Bronchiolitis

Bronchiolitis

Bronchiolitis is a chest condition that causes breathing problems in babies. It's catching so wash your hands before and after handling baby.

Key points to remember

  • bronchiolitis is a chest condition that causes breathing problems in babies
  • bronchiolitis is catching (can spread between children and adults) so wash your hands before and after handling baby
  • breast feeding, a smoke free environment and immunisations up to date give the best protection against bronchiolitis
  • keep baby warm and comfortable and offer small and frequent feeds
  • bronchiolitis is usually a mild illness that can be treated at home
  • some sicker babies need to be admitted to hospital
  • there is no specific medicine for uncomplicated bronchiolitis

See a doctor urgently if your child:

  • has difficulty breathing
  • is taking less than half of normal feeds
  • is getting worse

Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if your baby:

  • looks very pale
  • is very sleepy or floppy
  • has periods of irregular or stopping breathing
  • is blue in the tongue and lips

What is it?

  • bronchiolitis is a common illness caused by a respiratory infection
  • it affects the smallest airways (called bronchioles) throughout the lungs
  • it is usually a mild illness but some babies are sicker and need to be admitted to hospital

What causes it?

Bronchiolitis is usually caused by a viral infection. Many viruses can cause the illness. The most common are RSV (respiratory syncytial virus) or rhinovirus.

Is it catching?

Yes, bronchiolitis is very easy to catch - it's very contagious which means it can spread easily between children or from adults to children. 

It is most common in winter and spring.

What puts my child at risk of getting it?

  • bronchiolitis usually occurs in babies in their first year of life
  • it commonly occurs between 3 and 6 months of age
  • babies who were born prematurely are more at risk of severe bronchiolitis than full-term babies
  • babies who already have heart or lung disease are at high risk of severe bronchiolitis

What are the signs and symptoms?

Bronchiolitis can start as a cold, with a runny nose. Your baby may have a fever for 2 to 3 days and then begin to cough, breathe fast and have noisy breathing (wheeze). The second or third day of the chesty part of the illness is usually the worst.

Bronchiolitis can last for several days. Cough often continues for 10 to 14 days but it may last as long as a month.

When should I seek help?

When do I need to see a doctor?

You should see your family doctor or go to an after hours medical centre urgently if your baby:

  • is under 3 months old
  • is breathing fast, has noisy breathing and is having to use extra effort to breathe
  • looks pale and unwell
  • is taking less than half of their normal feeds
  • is vomiting
  • has not wet a nappy for 6 hours

You should also see a doctor if you are worried about your baby.

Even if you've already seen your doctor, if your baby's breathing difficulties get worse or you are worried, take your baby back for checking.

Even if you've already seen your doctor, if your baby's breathing difficulties get worse or you are worried, take your baby back for checking.

When should I dial 111?

Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if your child:

  • has blue lips and tongue
  • has severe difficulty breathing
  • is becoming less responsive
  • is very pale
  • is floppy
  • has periods of irregular or stopping breathing

What will my doctor do?

Your doctor will:

  • ask you about baby's symptoms
  • listen to your baby's breathing
  • check that your baby is drinking enough
  • may ask you to bring your baby back again in 24 hours as the symptoms may get worse over the first few days
  • may refer you to hospital if your baby needs to be given oxygen or fluids

In very young babies, less than 2 months old, it can be hard to tell the difference between bronchiolitis and pneumonia so your doctor may refer your baby to hospital.

How is it diagnosed?

Bronchiolitis is usually diagnosed from the description of symptoms and an examination.

What is the treatment?

Most babies get better by themselves

Most babies with bronchiolitis get better by themselves without any special medical treatment.

  • bronchiolitis is caused by a virus so antibiotics do not help or cure it
  • asthma puffers or inhalers are usually not effective in bronchiolitis
  • using blue reliever asthma puffers or inhalers in babies less than 6 months of age may make their breathing worse
  • in some babies nearer to 12 months of age, it may be hard to tell if the problem is bronchiolitis or asthma, so treatment with asthma puffers or inhalers may be trialled

You can look after your baby at home if they:

  • are feeding well
  • do not look sick
  • are not working too hard with their breathing

Babies with moderate to severe illness may need to go to hospital

Babies with moderate to severe illness may require supportive treatment in hospital. Bronchiolitis affects your baby's breathing and sometimes this makes it hard for them to get enough oxygen. Signs of not getting enough oxygen may include any of the following:

  • looking very pale
  • going blue in the tongue and lips
  • becoming very sleepy and not easy to rouse
  • working very hard at their breathing

If your child has any of these signs, you should seek urgent medical help. Babies with low oxygen levels will need to be given extra oxygen in hospital. This is usually given through nasal prongs (small soft plastic tubes) that fit into your child's nose or by a soft plastic mask that fits over their face.

If your baby is not drinking enough, they may need to be given fluid by an intravenous drip (into a vein) or by nasogastric feeding (feeding through a tube that is passed through the nose or mouth into the stomach).

How can I care for my child at home?

  • babies with bronchiolitis may not be able to feed for as long as usual - offer smaller amounts of breast milk or infant formula more frequently
  • keep your baby warm but not too hot
  • give your baby as much rest as possible
  • don’t smoke in the house or around your baby
  • keep your baby's nose clear. If it is blocked or crusty you can use saline nose drops (from a pharmacy)
  • keep your baby away from other children so as not to spread the disease
  • if your baby is miserable and upset, you can give paracetamol. (You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose)

How can I prevent my child getting bronchiolitis?

Babies who are breast fed and those who live in smoke-free environments are less likely to get bronchiolitis.

Breastfeeding

Breastfeeding your baby protects them from getting bronchiolitis by boosting their immune (infection fighting) system. Breastfeeding beyond 4 months of age offers the best protection.

Smoke-free environment

Make sure your child's environment is smoke-free. If you want to give up smoking:

  • call the Quitline on 0800 778 778 for free
  • check out the website Quitline
  • ask your health professional

A warm house

Keeping the house warm and well insulated will also decrease your baby's risk of developing bronchiolitis.

Stay away from people with coughs and colds

It is sensible to keep young babies away from people who have colds and coughs.

Clean hands

Make sure everyone in your family washes their hands regularly and thoroughly and dries them well, including (but not only) before preparing food and eating. This can reduce the spread of infection.

Will my child get asthma?

It is difficult to diagnose asthma with certainty until a child is over 1 year of age. Eight out of every 10 babies who start wheezing in the first 2 years of life do not go on to have asthma.

  1. Starship Children's Health clinicians. June 2010. Starship Children's Health clinical guideline: Bronchiolitis. Auckland: Starship Children's Health. https://www.starship.org.nz/for-health-professionals/starship-clinical-guidelines/b/bronchiolitis/ [Accessed 19/1/2017]
  2. Paediatric Society of New Zealand. 2005. Best practice evidence based guideline: Wheeze and chest infection in infants under 1 year. Paediatric Society of New Zealand. http://www.paediatrics.org.nz/files/guidelines/Wheezeendorsed.pdf [Accessed 19/1/2017]

This page last reviewed 10 March 2014.
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