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Children’s Ward
Colchester Hospital
Tel: 01206 746 208 or 01206  746 209

Children’s Assessment Unit
Tel: 01206 746 200

Bronchiolitis in children

Bronchiolitis is a common lower respiratory tract infection that most commonly affects babies and young children under two years old. Most cases are mild and improve without specific treatment within about two weeks, although some children have severe symptoms and need treatment in hospital. The early symptoms of bronchiolitis are similar to those of a common cold, such as a runny nose and cough.

Further symptoms then usually develop over the next few days, including:

• a slight high temperature (fever)
• a dry and persistent cough
• difficulty feeding
• rapid or noisy breathing

Who is most at risk of developing bronchiolitis?

Bronchiolitis is very common in infants and is usually mild. However, there are several things that can increase your chances of developing the condition. These include:

• being breastfed for less than two months or not at all
• being exposed to smoke, for example if parents smoke
• having brothers or sisters who attend school or nursery, as they are more likely to come into contact with a virus and pass it on

Symptoms of bronchiolitis

Most children with bronchiolitis have mild symptoms and recover within two weeks, but it’s important to look out for signs of more serious problems, such as breathing difficulties.

The early symptoms of bronchiolitis tend to appear within a few days of becoming infected. These are usually similar to those of a common cold, such as a blocked or runny nose, a cough and a slightly high temperature (fever).

The symptoms usually get worse during the next few days before gradually improving. During this time your child may develop some of the following symptoms:

• a rasping and persistent dry cough
• rapid or noisy breathing (wheezing)
• brief pauses in their breathing
• feeding less and having fewer wet nappies
• vomiting after feeding
• being irritable

Although most cases of bronchiolitis are not serious, these symptoms can be very worrying.

When to seek medical advice for bronchiolitis

If your child only has mild cold-like symptoms and is recovering well, there is usually no need to seek medical advice. In these cases you can normally care for your child at home. Contact your GP if you are worried about your child, or if your child develops any of the following symptoms:

• struggling to breathe or blue around the face and lips
• poor feeding (your child has taken less than half the amount that they usually do during the last two or three feeds)
• no wet nappy for 12 hours or more
• a breathing rate of 50 to 60 breaths per minute
• a high temperature of 38°C (100.4°F) or above
• seeming very tired or irritable

It is particularly important to seek medical advice if your baby is under 12 weeks old or they have an underlying health problem, such as a congenital (present from birth) heart or lung condition.

When to call 999

While it is unusual for children to need hospital treatment for bronchiolitis, the symptoms can get worse very quickly.

Call 999 for an ambulance if:

• your child has severe breathing difficulties or exhaustion from trying to breathe – you may see the muscles under your child’s ribs sucking in with each breath, your child may be grunting with the effort of trying to breathe, or they may be pale and sweaty
• your child has a rapid breathing rate of more than 60 breaths per minute
• you are unable to rouse (wake) your child or, if roused, they do not stay awake
• your child’s breathing stops for a long period (more than 10 seconds at a time), or there are regular shorter pauses in breathing of 5 to 10 seconds
• your child’s skin begins to turn very pale or blue, or the inside of their lips and tongue are a blue colour (known as cyanosis).

 What causes bronchiolitis?

Bronchiolitis is usually caused by a virus known as the respiratory syncytial virus (RSV), which is spread through tiny droplets of liquid from the coughs or sneezes of someone who is infected. This causes the smallest airways in the lungs (the bronchioles) to become infected and inflamed.

The inflammation reduces the amount of air entering the lungs, making it more difficult to breathe.

Who is affected by bronchiolitis?

It is estimated that one in every three children in the UK develop bronchiolitis in their first year of life. The condition is most common in babies between three and six months old. By the age of two, almost all infants have been infected with RSV and up to half of these will have had bronchiolitis.

Bronchiolitis is most common during the winter months, from November to March. It is possible to get bronchiolitis more than once during the same season.

An infected child can remain infectious for up to three weeks, even after the symptoms have gone.

Treating bronchiolitis

There is no medication to kill the viruses that cause bronchiolitis, but the infection usually clears up within two weeks without any need for treatment. Most children can be cared for at home in the same way that you’d treat a cold.

Make sure that your child gets enough fluid to avoid dehydration, and give infants paracetamol or ibuprofen (infants over one month only) to bring down their temperature if the fever is upsetting them. Some babies with bronchiolitis need to go to hospital. This is because they develop more serious symptoms, such as difficulty breathing. This is more common in premature babies (babies born before week 37 of pregnancy) having chronic lung disease of prematurity (when injury to the lungs causes long term respiratory problems in premature babies) and those born with a heart or lung condition.

