Paediatrics - Bronchiolitis

What is bronchiolitis?

Bronchiolitis is an illness where the smallest air passages in the lungs get inflamed (irritated and swollen).

This swelling results in a narrowing of these air passages, making it more difficult to breathe.

It is usually caused by an infection due to a virus commonly known as respiratory syncytial virus (RSV), which is spread by tiny droplets of liquid from the coughs and sneezes of someone who is infected.

It is most common in the winter months and tends to affect babies and children up to 2 years of age. Most cases are mild and clear up in 2-3 weeks without the need for treatment although some children have severe symptoms and require hospital treatment.

Babies with heart and lung disease, premature babies, and babies under 6 weeks of age are more at risk.

What are the symptoms?

Early symptoms are similar to those of a common cold:

• Runny eyes and nose
• Cough
• Fever

Further symptoms may develop over the next few days including:

• Wheezing
• Shortness of breath
• Pauses in breathing in young babies
• Poor feeding
• Vomiting after feeding
• Fewer wet nappies

Symptoms are usually at their worst between day 3 and day 5, the cough may last as long as 3 weeks.

How can I help my child?

• Offer smaller, more frequent feeds and/or their usual drinks. You should continue breastfeeding and keep a record of your baby's fluid intake
• Completely avoid cigarette smoke
• Make sure the room is not too dry or hot, and your child is not lying completely flat
• You can give paracetamol (in the recommended dose) for fever or discomfort

Is there any treatment?

There is no specific treatment for the virus. Treatment for relief of your child’s symptoms will depend on the severity of symptoms. Your local pharmacy, GP practice or Children’s Community Nursing Team can support you with this. With rest, your child should recover in his or her own time. Antibiotics do not help a viral infection.

When should I ask for more help?

If your child has any of the following you need to see a doctor or nurse (for example, at your GP practice or walk-in centre):

• They are feeding much less than usual
• They are having fewer wet nappies than usual
• Vomiting more than usual
• A temperature above 39 degrees Celsius
• A problem with their heart or lungs, a disability, or was born prematurely
• He or she seems to be worse, or you are worried

If your child has any of the following symptoms you need urgent help, call 999 or go to accident and emergency straightaway:

• Making an ‘effort’ noise every time they breathe out (often called grunting)
• The skin around or inside their lips or under their tongue turns blue (cyanosis)
• Flaring their nostrils
• Their chest may ‘suck in; between their ribs
• Struggling to breathe
• Pauses in breathing for more than 10 seconds (apnoea) or an irregular pattern of breathing
• Signs of exhaustion, your child is not responding to you as they normally would, is excessively sleepy, irritable, floppy or hard to wake up

What will happen in hospital?

A doctor and/or nurse will examine your child and ask about their breathing and feeding. Your child’s breathing frequency and oxygen levels will be measured. If your child needs oxygen or help with feeding they will need to stay in hospital.

If your child needs oxygen it will be given through a mask or small prongs in their nose and he or she may be given a nebuliser (a medicine given in the form of vapour through a mask). A small number of children need extra help with their breathing.

If your child needs help with their feeding they may get milk through a fine tube passed through the nose into the stomach, or they may need fluid through a drip.

Your child may have a small amount of mucus taken from their nose to test for viruses and some children may need blood tests and x-rays.

It is very important to control the spread of infection in hospital and your child will be cared for in his/her own room, or in a ward with other children who have bronchiolitis. You will be able to stay with your child in hospital but will be asked to wash your hands carefully when caring for your son or daughter.

When your child is feeding and is able to breathe more easily in air without needing oxygen the doctors and nurses will discuss your child going home. Most children get better within about 2 weeks, although a cough may linger for several more weeks.

Preventing bronchiolitis

This can be difficult. However, some simple steps may help:

• Keep newborn babies away from people suffering from colds and flu as far as practical
• Wash your hands and your child’s hands regularly
• Wash or wipe toys and surfaces regularly
• Avoid smoking

Contact details

Children's Unit at Royal Oldham Hospital is 0161 627 8866
Oldham Community Nursing Team is 0161 357 5115
Heywood, Middleton and Rochdale Community Nursing Team is 01706 676777

Helpful telephone numbers

NHS 111 – Emergency and urgent care service.

You may also use this space to record other telephone numbers you may find useful.

GP -
Health visitor --
Community Children's Nursing Team -
BARDOC/ Go to doc -

References

https://www.nhs.uk/conditions/bronchiolitis (2018)
Bronchiolitis in Children, Quality Standard QS122
Bronchiolitis Information Leaflet, Stockport NHS Foundation Trust, 2019
Bronchiolitis, Patient Information, Wrightington, Wigan and Leigh NHS Foundation Trust, 2019

Special thanks to the children and families attending the Children’s Unit at The Royal Oldham Hospital for their help in reviewing and updating this leaflet.