Bronchiolitis is an infection of the bronchioles, small air passages in the lungs. It is common in children and is the leading cause of serious lower respiratory illness in infants.
Bronchiolitis is usually caused by a virus, especially respiratory syncytial virus (RSV), and frequently occurs in the late fall to early spring.
Symptoms of bronchiolitis include runny nose, cough, and fever. After a few days, your child may experience shortness of breath and/or breathing that is rapid and labored with wheezing. The symptoms usually worsen until the 4th – 5th day of the episode and improve steadily thereafter.
A severe infection in infants may cause a noticeably increased breathing rate. Seek immediate medical attention if your infant develops difficulty breathing (chest retractions, nasal flaring, see-sawing of the chest and abdomen, rapid repertory rate >50 breathes per minute).
If your child has heart disease or was born prematurely, call our office (or page operator for after hours) at the first sign of bronchiolitis.
Symptoms of bronchiolitis may last anywhere from 1 – 2 weeks. Most children recover within a week.
A health professional may diagnose bronchiolitis based on a medical history, your child's symptoms, and a physical exam. Testing is usually not needed if your health professional suspects the bronchiolitis is caused by RSV.
Home treatment to manage the symptoms of bronchiolitis is usually all that is necessary. If there is wheezing on physical exam, we may recommend the use of a nebulizer (explained below). Have your child drink plenty of liquids to avoid dehydration. If your child has a fever, acetaminophen (such as Tylenol) may help. Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome, a serious illness.
Call us if:
- Your child is vomiting and can't keep liquids down.
- Your child is breathing rapidly.
- You can see your child's skin pull in between the ribs (retractions) when breathing. This is a sign that your child is having difficulty breathing.
- In severe cases, your doctor may suggest hospitalization and supplemental oxygen to help your child breathe easier.
It is common for children to develop respiratory problems (such as bronchiolitis caused by a viral infection) because they are often exposed to people who have infections to which they have not built up immunity. Bronchiolitis is spread just like a cold. To prevent bronchiolitis:
- Avoid contact with other children who have bronchiolitis or upper respiratory infections. If there is an ill child in the home, separate him or her from other children, if possible. Put the child in a room alone to sleep. If your child has bronchiolitis, keep him or her home from school or day care until the cough is gone.
- Wash your hands regularly to prevent spreading the disease. Hand washing eliminates the germs on your hands and the spread of germs to your child when you touch your child or touch an object he or she might touch.
- Do not smoke or use other tobacco products around your child. Secondhand smoke irritates the mucous membranes in your child's nose, sinuses, and lungs and increases the risk for respiratory infections.
If your child is considered at high risk of developing RSV (such as a premature baby [< 32 weeks at birth] or congenital heart defect), we will counsel you about whether your child should receive injections of palivizumab (Synagis). This medication helps prevent bronchiolitis and other complications of RSV. It is injected once a month during RSV season—late fall to early spring.
Nebulizer Treatments
Sometimes after a long cold or bronchiolitis you may see some of the following problems:
- wheezing (a high-pitched whistling or musical sound while breathing)
- recurrent attacks of wheezing, coughing, chest tightness, and difficulty in breathing
- sneezing and a runny nose (often but not always)
What causes the wheezing or coughing?
The wheezing/coughing may be secondary to a "twitchy" lung. When allergic or irritating substances enter the airways, they spasm and airway swelling occurs. Viral respiratory infections (colds) trigger most attacks, especially in younger children. If the wheezing is due to pollens, it flares up only during a particular season.
How long does it last?
Wheezing/coughing attacks may be frightening, but they are treatable. When medicines are taken as directed, the symptoms completely clear up within a few weeks and generally there are no permanent lung changes.
What medicines will my child need?
- Preventive Medicine – Pulmicort (shaped like a soccerball): This medication will be used to reduce the inflammation (swelling of the airway walls) that is occurring in your child’s lungs.
Use this medication in the nebulizer 2x/day (once in the morning and once at night) for 2 weeks. In some cases it may be needed longer.
- Rescue Medicine – Albuterol (shaped like a long coke can with a triangle on top): This medication will be used to open up the airways of your child’s lungs.
Use this medication in the nebulizer every 4 hours as needed until the coughing/wheezing has improved. You can use this up to 6x/day safely.
- You can give both at the same time! If it is time to give your child the Pulmicort medication and you also feel that your child needs an Albuterol dose for wheezing/coughing, it is perfectly fine to mix the two medications and give them in the same nebulizer treatment dose.
- It is best to use these medicines before brushing teeth.
Revised 3.22.09