How can bronchiolitis in children be prevented?

  • Ask if your child should receive medicine to protect against RSV: Your child may need to receive RSV immunoglobulin medicine to help protect him from RSV. When needed, your child will receive 1 dose every month for 5 months. The first dose is usually given in November or December before RSV season.

  • Avoid other people who are ill: Keep your child away from crowds or people with colds or other respiratory infections. Avoid having your child 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: Clean objects that your child has touched, such as sheets, tables, and cribs. Also clean toys that are shared with other children and items touched by sick children or adults.

  • Do not expose your child to 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: Wash your hands and your child's hands often with soap and water to remove germs. A germ-killing hand lotion or gel may be used when no water is available. This is the most important thing you can do to prevent the spread of germs.

What are the risks of bronchiolitis in children?

  • Your child may have difficulty eating because of congestion and breathing problems. Your child may get dehydrated. Breathing problems could cause 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 an ear infection or other problems when he is sick. Medicines to treat bronchiolitis may cause an allergic reaction. This could cause your child to have skin rashes or trouble breathing. Even with treatment, if your child has heart or other lung problems, he can have a life-threatening illness.

  • If your child's bronchiolitis is left untreated, his condition may get worse. Your child may lose weight or not gain weight as he should. Dehydration can lead to problems with his organs, such as his heart, brain, or kidneys. He may have further breathing problems, leading to decreased oxygen levels and damage to organs such as the kidneys, heart, and brain. He may get very tired from working hard to breathe and completely stop breathing. If your child does not get or does not respond to treatment and his condition worsens, he may die. The risks of serious illness or death are small if you follow your child's caregiver's advice.

Where can I find more information?

  • 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

When should I contact my child's caregiver?

Contact your child's caregiver if:

  • Your child is not eating, or has nausea or vomiting.

  • Your child is acting very tired or sleeping more than usual.

  • Your child has a fever.

  • Your child is breathing fast:

    • More than 50 breaths in 1 minute for newborn babies up to 6 months of age.

    • More than 40 breaths in 1 minute for babies 6 months to 1 year of age.

    • More than 30 breaths in 1 minute for a child 1 year of age and older.

  • You have questions or concerns about your child's condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • Your child has a hard time breathing, has more wheezing, or has pauses in his breathing.

  • Your child's lips or nails are bluish.

  • Your child's symptoms do not get better or get worse.

  • Your child seems weak.

  • Your child is breathing so hard it is difficult for him to eat or drink.

  • 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 1 year old

    • Urinating less than usual, or not at all

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. 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.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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