Bronchiolitis is a viral respiratory illness that commonly affects children under the age of two. Most cases occur during the winter months and are caused by a variety of viruses, with respiratory syncytial virus (RSV) being the most common. As a parent, it is important to know the signs and symptoms of bronchiolitis, how it is diagnosed, and how it can be treated.
What is Bronchiolitis?
Bronchiolitis is a viral infection that causes inflammation, swelling, and mucus build-up in the small airways (bronchioles) of the lungs. This can lead to difficulty breathing, wheezing, and a cough that may last for several weeks. The illness is most common in children under the age of one and has become one of the most common reasons for hospitalisation of children younger than two during the winter months.
Bronchiolitis usually starts out like a cold, with symptoms such as a runny nose, cough, and fever. However, as the illness progresses, the child may experience more severe symptoms, such as a persistent and worsening cough, difficulty breathing, wheezing, and poor feeding.
While most cases of bronchiolitis are mild and will resolve on their own, in some cases, the illness can become severe and even life-threatening.
What Causes Bronchiolitis?
Bronchiolitis is caused by a viral infection, most commonly RSV. Other viruses that can cause bronchiolitis include human metapneumovirus, influenza virus, parainfluenza virus, corona virus, adenovirus, and rhinovirus. These viruses are highly contagious and can be spread through coughing, sneezing, or touching surfaces contaminated with the virus.
RSV is the most common cause of bronchiolitis in infants and young children. In fact, it is estimated that by the age of two, nearly all children will have been infected with RSV at least once.
While most cases of RSV infection will result in mild cold-like symptoms, some children may develop more severe bronchiolitis, especially if they have underlying health conditions such as prematurity, congenital heart disease, or chronic lung disease and infants younger than 3 months.
Clinical features:
Bronchiolitis typically starts as a mild cough and a runny nose or a blocked nose. Over the next day or two, the cough will get progressively worse, and your baby will have some breathing problems including the following symptoms:
- Fast breathing
- Noisy breathing that sounds wheezy
- Breathing difficulty – you may see the ribs or skin under the neck sucking in or nostrils flaring when they are breathing. Younger babies may bob their heads when breathing
- Difficulties eating or drinking
- Fever
- Irritability
Bronchiolitis typically follows a course where symptoms worsen on the second or third day, with gradual improvement thereafter. The illness usually lasts for 7 to 10 days, although coughing may persist for up to 2 to 4 weeks.
The symptoms are often worse at night.
How is Bronchiolitis Diagnosed?
Bronchiolitis is usually diagnosed based on the child's clinical history and a physical examination that includes auscultation of the lungs to detect characteristic sounds like wheezing and crackles.
In most cases, there is no need for blood tests or chest X-rays to make a diagnosis. However, in some cases, a nasal swab may be ordered to confirm the presence of the virus causing the illness.
How can Bronchiolitis be Treated?
Unfortunately, there is no specific treatment for bronchiolitis.
Antibiotics are not effective against viruses, and asthma puffers such as Ventolin and Atrovent are also not helpful as the wheezing is not related to asthma.
Steroids such as Predmix or Redipred are also not helpful in Bronchiolitis.
Instead, treatment focuses on providing supportive care to relieve symptoms and may include the following measures:
- Try giving your baby shorter and more frequent breastfeeds or smaller amounts of formula more often. This can prevent them from getting too tired while feeding and ensure they stay hydrated.
- You can also use saline nasal drops or spray to clear your baby's nasal passages of mucus, which can help them breathe more easily and feed more comfortably. A nasal aspirator may help to remove mucus.
- Encourage your baby to rest.
- You can give Paracetamol (Panadol, Dymadon, Panamax) or Ibuprofen (Nurofen, Advil) if your baby has a temperature and is unsettled. Give your child the dose that is recommended on the packaging for their age and weight.
- Do not smoke in the home or around your baby. This is especially important around babies with any breathing problems.
In more severe cases, hospitalisation may be necessary to provide oxygen and other supportive measures.
Treatment in Hospital:
- Monitoring your baby closely to make sure they do not become more unwell.
- Oxygen via nasal prongs or by using a high flow nasal cannula (oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a high flow rate).
- Feeding support by providing expressed breast milk, formula or fluids through a tube placed through the nose into the stomach (nasogastric tube) or by giving fluids into the vein.
- Nasal suction.
Prevention:
In addition to supportive care, there are steps you can take to help prevent the spread of bronchiolitis. Good hand hygiene is important, so be sure to wash your hands frequently, and encourage others who come in contact with your child to do the same.
If your child is sick, keep them away from others, especially infants and young children who may be more susceptible to the illness.
If your child is in day care, keep them at home until they are no longer contagious.
Can my child get Bronchiolitis again?
Unfortunately, the answer is yes.
Bronchiolitis is caused by a viral infection, and there are several different viruses that can cause it. While having bronchiolitis once may provide some immunity to the specific virus that caused it, it does not protect against other viruses that can cause the illness.
When to seek help?
While most cases of bronchiolitis are mild and will resolve on their own, in some cases the illness can get worse and require medical attention.
You should see your GP if your baby has bronchiolitis and:
- They have a cough or wheeze that is getting worse.
- Born prematurely or if younger than 3 months.
- Underlying chronic lung disease, congenital heart disease or immunocompromised (weakened immune system).
- They seem more tired or are more sleepy than usual.
- You are worried in any way.
Go to your nearest doctor or emergency department if your baby:
- Has difficulty breathing, irregular breathing or breathing fast.
- They have less than half their normal feeds or are refusing to drink.
- Very sleepy and difficult to wake.
- Face turns blue when coughing.
- Skin looks pale and sweaty.
Call an ambulance immediately if your baby is struggling to breathe or if their lips start to turn blue.
Summary:
Bronchiolitis is a common respiratory illness that affects infants and young children, especially during the winter months. It is caused by a viral infection that leads to inflammation and swelling in the small airways of the lungs.
Babies usually get better in 7 to 10 days, but the cough may continue for up to 2 to 4 weeks.
While most cases of bronchiolitis are mild and will resolve on their own, in some cases the illness can become severe and require hospital admission.
Treatment for bronchiolitis focuses on supportive care, including ensuring adequate hydration by providing smaller and more frequent feeds, applying saline to the nose, and administering acetaminophen or ibuprofen to help reduce fever and discomfort.
Antibiotics, steroids and Ventolin puffers do not help.
If your child looks unwell or if you are concerned, go to your nearest doctor or emergency department or call 000.
Written by Dr Samuel Heitner