Bronchiolitis
Bronchiolitis is a viral infection of the lower breathing passages. It is a very common illness in infants and young children less than 2 years of age. Bronchiolitis occurs most often between November and April. It affects the entire breathing passageways, including the bronchioles, which are the smallest air passages in the lungs. Infection causes inflammation, which leads to partial or complete blockage of air passages.
What causes bronchiolitis?
Several different viruses that cause colds and flu-like illness can cause bronchiolitis. Respiratory Syncytial virus (RSV) is the most frequent cause of bronchiolitis. Young children catch these viruses from close contact with older children, family members, or others who are sick. The virus is spread when a sick person coughs or sneezes near another person’s face. The virus can also be spread by hands that touch contaminated objects and then touch their eyes or nose. The illness begins about 3-7 days later.
How will you know if my child has bronchiolitis?
Bronchiolitis is often diagnosed by information from parents and examining the child. Symptoms are classic in how they start and progress. X-rays and labs may be ordered, but often are not needed.
What symptoms will my child have if infected with bronchiolitis?
Bronchiolitis usually begins as a cold. Often, symptoms include
- Fever.
- Runny nose or nasal stuffiness.
- Mild cough.
- Less appetite.
- Mild problems breathing.
- As the virus spreads to the small airways of the lungs (1-3 days later), a whistling sound called wheezing may be heard when the child breathes out.
Children may have
- Rapid breathing (60-80 times per minutes).
- Mild to severe breathing problems breathing.
- Constant coughing.
- Problems eating.
- Babies who were born early or who are less than 2 months old may stop breathing for short periods of times at the start of the illness. This is known as apnea.
In healthy infants and children, bronchiolitis will usually go away on its own. Bronchiolitis is most often mild. The child often gets better after 3-4 days. Sometimes, the infection is more serious and the child needs to be hospitalized.
How will my child be cared for in the hospital?
Because the virus that causes bronchiolitis can be spread to others, your child will be put into an isolation room. A sign will be posted on the door to remind everyone of things to do to prevent the spread of infection.
Hand washing: Everyone going into and out of your child’s room must wash their hands. Staff must wash their hands before and after touching your child or any object in the room. Hand washing is the best way to prevent the spread of infection.
Gowns, gloves, and mask: These items are required for all persons who go into your child’s room. They prevent contact with infected items and secretions. Items should be left in the room when no longer needed.
Treatment in most cases involves treating symptoms related to the infection. We also make sure your child receives enough oxygen and fluids.
Feeding: Your child will be provided with plenty of fluids. Most babies are offered formula or breast milk. If your child is having trouble eating due to breathing problems, feedings may be decreased or stopped for a short time. If feedings are decreased or stopped briefly, fluids may be given thru a tube in the nose (nasogastric or NG tube) or through a small tube that is put into a vein (an IV).
Suctioning the nose: When babies have bronchiolitis, their noses often get plugged. This can make it hard to breathe while eating. It helps to suction the nose before feeding. It also helps to suction before breathing treatments and any time the child is having more trouble breathing. It also helps to suction before naps or bedtime.
If the mucus is very thick, it helps to give a few saline drops into the nose before suctioning. While in the hospital, it will be important to learn how to use a bulb syringe to suction the nose before you go home.
You can buy saline nose drops in most drug stores. If you choose, you can make the drops at home by adding ¼ teaspoon salt to 8 ounces (1 cup) of warm (not hot) water. Stir to dissolve the salt. Fresh saline drops should be made daily.
To use a bulb syringe
- Place the infant on his/her back.
- Use a clean eye dropper or clean cotton ball to place 2-4 drops of saline solution in each nostril.
- Let the drops stay in the nose for one minute.
- Squeeze and hold the bulb syringe to remove the air.
- Gently insert the tip of the bulb syringe into one nostril.
- Release the bulb. Suction will draw mucus out of the nostril into the bulb.
- Squeeze the mucus out of the bulb into a tissue.
