At a Glance:
- Bronchiolitis is a common lung infection in children under three years old
- The most common cause is the respiratory syncytial virus (RSV), though it can also be caused by other viral infections, such as a cold or flu
- It causes inflammation in the bronchioles, the small air passages that link the bronchi to the alveoli (air sacs) in the lungs making it difficult to breathe
- Bronchiolitis may first appear to be a cold thanks to a runny nose and cough, but after a few days it typically progresses to a cough and difficult or rapid breathing
- Most cases of bronchiolitis can be treated with rest and hydration, resolving in around seven to 10 days
- In some cases, hospitalisation may be required due to dehydration or a lack of blood oxygen
What is Bronchiolitis?
Bronchiolitis is a common form of chest infection in young children and babies that causes inflammation in the bronchioles, the small airways that branch off to the main airways, the bronchi, and connect to the alveoli (air sacs) in the lungs. This inflammation causes air to become trapped, reducing lung capacity, leading to difficulty breathing difficulties, coughing and wheezing.
The condition is common in babies under six months old but may occur in children up to approximately three years of age. This age group is more susceptible to developing bronchiolitis as their lungs and immune system aren’t yet fully developed. Bronchiolitis may be more severe in underweight or premature babies.
The cause of bronchiolitis is almost invariably a virus, and may develop from a common cold. As such, cases of bronchiolitis are more commonly seen in Autumn and Winter. Due to a similarity in symptoms may be mistaken for a cold or asthma.
A child will typically recover from bronchiolitis in around seven to 10 days but some symptoms, such as a cough, may remain for an extended period of up to a month. Premature babies and those with conditions that may compromise their immune system or affect their heart or lungs may have longer lasting, more severe symptoms.
Schedule an appointment with a doctor , or a telehealth consult with the virtual respiratory clinic for help or advice on what you can do to help them recover
Symptoms of Bronchiolitis
Bronchiolitis may first present as a common cold, with the baby getting a runny or stuffy nose , a slight fever and a cough , but the symptoms typically progress after a few days, affecting the child’s breathing.
As the symptoms progress, the fever and runny nose may subside to be replaced with a number of breathing related symptoms, including:
- Wheezing when exhaling
- Rapid breathing
- Flaring of the nostrils
In most cases, these symptoms subside after around a week of rest and hydration, but if any of the following symptoms present then medical care should be immediately sought.
- Very rapid and shallow breathing/panting - this is typically classified as more than 60 breaths a minute
- Laboured breathing - difficulty inhaling and exhaling. It may appear that the baby’s chest collapses when they exhale. In other cases this may be indicated by nostrils flaring as the draw in breath. A small baby may bob their head while trying to breathe
- Sluggishness or lethargy - lack of energy or willingness/ability to move
- Difficulty eating and drinking - may be due to rapidity of breathing making eating and drinking difficult or just an inability/unwillingness to do so. Babies can easily become dehydrated, so problems drinking can be especially problematic
- Cyanosis - a blue tinge to the skin, especially the lips and fingernails indicating insufficient blood oxygen
What Causes Bronchiolitis?
The vast majority of cases are caused by RSV, the respiratory syncytial virus. This virus is extremely common - by the age of two, most children have been exposed to it. The virus is most common in the colder months and does not seem to confer any type of immunity or resistance, so children who have been infected with RSV may be re-infected during another outbreak.
Bronchiolitis may also be caused by other viruses, such as the common cold or influenza. Due to how contagious the viral infections that lead to bronchiolitis are it should be considered contagious, although it is the virus that is transmissible, not the bronchiolitis itself.
A number of risk factors may increase the chance of a child developing bronchiolitis, or increase the severity of the condition, such as:
- Being born premature
- Conditions that affect the heart or lungs
- A depressed or compromised immune system
- Exposure to second hand tobacco smoke (typically from a parent)
- Being bottle or formula raised - breastfeeding may confer benefits to a baby’s immune system
- Frequent close contact with other children - such as in daycare, creche or young siblings, especially if those siblings attend school (and bring home infections)
Treatment for Bronchiolitis
For the most part there are no treatments readily available for bronchiolitis. As the condition is caused by a virus, antibiotics have no effect and similarly bronchodilators like ventolin or inhaled corticosteroids have little use. Paracetamol or other NSAIDS (non-steroidal anti inflammatory drugs) may be used to help control a fever, but the best course of treatment is rest and hydration.
The breathing difficulties and coughing caused by bronchiolitis may make it difficult for a child to eat and drink. This may lead to dehydration. Being well hydrated may also loosen the mucus that builds up in the bronchioles as a result of the inflammation, making it easier to move.
Giving children with bronchiolitis small amounts of fluid more often than you would a regular drink or feeding can help give the child stay hydrated and make the fluid easier to swallow. You can monitor a baby’s level of hydration by checking the number of feeds or amount of fluid imbibed against the number of wet nappies.
The majority of children with bronchiolitis recover well at home, but in some cases medical care may be necessary. If the child does become dehydrated, they may require immediate medical attention and hospitalisation to be given fluids through a drip or nasogastric tube.
Children exhibiting severe difficulty breathing - extremely rapid or shallow breathing, heavy wheezing or cyanosis - will also require hospitalisation so they can be given oxygen. In the most severe cases, antiviral medications such as ribavirin may be given, but due to the number of possible side effects of the drug the use is typically limited.
There is no immunisation for RSV, the most common cause of bronchiolitis, but getting an annual flu shot may help reduce the risk of development of the condition in children over six month old. In babies with underlying heart or lung conditions, or those with compromised immune systems may be given a drug called palivizumab (Synagis), a monoculture antibody may reduce the risk of a baby contracting RSV.
Even though there is no sure-fire way to avoid illness, there are a number of things a parent can do to reduce the risk of their child developing bronchiolitis. Steps should be taken when a parent is sick or during the RSV season, such as:
- Wear a mask - if you have a cough or cold, wear a mask to catch the droplets that carry the virus and reduce the chance of it spreading to other members of the household. If you don’t have a mask, cover your mouth and nose with a tissue when you cough or sneeze and then immediately dispose of the tissue.
- Wash Your Hands and Surfaces - frequently washing your hands, and those of your child may help reduce the risk of catching a virus that can lead to bronchiolitis. Similarly, cleaning and disinfecting areas that are commonly touched may also reduce the risk of infection.
- Don’t share glasses or cutlery - don’t share a glass or cutlery with your child if you are ill.
- Avoid crowded places - if your baby is young or in an especially at risk category, avoiding crowded areas, like shopping centres limits their exposure to people with viral infections.
- Breast feed - babies that are breastfed are less likely to develop respiratory infections than those that are not.