Keep your child upright

This may help make their breathing easier and may be useful when they are trying to feed. If your child has a nap in an upright position, make sure that their head does not fall forward by supporting it with something, such as a rolled-up  blanket.

Drink plenty of fluids

If your child is being breastfed or bottle-fed, try giving them smaller feeds more frequently. Some additional water or fruit juice may help avoid dehydration.

Signs of dehydration include:

• a dipped fontanelle (the soft spot on the top of the head) in babies
• dry mouth and skin
• drowsiness
• producing little or no urine

 Keep a smoke-free environment

Inhaling smoke from cigarettes or other tobacco products may aggravate your child’s symptoms. If you smoke, avoid doing so around your child.

Passive smoking can affect the lining of your child’s airways, making them less resistant to infection.

Keeping smoke away from your child may also help prevent future episodes of bronchiolitis.

Saline (salt water) nasal drops are available over the counter from pharmacies. Placing a couple of drops of saline inside your child’s nose before they feed may help to relieve a blocked nose. Always follow the manufacturer’s instructions or check with your pharmacist before using saline nasal drops.

Preventing bronchiolitis

Although it is very difficult to prevent bronchiolitis, you can take steps to reduce your child’s risk of catching it and help prevent the virus spreading. This includes:

• washing both your child’s hands and your hands frequently
• washing or wiping toys and surfaces regularly
• keeping infected children at home until their symptoms have improved
• keeping new born babies away from people with colds or flu
• preventing your child being exposed to tobacco smoke

Some children who are at high risk of severe bronchiolitis may have monthly antibody injections, which help limit the severity of the condition.

Further tests

If it is not clear what is causing your child’s symptoms or your child has signs of severe bronchiolitis, your child may need further tests to confirm the diagnosis. These tests might include:

• a mucus sample test – a swab is used to collect a sample of mucus from your child’s nose, which is tested to identify virus causing your child’s bronchiolitis
• urine or blood tests
• a pulse oximeter test – this small electronic device is clipped to your child’s finger or toe to measure the oxygen in your child’s blood
• a chest X-ray – this can be used to check for any abnormalities in the lungs, or other conditions such as pneumonia

Treatment in hospital

Some children with bronchiolitis need to be admitted to hospital. This is usually necessary if they aren’t getting enough oxygen into their blood because they are having difficulty breathing, or if they are not eating or drinking enough.

A sample of your child’s mucus may be tested to see which virus is causing the bronchiolitis. This will confirm whether the respiratory syncytial virus (RSV) is responsible for the condition. If your child has RSV, they will need to be kept away from other children in the hospital who are not infected with the virus. This is to control the spread of the virus.

The level of oxygen in your child’s blood will be measured with a pulse oximeter. This is a small clip or peg that is attached to your baby’s finger or toe. It transmits light through your baby’s skin and the sensor uses this to detect how much oxygen is in their blood. If your child needs more oxygen, it can be given to them through thin tubes in their nose or a mask that goes over their face.

If your child is having trouble feeding, he or she may be given fluids or milk through a feeding tube. This is a thin plastic tube that goes into your child’s mouth or nose and down into their stomach. Alternatively, your child may be given fluids intravenously (directly into a vein).

If your child’s nose is blocked and they have trouble breathing, nasal suction may be used. This involves a small plastic tube being inserted into their nostrils to clear out the mucus.

Leaving hospital

Most children who are admitted to hospital will need to stay there for a few days. Your child will be discharged from  hospital and can go home when they have enough oxygen in their blood without the need for medical assistance, and they are able to take and keep down most of their normal feeds.

Complications of bronchiolitis

If your child develops complications from bronchiolitis, it’s likely they’ll need hospital treatment.

Long-term effects of bronchiolitis

Bronchiolitis does not usually cause long-term breathing problems. However, it can cause damage to the cells in your child’s airways. This damage can last for three to four months in some children, causing persistent wheezing and coughing.

If you have any further queries or concerns please do not hesitate to speak the nurse or doctor caring for your child or phone one of the numbers on the front of this leaflet.

Your child’s NHS number

When your child attends hospital you will be asked for their NHS number and other information, such as your address. Please be patient with this procedure as it is to ensure our records are kept up to date and to protect your child’s safety.

If you do not know their NHS number, please don’t worry, he or she will still receive care.

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