Bronchiolitis

Key points about bronchiolitis

• bronchiolitis causes breathing problems in pēpi
• bronchiolitis is very easy to catch
• breastfeeding and a smoke-free environment give the best protection against bronchiolitis
• bronchiolitis is usually a mild illness but some sicker pēpi need to go to hospital
• there is no medicine that makes bronchiolitis better
• if your baby with bronchiolitis is under 3 months old, you should always see a doctor

Breastfeeding and a smoke-free environment give the best protection against bronchiolitis.

What is bronchiolitis?

Bronchiolitis is a common illness usually caused by a virus. The most common are RSV (respiratory syncytial virus) and rhinovirus but there are many viruses that can cause bronchiolitis.

See the KidsHealth page on RSV.

Bronchiolitis affects the smallest airways (called bronchioles) throughout the lungs.

Can you catch bronchiolitis?

Yes, bronchiolitis is very easy to catch - it can spread easily.

It is most common in winter and spring.

Who gets bronchiolitis?

• bronchiolitis usually affects pēpi under the age of one
• pēpi who are around people who smoke are more likely to get bronchiolitis
• severe bronchiolitis is more common in premature pēpi or pēpi with heart or lung problems

A paediatrician may recommend a medicine to prevent serious illness caused by RSV in high-risk babies. (RSV is a common casue of bronchiolitis).

Read about RSV passive immunisation for high risk babies.

What are the signs and symptoms of bronchiolitis?

Bronchiolitis often starts as a cold, with a runny nose.

Pēpi with bronchiolitis:

• may have a fever
• start to cough
• breathe fast
• put a lot of extra effort into breathing
• 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. The cough often lasts for 10 to 14 days but it may last as long as a month.

Watch this video of a baby with noisy breathing (wheezing) (Damian Roland's YouTube channel)

When should I seek help for bronchiolitis?

Check the signs that show your child is struggling to breathe

When do I need to see a doctor?

Even if you've already seen your doctor, if your baby's breathing gets worse or you are worried, take your baby back to the 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 had a wet nappy for more than 6 hours

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 to the doctor.

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 baby:

• has blue lips and tongue
• has severe difficulty breathing
• is becoming very sleepy and not easy to wake up
• is very pale
• is floppy
• has breathing that is not regular, or pauses in breathing

What is the treatment for bronchiolitis?

Most pēpi get better by themselves

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

• antibiotics do not help babies with bronchiolitis because it's caused by a virus
• asthma puffers or inhalers don't help babies with bronchiolitis
• using reliever asthma puffers or inhalers in babies less than 12 months of age may make their breathing worse
• steroid medicine by mouth or inhaler does not help babies with bronchiolitis
• in babies over 12 months of age, it may be hard to tell if the problem is bronchiolitis or viral wheeze - your doctor may try asthma puffers or inhalers

Babies with more serious illness may need to go to hospital

Babies with more serious bronchiolitis may need to go to hospital. Sometimes babies need help with their breathing. This might include extra oxygen through small soft plastic tubes that fit into your baby's nose.

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

Can I care for my baby with bronchiolitis at home?

If your baby has bronchiolitis, keep them at home, away from other pēpi and tamariki, to stop bronchiolitis spreading.

Pēpi who can stay at home

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

Suggestions for looking after pēpi

Pēpi with bronchiolitis may not be able to feed for as long as usual. Offer smaller feeds more often.

Give pēpi as much rest as possible.

Don't smoke in the house or around pēpi.

Keep your baby's nose clear. If it is blocked or crusty you can use saline nose drops (from a pharmacy).

Keep pēpi away from other pēpi and tamariki, and from childcare centres, to stop bronchiolitis spreading.

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.

Remember to sleep baby on their back in their own bed and don't prop them up with pillows or blankets.

How can I prevent pēpi getting bronchiolitis?

Breastfeeding

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

Smoke-free environment

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

• call the free Quitline Me Mutu on 0800 778 778 or text 4006
• 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.

Read about keeping your home warm and dry

Stay away from people with coughs and colds

It is sensible to keep young pēpi 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.

If my baby has had bronchiolitis, will they get asthma?

Bronchiolitis is not the same as asthma. Most pēpi with bronchiolitis do not go on to have asthma. Asthma is more likely in tamariki if there are other family members with asthma.