Bronchiolitis

1 in 3 infants will get bronchiolitis in their first year of life. For most babies this will be mild, but it can cause some children to become very unwell. As parents and carers, it’s important to be aware of the features of bronchiolitis and know when you should seek help.

What is Bronchiolitis?

Bronchiolitis is a very common infection of the lower respiratory tract. Small airways (bronchioles) become inflamed and fill up with mucus, causing breathing to become more difficult.

Diagram showing different types of airways with bronchioles highlighted. — Diagram showing different types of airways. Bronchioles (highlighted) are affected in bronchiolitis

What Causes Bronchiolitis?

Many viruses can cause bronchiolitis, but the most common cause is a virus called Respiratory Syncytial Virus (RSV). RSV is transmitted through coughs and sneezes, and can survive on surfaces for up to 7 hours.

Who Gets Bronchiolitis?

Bronchiolitis typically affects children under the age of one (or two if they were premature) because they have small airways which can get blocked easily.

It is most common in babies who…

Are 3-to-6 months old
Attend nursery
Have older siblings at school or nursery

When is Bronchiolitis Most Common?

Viruses that cause bronchiolitis are usually more common in winter and less common in summer. However, because of covid restrictions, there were fewer viruses going around last winter. Hospitals have seen more cases of bronchiolitis this summer as people have started mixing again.

What are the Symptoms of Bronchiolitis?

Bronchiolitis usually starts with a snotty nose for a few days followed by a persistent cough. You may then notice other symptoms including…

Fast breathing (more than 50-60 breaths per minute)
Noises with breathing like wheezing
Fever (30% of cases)
Difficulty in feeding
Being less active than normal
Being irritable
Brief pauses during breathing

Most cases of bronchiolitis are not worrying but the symptoms can be worrying for a parent. If you notice that your infant has any of the symptoms mentioned above please seek medical attention.

The condition is self-limiting and a small number of babies will need to go to hospital for supportive care including supplemental oxygen.

How Long Does Bronchiolitis Last?

Symptoms usually peak on days 3-5 of the illness before starting to usually resolve over a period of a 10-14 days. However, your child may have a cough for up to a month.

What Should I Do if I Think My Child Has Bronchiolitis?

Mild cases of bronchiolitis can be managed at home.

You should seek medical attention if…

Your baby has increased work of breathing (breathing a lot faster and using more energy to breathe compared to normal)
Your baby has been taking less than 50% of their usual amount of feed – this can suggest that they are becoming tired
Your baby has had fewer wet nappies than normal – this suggests they are dehydrated
Your baby is irritable or drowsy
You are worried about your baby or do not feel you can manage them at home

You should call an ambulance (999) if…

Your baby turns blue or very pale
Your baby stops breathing, or has long pauses in their breathing
Your baby is unresponsive

How is Bronchiolitis Diagnosed?

Diagnosis of bronchiolitis is clinical and is based on history and examination only. Most children will not need any investigations for bronchiolitis unless severe or the diagnosis is uncertain.

How is Bronchiolitis Managed?

There is no medication that specifically treats bronchiolitis – treatment is supportive. This means making sure your baby is well hydrated and keeping them comfortable.

Antibiotics are not given in bronchiolitis as it is caused by a virus.

If your baby is not feeding as much as normal, try offering smaller feeds more often.
Sitting your baby up can help their breathing and make feeding more comfortable.
You can also give paracetamol or ibuprofen to help reduce fever if this is causing them to be upset.

Babies are nasal breathers, if their noses are blocked then they struggle to feed and are at risk of becoming dehydrated. Using simple measures such as snot suckers and saline drops can clear the nasal passages and allow them to feed more effectively. I tend to advise snot suckers such as The Frida Baby Snot Sucker (https://www.fridababy.co.uk/product-page/nosefrida-the-snotsucker-saline-kit) and saline drops (follow the instructions on the package). Use TCM2021 to receive 20% off your purchase.

Symptoms should start to resolve on their own within a week.

Will My Baby Need to be Admitted to Hospital?

Around 2-3 in every hundred babies with bronchiolitis will need to be admitted to hospital. This is usually because they have low oxygen saturations in their blood, or they are not managing acceptable amounts of fluids and feeds at home.

In hospital, your child may be given extra oxygen through a tube or face mask. Blockages caused by mucus can be suctioned out to help their breathing. A nasogastric (NG) tube may also be inserted through your child’s nose and into their stomach to help with feeding.

Is My Baby at Risk of Getting Severe Bronchiolitis?

Some babies are at a higher risk of becoming very unwell if they develop bronchiolitis. These include:

Babies under 2 months old
Premature babies born before 37 weeks of pregnancy
Babies born with congenital heart disease
Babies with chronic lung disease of prematurity
Babies who are exposed to cigarette smoke

How Long is RSV Infectious For?

Some infants can remain infectious with RSV for up to 3 weeks. However, they can go back to nursery and playgroups when they are feeling better.

My Baby Has Had Bronchiolitis – Are They Likely to Get it Again?

Some babies will get bronchiolitis more than once, but it is likely to be less severe the second time.

My Baby Has Had Bronchiolitis – Are There Any Long-Term Effects?

Most babies will recover well from bronchiolitis and not have any long-term effects. Sometimes the cells in the lungs can get damaged temporarily causing a cough and wheeze that can last up to 3-4 months. Please see your healthcare provider if you’re worried about a chronic cough.

What is the Difference Between Bronchiolitis and Viral Induced Wheeze?

Both bronchiolitis and viral induced wheeze (VIW) are caused by common viruses. Bronchiolitis is usually seen in under-ones, whereas VIW is more common in the 6-month to 5-year age range. Bronchiolitis tends to have a more gradual onset of symptoms over days, with runny nose symptoms coming before respiratory symptoms. It is not usually treated with salbutamol inhalers. VIW comes on more quickly over hours and can be responsive to salbutamol inhalers.

What is the Difference between Bronchiolitis and a Common Cold?

Common colds are usually much milder than bronchiolitis and only affect the upper respiratory tract (i.e., nose and throat). You wouldn’t expect to hear a wheeze or see belly breathing with a common cold as it affects an infant above the neck level and not down in the lungs.

What is the Difference Between Bronchiolitis and Bronchitis?

Bronchitis affects the larger airways called bronchi and usually affects older

children whereas bronchiolitis affects smaller airways called bronchioles (as shown below) and smaller children (<1’s).

Is There a Way I Can Prevent Bronchiolitis?

Viruses that cause bronchiolitis are very common, and it can be difficult to avoid them.

Simple measures such as washing hands and keeping surfaces clean can help reduce the risk of infection. If you have a new-born baby, keeping them away from people with coughs and colds can help prevent bronchiolitis. Breastfeeding for more than two months has also been shown to reduce the risk of getting bronchiolitis.

Some children who are at a high risk for becoming seriously unwell with bronchiolitis may be offered a monthly injection throughout winter called Palivizumab. This is an injection of an antibody against RSV. Decisions around giving Palivizumab to high-risk children are made by their consultants after discussions with parents and carers.

My Child Has Bronchiolitis – How Can I Stop Them Going to Hospital?

Keeping your baby comfortable and ensuring they are well hydrated is the best way to help manage the symptoms of bronchiolitis. Whilst most babies will recover well at home, some babies will need to go to hospital to help with their breathing or feeding. Children under the age of 2 can deteriorate quite quickly, so trust your gut, and seek help early if you are worried.