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Bronchiolitis

What is bronchiolitis?

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?

Bronchiolitis is usually caused by a virus, most often by the respiratory syncytial virus (RSV). Bacteria can also cause bronchiolitis. An infected person can 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, usually in the fall, winter, or early spring. The risk for severe bronchiolitis is higher if your baby is younger than 12 weeks, 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?

Bronchiolitis begins like a common cold and usually lasts 5 to 7 days. Your child may have any of the following:

  • Wheezing or fast breathing

  • A cough

  • Runny or stuffy nose

  • A fever

  • Fussiness or not eating or sleeping as well as usual

How is bronchiolitis diagnosed?

Your child's healthcare provider will examine your child and ask about his symptoms and medical history. Tell him if your child has been around anyone who is sick. He may ask how well your child eats, drinks, and sleeps. Your child may need any of the following:

  • A pulse oximeter measures how much oxygen is in your child's blood. A small clip or sticky strip will be placed on your child's finger, ear, or toe. A cord connects the oximeter to a machine.

  • A culture may show what germ is causing your child's bronchiolitis. A cotton swab is used to get a tissue sample from his nose or throat.

  • Blood tests may show an infection or dehydration.

  • A chest x-ray is a picture of your child's lungs and heart to see how well they are working.

How is bronchiolitis treated?

Bronchiolitis usually goes away on its own. Most children can be treated at home. Your child may need any of the following:

  • Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to give your child and how often to give it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.

  • NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child's doctor.

  • Antibiotics help treat a bacterial infection.

  • Bronchodilators help open the airways in your child's lungs.

  • Extra oxygen may be needed if your child's 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.

  • 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.

How can I manage my child's bronchiolitis?

  • Encourage your child to drink liquids as directed. You may need to give your child more liquid than usual to prevent dehydration. Liquids also help thin the mucus in his lungs so he can breathe easier. Ask how much liquid your child should drink and which liquids are best for him. If you are breastfeeding, continue to breastfeed your baby. Breast milk helps your baby fight infection.

  • Remove mucus from his nose as directed. Put several drops of saline in one nostril, then gently suction it out with a bulb syringe. Repeat this process on the other side. Do this before you try to feed your child. It will be easier for him to drink and eat if he can breathe through his nose. Ask your healthcare provider for more information on how to use a bulb syringe. If your child is old enough, teach him to blow his nose.

How can I help prevent bronchiolitis?

  • Wash your and your child's hands often. Use soap and water. A germ-killing hand lotion or gel may be used when no water is available. Wash your and your child's hands after you use the bathroom, sneeze, or eat.

  • Clean toys and other objects with a disinfectant solution. Clean tables, counters, doorknobs, and cribs. Also clean toys that are shared with other children. Wash sheets and towels in hot, soapy water and dry on high.

  • 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.

  • Avoid other people who are sick. Keep your child away from crowds or people with colds or other respiratory infections.

  • 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. Ask your healthcare provider for more information about this medicine.

Call 911 for any of the following:

  • Your child has trouble breathing.

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

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

When should I seek immediate care?

  • Your child has any of the following signs of dehydration:

    • Crying without tears

    • Dry mouth or cracked lips

    • More irritable or fussy than usual

    • More sleepy than usual

    • Sunken soft spot on the top of the head if your child is younger than 1 year

    • Urinating less than usual, or not at all

When should I contact my child's healthcare provider?

  • 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 or older

  • Your child's lips or nails are bluish.

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

  • Your child is weak.

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

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

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

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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