Bronchiolitis

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What is bronchiolitis?

Bronchiolitis is a viral infection of the lungs that affects infants and young children. Bronchiolitis begins as a cold with a runny nose and then moves down into the lungs and the small airways of the lung, known as the bronchioles. As these airways become inflamed, they swell and fill with mucus, making breathing difficult.

Although it's usually a mild illness, some children develop more severe bronchiolitis that requires admission to the hospital. Bronchiolitis is the most common reason for babies to be admitted to the hospital with more than 100,000 hospital admissions each year. It is most common in the winter and spring.

Some conditions increase the risk that a child will develop severe bronchiolitis. They include prematurity (born more than 2 weeks early), prior chronic heart or lung disease, a weakened immune system due to illness or medications, or muscle weakness.

What causes bronchiolitis?

Bronchiolitis is usually caused by a viral infection, most commonly respiratory syncytial virus (RSV). Other viruses associated with bronchiolitis include rhinovirus, influenza (flu) and human metapneumovirus, the same virus that causes the common cold in older children and adults.

The viruses that cause bronchiolitis are contagious. The germs can spread in tiny drops of fluid from an infected person's nose and mouth, which may get into the air with sneezes, coughs or laughs, and can end up on things the person has touched, such as tissues or toys. The incubation period (the time between infection and the beginning of symptoms) ranges from several days to a week, depending on the type of virus causing the bronchiolitis.

The best way to prevent the spread of viruses that can cause bronchiolitis is frequent hand washing. It may help to keep infants away from others who have colds or coughs. Flu shots are recommended for infants 6 months of age or older and for all family members and caregivers of infants.

For infants at high risk for severe bronchiolitis (who were premature or have chronic lung or heart disease), there is an injection called Synagis (palivizumab) that can decrease the baby’s chances of being admitted to the hospital with an RSV infection. The injection is given monthly during the winter months, and should be discussed with your medical provider if you think your infant may qualify.

Who gets bronchiolitis?

Bronchiolitis is common and typically occurs during the first 2 years of life, most commonly between 3 to 6 months of age. It most often affects infants and young children because their airways are smaller and can become blocked with mucus more easily than those of older kids or adults.

Infants with a history of prematurity, congenital heart or lung disease, a weakened immune system, or muscle weakness are at higher risk of severe bronchiolitis. Babies who are exposed to cigarette smoke are more likely to develop more severe bronchiolitis and be hospitalized compared with those from smoke-free homes. It is important for all children to avoid exposure to cigarette smoke.

Helpful resources:

Healthy Children provides parents with health information on a variety of health issues and is from the American Academy of Pediatrics.
Medline Plus provides easy-to-understand information based on the latest medical research with links to pictures, related topics and other trusted sources.

What are the signs and symptoms of bronchiolitis?

The first symptoms of bronchiolitis are usually the same as those of a common cold:

Stuffy/runny nose
Mild cough
Mild fever
Mild wheezing (high-pitched whistling noises when exhaling)

Sometimes more severe respiratory difficulties develop, marked by:

Fast, shallow breathing
A fast heartbeat
Retractions (drawing in of the neck and chest with each breath)
Faring of the nostrils
Irritability, with difficulty sleeping and signs of fatigue or lethargy
Poor feeding and dehydration
Apnea (pauses in breathing longer than 15 seconds)
Cyanosis (blue color of the lips, tongue and skin)

You should seek immediate medical attention if your child is showing signs of severe respiratory difficulties.

Symptoms of bronchiolitis typically last about 12 days, but can last as long as 2 to 3 weeks.

How do providers at Children’s Hospital Colorado diagnose bronchiolitis?

Bronchiolitis is usually diagnosed based on a patient’s history and a physical exam. Your healthcare provider will look for cough, wheezing, trouble breathing and other signs of illness. Children will frequently have their oxygen levels checked. Most children do not require other testing. In some cases, diagnostic testing may be used, including chest X-rays, blood work or viral testing.

How is bronchiolitis treated?

Fortunately, most cases of bronchiolitis are mild and do not require specific treatment. The best treatment for most kids is time to rest and recover and drinking plenty of fluids. Fluids should be offered in small amounts and at more frequent intervals than usual.

To clear nasal congestion, try a bulb syringe and saline (saltwater) nose drops. This can be especially helpful just before feeding and sleeping. A cool mist-vaporizer or humidifier can help loosen mucus and relieve cough and congestion.

Acetaminophen can be given to reduce fever and make the child more comfortable. Be sure to follow appropriate dosing and timing of medication based on your child’s weight. Over-the-counter cough and cold remedies are not approved for infants and young children and are not recommended.

Antibiotics are not useful because bronchiolitis is caused by a viral infection, and antibiotics are only effective against bacterial infections. Breathing treatments with medicines such as albuterol or epinephrine are helpful for certain children and may be prescribed by your doctor.

Infants who have trouble breathing, pauses in their breathing, a blue color to their skin, are dehydrated or are sleepier than usual should always be evaluated by a doctor. Those who are moderately or severely ill may need to be hospitalized, watched closely, and given fluids and humidified oxygen. In very severe cases, some babies are placed on respirators to help them breathe until they start to get better, but this is rare.

Why choose Children’s Hospital Colorado for your child’s bronchiolitis?

Children's Hospital Colorado Breathing Institute's mission is to provide comprehensive clinical care and consultation for children with common and complex breathing problems, including bronchiolitis.

As a regional care center, our Breathing Institute provides professional education and advancement of knowledge through research. Our doctors are responsible for discoveries in pulmonary medicine, including the first use of inhaled nitric oxide (iNO) to treat premature infants with respiratory failure.

We are nationally recognized for our expertise in asthma, cystic fibrosis, airway anomalies and disease, pulmonary hypertension, apnea and sleep-disordered breathing, primary ciliary dyskinesia and children's interstitial lung disease. Children's Colorado has the depth and breadth of experience to treat the broad spectrum of all breathing conditions in children.

The latest in diagnostic testing is available for both infants and older children, and an experienced staff of pediatric specialists including physicians, nurses, dietitians, social workers and respiratory therapists allows families to benefit from a team approach to treating breathing disorders. Our collaborative approach to lung care incorporates and facilitates family involvement.