- Repeat the suction process several times in each nostril until most of the mucus is removed.
- Wash the dropper and bulb syringe in warm, soapy water. Rinse well and squeeze to remove any water.
- The bulb syringe can be used 2-3 times per day as needed to remove mucus. This is best done before feedings. The saline and suction process can cause vomiting after feedings.
Oxygen: Your child’s doctor, nurse, and Respiratory Therapist (RT) will check to see how your child is breathing. This will help to decide if your child needs oxygen, or if oxygen being used can be decreased or stopped. Your nurse and RT will teach you how to look for signs of breathing problems.
A machine called a pulse oximeter may be used to help the breathing checks. Your child does not need to be connected to this machine all of the time. We can check how hard your child is working to breath by watching him or her.
Laboratory and other tests: Bronchiolitis most often does not require tests. There may be times when a blood test or chest x-ray is ordered. If these tests are needed, their purpose will be explained to you.
Medicines: Bronchiolitis often goes away by itself. It is not always helpful to give medicines in most cases. If medicines are used, they may include:
- Albuterol is a medicine to help make breathing easier if we think the breathing airway muscles are having some spasm.
- An antibiotic is used if your child has an infection such as an ear infection or pneumonia.
- Tylenol or ibuprophen is used if your child is uncomfortable or has a fever.
When can my child be discharged from the hospital?
The normal hospital stay is 3-5 days. Your child may go home when
- Your child is improving.
- Your child is breathing more easily than on admission.
- Oxygen saturations are greater than or equal to 94% on room air while awake.
- Your child is eating well enough to avoid dehydration.
- Any needed medicines can be given at home.
- When your provider is comfortable that your child is doing well.
When you are comfortable caring for your child. This includes how to use the bulb syringe, how to recognize breathing problems and how to know your child is getting enough fluids.
What should I expect after discharge from the hospital?
It is normal for your child to have symptoms for up to a month. Wheezing should get better within a week or so. The stuffy nose and cough may last for another 1-2 weeks. Sleeping and eating routines may not return for up to a week.
When should I call my doctor or nurse after we are home?
- Your child is very sleepy, weak or looks very ill.
- Your child has a fever (temperature greater than 100.4° F or 38°C), especially if your child is younger than 90 days old.
- Your child is having problems feeding.
- Your child is having fewer wet diapers than usual, the lips and mouth are dry, there are no tears with crying, the eyes appear sunken and dark, or the soft spot on top of your infant’s head is sunken.
- You have any questions or concerns.
Seek immediate medical attention if your child develops worsening bronchiolitis. These symptoms include:
- Breathing that is not improving.
- Pale or blue-tinged skin (cyanosis).
- Severe coughing episodes.
- Severe sucking in of the skin around the ribs or base of the throat (retractions).
- If your child stops breathing.
Parents should not try to drive their child to the hospital if the child is severely agitated, blue, struggling to breathe, stops breathing, or is excessively drowsy (lethargic). Emergency Medical Services should be called by dialing 911.
Reminders
- Be sure no one smokes in the house. Smoke can be very harmful for babies, especially when they have bronchiolitis.
- Wash your hands often, mainly before and after handling your child.
- Do not give decongestant nose drops, antihistamines, or cold medicines to your child unless told to do so by your doctor.
- Never give aspirin unless told to do so by your doctor.
- Avoid contact with people who have infection. You want to prevent re-infecting your child.
- Unfortunately, there is no vaccine to prevent against the most common causes of bronchiolitis. The flu vaccine is recommended for all children ages 6 months through 18 years, and for household contacts of children ages birth thru 59 months.
- Keep your child home from school or daycare until he or she is better.
Related Health Facts for You topics
Isolation Precautions for Pediatric Patients (#6415)
Isolation Precautions for Pediatric Patients (Spanish version, #7187)
Respiratory Syncytial Virus (#4319)
The Common Cold and your Child (#5072)
The Common Cold and your Child (Spanish version, #5868)
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 12/07/2011
Copyright © 12/07/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7301
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