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Bronchiolitis – Symptoms and Treatment

Bronchiolitis (“bron-key-oh-lite-us”) is common in infants and sometimes toddlers. The smallest breathing tubes in the lungs, the “bronchioles,” become swollen and filled with mucous and cells. A virus called RSV causes most cases of bronchiolitis.

The disease occurs from late fall through early spring in North America. Babies usually have cold symptoms and then develop a low fever (around 100.5°F or 38°C), with a wet cough. Eventually most babies begin wheezing (making a whistling sound with breathing). Bronchiolitis lasts for 7 to 21 days, though the worst is usually over in the first week.

What is the biggest concern?

Our biggest concern in bronchiolitis is breathing. Babies have to breathe faster and harder, which takes more energy and uses more oxygen. In very severe cases, oxygen levels may drop too low, or carbon dioxide levels may get too high. The other big concern is feeding. Babies often drink less milk or formula because they are breathing so fast, and because they don’t feel well. Some babies become dehydrated. Any baby with congenital heart defects or with other lung diseases is at much higher risk. Most doctors will either hospitalize those babies, or be very certain to stay in close touch with parents during an episode of bronchiolitis. Finally, because of the risk of “apnea” (stopping breathing), most doctors strongly consider hospitalizing any infant less than 2 months old at least for the first few days of bronchiolitis, even if it seems mild.

Bronchiolitis treatment

The frustrating thing is that there is no really good medicine to treat bronchiolitis. Fortunately, most babies get better on their own, with just a little extra care. Since your baby’s bronchiolitis is mild enough to be treated at home, your doctor knows that you do not have to be concerned about oxygen right now. The main job is to keep the baby hydrated, and to reduce the amount of work the baby needs to do for breathing.

Use a soft-tipped nasal suction bulb to gently clean out your baby’s nose, especially before feedings. Only continue to use the suction if you are actually getting mucous out of the baby’s nose – a lot of the noise the baby makes is coming from the lungs, where you cannot get at it.
Offer your baby frequent feedings, to keep up with liquids. Babies with bronchiolitis often get tired quickly, so the feedings may need to be short but frequent. Breast milk or formula are still the best things to feed the younger baby. There is no need to worry about milk “curdling” in the stomach or causing more mucous.

You can use acetaminophen (Tylenol®) to control fever in children over 3 months. Check with your doctor about using it in younger babies. Fever is not dangerous, but it can make the baby uncomfortable. If your baby seems comfortable there is no reason to give any medication just for fever.

Many doctors prescribe medications for babies with bronchiolitis, especially if there are other family members who have asthma. These medications include inhalers or nebulizers that make a fine mist of medicine for the baby to breathe, and steroid medications. The most common inhaled medication is called “albuterol” or “salbutamol.” Side effects include a fast heart rate and fussiness or jitters. These side effects are usually minor and safe. Some doctors give a steroid drug called dexamethasone, either by mouth or by a shot. This medication is safe to use and causes almost no side effects, but it may not offer any actual benefit. Children with family histories of asthma may be more likely to benefit from these medications than children without.

Do not use any over-the-counter cough or cold medications to treat bronchiolitis unless your doctor specifically recommends them. Many of these medicines cause rapid heart rates and fussiness, and they do not help the illness. They may even make it worse. Humidifiers probably do not help in bronchiolitis, but if you use one be sure to change the water every day to avoid fungal infections.

Dangerous Bronchiolitis Symptoms

One of the hardest things about bronchiolitis is that it lasts for so long. Babies may have a cough and some wheezing for up to three weeks after the first symptom. It is hard to watch your baby cough so much and work so hard to breathe. Most parents feel frustrated and helpless when their baby has bronchiolitis.

The good news is that most babies get through the illness without needing any special care at all. Here are a few things to look out for:

  • Any color change in the skin, especially around the mouth and nose. Babies who are not getting enough oxygen may look dusky or bluish in this area.
  • Fewer wet diapers, sunken appearance of the eyes, a sunken fontanel (soft spot), or pale, cool hands and feet can all mean dehydration.
  • Extreme fussiness, irritability, or sleepiness. All babies with bronchiolitis are fussy, but they can usually be consoled with holding or rocking. If your baby remains fussy or irritable, or if the baby has trouble waking up for feeding, call your doctor.
  • Fever above about 101°F or 38°C can mean a more serious infection or pneumonia.

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

Other points of concern

Other infections: many babies with bronchiolitis also develop ear infections, conjunctivitis (pink eye), and occasionally pneumonia. Usually these babies have higher fevers than usual, or obvious signs such as pus or irritation of the eyes.

Chapped or raw skin: babies often develop sore skin just underneath their nostrils because of all the mucous that comes out. This is not dangerous, but of course it is uncomfortable for the baby. Avoid frequently wiping the area with tissues – even though it cleans up the skin, it is very irritating. Some parents apply a tiny smear of Vaseline or Chap Stick to the area to keep it from getting worse.

Eczema: some babies, especially those from families with asthma, develop dry, red skin on their cheeks and other areas. Usually you can treat this with an unscented moisturizing cream or lotion such as Vaseline Intensive Care or Jergens. If that doesn’t help, ask your doctor if a low-dose steroid cream would be useful. Avoid using drying soaps that are intended for adults.

Other Conditions that Might Be Present with Bronchiolitis

Almost every baby gets bronchiolitis sometime in their first two years of life. On rare occasions, a baby with a cough and wheezing has some other condition. The most common of these is asthma – in fact, many doctors will not diagnose a child as having asthma until they are older than two years, just to be sure they are not confusing it with bronchiolitis. If the condition lasts longer than three weeks, check with your doctor.

Pneumonia is a bacterial lung infection that needs to be treated with antibiotics. Babies with bronchiolitis sometimes develop pneumonia as well. If your baby develops a high fever (over about 102°F/38.5°), becomes lethargic (too sleepy), or does not show signs of improvement after the first 3-5 days, check with your doctor.

Pertussis, or “whooping cough” can sometimes look like bronchiolitis, at least at first. Babies younger than 6 months have not had their whole first series of vaccines, and so are still at risk for pertussis. Babies with pertussis have a more serious cough than babies with bronchiolitis, and may have long spells of coughing without a break. At the end of one of these spells, babies may vomit. In many cases of pertussis, one of the parents is also sick with the same infection. Pertussis usually happens in outbreaks in which many people are ill. Your doctor will know if there is an outbreak in your area, and will be sure to test for pertussis if necessary.