Common Illnesses: Bronchiolitis

by Katie Porterfield
October 04, 2012

What is bronchiolitis?
Bronchiolitis is a respiratory infection that causes swelling in the small breathing tubes (bronchioles) of the lungs. Not to be confused with bronchitis, which affects the larger, more central airways and typically plagues adults, bronchiolitis usually affects children under the age of 2 and is most common in infants 3–6 months of age. Symptoms of bronchiolitis (the most severe being difficulty breathing) can last up to 14 days and usually resolve without medical treatment. However, bronchiolitis in sick or premature infants or children with other chronic health problems can be serious enough to require hospitalization. Repeated episodes of bronchiolitis have been associated with the development of asthma, although the link between the two illnesses is unclear.

How do children get bronchiolitis?
Bronchiolitis occurs when a virus enters the respiratory system, makes its way into the bronchioles, and causes these small breathing tubes to swell. Infants can develop bronchiolitis after coming into contact with an adult or older child infected with the cold or flu virus. Though several viruses can lead to bronchiolitis, respiratory syncytial virus (RSV) is the most common cause. Since children with bronchiolitis can be a source of infection, they should avoid contact with others until their symptoms subside.

What are the symptoms of bronchiolitis?
Like many respiratory illnesses, early symptoms of bronchiolitis resemble those of the common cold—runny nose, mild cough, and fever—but progress to rapid and labored breathing. Signs that your child is having trouble breathing include:

• Flaring (widening) of the nostrils
• Grunting or wheezing
• Difficulty sucking and swallowing
• Bluish fingertips and lips

How is bronchiolitis treated?
Unlike bacterial infections, viral infections don’t respond to antibiotics. Aside from rest and liquids, the American Academy of Pediatrics (AAP) suggests using saline nose drops and a nasal aspirator to clear mucus from your baby’s nose to help her breathe easier. Acetaminophen or ibuprofen can be used to relieve fever (your child’s health care provider can recommend the right dose). Parents are cautioned not to give their children aspirin due to the risk of Reye’s syndrome—a serious and sometimes fatal disease.

For more severe cases of bronchiolitis, your child’s health care provider may prescribe medication such as adrenaline (epinephrine) to open your child’s breathing tubes. Some children need to be hospitalized and given humidified oxygen to ease breathing and intravenous fluids to prevent or treat dehydration. In rare cases, babies may be placed on a respirator (breathing machine) until symptoms subside. Some health care providers give children oral steroids (dexamethasone) to reduce swelling and ease breathing. Whether steroids are effective is unclear. However, a systematic review in the British Medical Journal found that a combination of adrenaline and steroids reduced hospital admission rates among children seen in the emergency room, but not the length of stay in children already hospitalized.

How can bronchiolitis be prevented?
The best way to keep your family virus-free is to adopt healthy habits: frequent handwashing; keeping your child away from individuals with a cold, fever, or runny nose; and not sharing cups or utensils. Since RSV is the leading cause of bronchiolitis, parents should take a few minutes to review practices that reduce the risk of RSV.

When should I call a doctor?
The American Academy of Pediatrics (AAP) recommends that parents contact their child’s pediatrician if their child has difficulty breathing (as demonstrated by the signs detailed above) or shows signs of dehydration such as breastfeeding (or drinking) less, crying without tears, and urinating less.

Children with a weakened immune system are at greatest risk for severe bronchiolitis. Parents should call their child’s health care provider right away if their child shows signs of bronchiolitis and has any of the following:

• Cystic fibrosis
• Congenital heart disease
• Immune deficiency disease
• Organ or bone marrow transplant
• Cancer requiring chemotherapy

Katie Porterfield is a freelance writer and former magazine editor in Nashville, Tennessee. She is mom to twin boys.