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Bronchiolitis is a common type of chest infection so it’s best to know about it. Here we talk about its symptoms, treatment and how to prevent it.

What is bronchiolitis and what causes it?

Bronchiolitis affects one in three babies under one year old (NHS GOSH, 2016). It’s almost always caused by a viral infection (NHS, 2018). Bronchiolitis causes inflammation of the small airways in the lungs that are called the bronchioles. This makes it more difficult to breathe (More Than a Cold, 2016).

What are the symptoms of bronchiolitis?

Children will usually have a dry and persistent raspy cough, a blocked or runny nose, rapid or noisy breathing and a mildly raised temperature. The illness usually starts with a mild runny nose or cough, develops over three to five days and then gradually gets better, usually lasting about 10 to 14 days (NHS GOSH,2016). They might find it difficult to feed.

These symptoms can make it difficult to tell if a baby is suffering from bronchiolitis, a cold or Covid 19, so the NHS recommends contacting 111 if you are worried about your child and unsure what to do (RCPCH, 2021; NHSa, 2021).

Doctors will usually take a medical history of what symptoms are present and when they started. They will also be able to hear a wheeze or crackles that can tell them it’s bronchiolitis (NICE, 2015).

If it is a telephone consultation then you will be advised what to look out for and what action to take if symptoms worsen (RCPCH, 2021).

What is the treatment for bronchiolitis?

Most cases of bronchiolitis are mild and clear up in two to three weeks without needing any treatment. Some children have severe symptoms and need hospital treatment (NICE, 2015).

What can I do to help a child with bronchiolitis?

  • Give paracetamol or ibuprofen made for babies. As bronchiolitis is caused by a virus, antibiotics won’t help.
  • Keep your child upright as much as possible – this will make breathing and feeding easier.
  • Try vapour rubs or humidifiers. You can also get saline (salt water) drops to put inside the nostrils and help keep the nose clear.
  • Try giving babies smaller bottle- or breastfeeds more frequently. Some additional water may also stop them becoming dehydrated.

How common is bronchiolitis in babies?

The main virus that causes bronchiolitis in the UK is most active between October and March, and is the same virus as the common cold (NHS GOSH, 2016). Around one in three babies will develop clinical bronchiolitis in the first year of their lives. They’re most likely to get it between three and six months old and 2% to 3% of all babies will need to go to hospital for it.  

Why do some babies need a hospital stay?

Children are more likely to require hospital or intensive care treatment for bronchiolitis if they:

  • are younger than three months old
  • were born with a heart defect
  • have a lung disease
  • were born prematurely
  • have a weakened immune system – either because of a problem they were born with (congenital) or because of medicine they are taking for another problem. (NHS GOSH, 2016)

Contact your GP if you're worried about your child, or if they develop any of the following symptoms:

  • Laboured breathing.
  • Poor feeding, where the baby is taking significantly less milk than usual, or shows symptoms of dehydration.
  • No wet nappies for 12 hours or more.
  • Breathing rate of 50 to 60 breaths per minute.
  • High temperature.
  • Seeming very tired or irritable (NHS, 2018; BLF, 2016)

If your baby shows any of the following symptoms, call for medical advice immediately or go to the nearest hospital emergency department. 

  • If your child is struggling to breathe, pauses or is grunting during breathing.
  • Is very agitated, confused or difficult to wake.
  • Is under 3 months old with a temperature of 38°C or above.
  • Becomes pale, mottled or feels abnormally cold to the touch.
  • Has a blue or pale tinge to their skin, lips, tongue or nails, call for medical advice immediately (NHS GOSH, 2016, NHS, 2021b).

It's particularly important to get medical advice if your baby is younger than 12 weeks old, or they have an underlying health condition. An underlying health condition might be something like a heart or lung condition that’s been present from birth.

Bronchitis or bronchiolitis: What’s the difference?

Bronchitis is a condition that affects adults and children. Most cases of bronchitis develop when an infection irritates and inflames the bronchi – the airways that deliver air into the lungs. This makes them produce more mucus than usual, which your body tries to shift by coughing (NHS GOSH, 2016).

Any considerations around ethnicity? 

A recent American study suggested the risks of hospitalisation due to bronchiolitis in the first two years of life is higher for Black and Hispanic infants compared to White and Asian infants (Inagaki et al, 2021). It has also been shown that different ethnic groups demonstrate respiratory impairment in different ways (Fragoso et al, 2014)

This may be due to the disparities that exist in the quality of care received by minority groups as well as to genetic, environmental, cultural and social factors (Burroughs et al 2002)

How can bronchiolitis be prevented?

The virus that causes bronchiolitis is very common and easily spread, so it's impossible to completely prevent it. A few tips and tricks could help reduce the likelihood of your child developing or spreading the infection:

  • Cover their nose and mouth when they cough or sneeze.
  • Throw tissues away as soon as they've used them.
  • Wash your hands and theirs frequently, particularly after touching their nose or mouth, or after feeding.
  • Wash or wipe toys and surfaces regularly.
  • Keep children at home until their symptoms have improved.
  • Keep newborn babies away from people with colds or flu, particularly during the first two months of life or if they were born prematurely.
  • Do not smoke or let others smoke around your baby.
  • Ask your GP about short-term immunisations that can be given to babies at high risk during bronchiolitis season. (NHS, 2018; BLF, 2016)

This page was last reviewed in March 2021.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

 

BLF (British Lung Foundation). (2016) Bronchiolitis. Available from:
https://www.blf.org.uk/support-for-you/bronchiolitis [Accessed 27 March 2021

Burroughs VJ, Maxey RW, Levy RA. (2002) Racial and ethnic differences in response to medicines: towards individualized pharmaceutical treatment. Journal of the National Medical Association, 94 (10 Suppl) pp1-26, Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594139/  [Accessed 23 March 2021]

Fragoso C, McAvay G, Gill T, Conacato J, Quanjer P, Ness P. (2014). Ethnic Differences in Respiratory Impairment. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925402/ [Accessed 27/March 2021]. 

Inagaki K, Blackshear C, Burns P, Hobbs C, (2021) Racial/Ethnic Disparities in the Incidences of Bronchiolitis Requiring Hospitalization Available from: https://academic.oup.com/cid/article-abstract/72/4/668/5722407 [Accessed 27 March 2021]. 

NHS. (2021a) Coronavirus in children. Available From: https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/coronavirus-in-children/ [Accessed 27 March 2021]. 

NHS. (2021b) Bronchiolitis. Available from: https://what0-18.nhs.uk/professionals/childrens-nurses/safety-netting-documents-parents/bronchiolitis [Accessed 27 March 2021]. 

NHS. (2018) Bronchiolitis. Available from: https://www.nhs.uk/conditions/bronchiolitis/ [Accessed 27 March 2021]

NHS GOSH (Great Ormond Street Hospital for Children). (2016) Bronchiolitis. Available from: http://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/bronchiolitis [Accessed 27 March 2021]

NICE. (2015) Bronchiolitis in children: diagnosis and management. Available from: https://www.nice.org.uk/guidance/ng9 [Accessed 27 March 2021]

More Than a Cold. (2016) More than a cold – Bronchiolitis in babies. Available from: https://www.morethanacold.co.uk/ [Accessed 27 March 2021]

RCPCH (Royal College of Paediatrics and Child Health). (2021) National guidance for the management of children with bronchiolitis and lower respiratory tract infections during COVID-19. Available from: https://www.rcpch.ac.uk/resources/national-guidance-management-children-bronchiolitis-during-covid-19#summary-flow-chart [Accessed 27 March 2021]. 

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