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Overview
Bronchiolitis is an infection that’s usually caused by respiratory syncytial virus (RSV). It can be caused by other viruses as well. Viruses can inflame the small airways (bronchioles) that carry oxygen to the lungs. Symptoms are often similar to a mild cold, but can progress to trouble with breathing.
RSV is very contagious. By age 2, most children have had at least one RSV infection. It spreads by touching or kissing an infected person, or touching a surface where the virus is present.
Antibiotics aren’t used to treat bronchiolitis because they don’t work against viruses. Most children usually need only home treatment and supportive care. If your child has severe symptoms, they may need to be cared for in a hospital.
Causes
Bronchiolitis is most often caused by respiratory syncytial virus (RSV).
When a person with RSV sneezes or coughs, they release tiny droplets of virus into the air. These droplets can land on nearby surfaces and on your clothing and hands. RSV can survive on surfaces (including used tissues) for up to 5 hours and on your hands for about 30 minutes.
Children are more likely to catch RSV when they’re together in large groups, such as a day care center or classroom.
Sometimes bronchiolitis is caused by other viruses, including:
- Flu (influenza)
- Rhinovirus
- Human metapneumovirus
Prevention
You can lower your child’s risk for RSV infection by taking these steps:
- Wash your hands and your child's hands often. Always wash before touching your baby, and ask others do the same (including care providers).
- Don’t share drinking glasses or utensils with others, and don’t allow your child to share their utensils with others (at day care or school).
- Wear a mask when you’re near your baby if you have a cold, fever, or flu. Ask anyone who may have an infection to avoid contact with your baby.
- Try to keep children with cold-like symptoms away from your baby. If your baby was premature, or has a weak immune system or heart condition, avoid large crowds. This is especially important during cold and flu season and RSV outbreaks.
- Don’t smoke around your baby or allow others to do so. Smoking raises their risk of catching RSV.
- Give your baby vitamin D drops if you're breastfeeding. Studies show that babies who don’t get enough vitamin D may be more likely to get RSV infections.
There’s no vaccine to prevent RSV infection. We’ll sometimes give the antibody palivizumab (Synagis) to very premature babies and immunosuppressed children. This helps protect their lungs from severe RSV infection.
Symptoms
RSV infection symptoms can be mild to severe, depending on your child's age and general health. Symptoms usually appear within 4 to 6 days after contact with the virus. Mild symptoms include:
- Cough
- Fever
- Runny or stuffy nose
- Lack of appetite
Bronchiolitis can develop after a child has a few days of these cold-like symptoms. Bronchiolitis can look like:
- Wheezing (often lasting as long as a week)
- Rapid breathing
- Persistent cough (may last 2 weeks or longer)
- Difficulty feeding (babies) or eating
- More severe symptoms
Severe symptoms can develop in very young babies and babies born prematurely, as well as in children with:
- Ongoing health conditions, such as asthma
- Weakened immune systems
- Heart or lung disease
These children may need care in a hospital.
Have your child seen right away if they have:
- Difficulty eating and drinking because they’re exhausted from struggling to breathe.
- Trouble swallowing.
- Difficulty breathing, in babies under age 1. Signs of respiratory distress include nostrils flaring, or pulling in the ribs, when they inhale.
- High fever.
Possible Complications
RSV infection and bronchiolitis can lead to complications in young children, such as:
- Ear infection
- Croup
- Pneumonia
- Lung failure
If your child has moderate to severe symptoms, their risk for developing asthma can be higher. If your child already has asthma, bronchiolitis can make it worse.
Diagnosis
Bronchiolitis caused by RSV is diagnosed by doing a physical exam and checking your child's symptoms.
We may swab your child’s nose for a mucus sample. We usually get test results within 1 to 2 days.
Treatment
Mild cases usually need only home treatment. For some children with moderate symptoms, we may prescribe an inhaler or a breathing treatment.
We don’t use antibiotics to treat RSV or the other viruses that cause bronchiolitis.
Home treatment
Mild RSV is similar to a common cold. Children usually get better in about a week. You can help relieve your child’s symptoms and support their recovery with these steps.
- Give your child plenty of fluids to avoid dehydration. If they become listless or urinates infrequently, please call us. Dehydration can be serious in babies and young children.
- Keep the air moist with a cold-mist home humidifier. Keep it free of mold by cleaning it daily with diluted bleach and hot water. Don’t use a steam or hot-water vaporizer.
- Give acetaminophen (Tylenol) for fever. Ibuprofen (Advil, Motrin) can be given if your child is older than 6 months. Follow package instructions and measure the medicine carefully. Don’t give aspirin to a child with a fever as it may lead to a life-threatening illness called Reye's syndrome. Don’t give over-the-counter cough medicines and decongestants to children under 4 years.
- Gently suction your baby's nose to clear mucus and help them breathe. You can use a few drops of saline (sterile) solution to loosen thick mucus before using a bulb syringe. Suction one nostril at a time. Do this before feedings and when they’re very congested. In older children, a nasal aspirator can be used.
- Raise the head of your child's bed. For an older child, you can place 1 or 2 thick books under the mattress at the head of the bed.
Hospital treatment
If your child’s symptoms get worse, they may need to be hospitalized, especially if your child is younger than 1 year of age.
In the hospital, your child may receive:
- Supplemental oxygen and humidified air via a nasal canula to help with breathing. From time to time we stop giving oxygen and check your child’s blood oxygen level. We slowly reduce the oxygen and stop it when oxygen levels are normal.
- Intravenous (IV) fluids or a nasal feeding tube to prevent dehydration.
- Breathing treatments.
- Medications to help ease symptoms.
When to Call Us
Call us at the Appointment and Advice Call Center at 1-866-454-8855 to schedule an appointment if your child has cold symptoms along with rapid breathing, or has trouble breathing normally.
Call to let us know if your baby has cold symptoms and suddenly becomes very irritable or refuses to eat or drink.
Call us immediately if your child has:
- Wheezing, grunting, or difficulty breathing (flaring nostrils, ribs, or chest pulling in).
- Fever of 100.4°F or higher in a baby younger than 4 months old.
- Signs of dehydration, such as no tears while crying or fewer wet diapers.
- Worsening symptoms after they were getting better.
Call 911 or get emergency medical care for your child if they:
- Struggle to breathe or stop breathing.
- Had mild breathing difficulty that gets worse.
- Have bluish colored lips or fingertips (cyanosis).
- Have severe coughing spells.
If you’re unsure of what to do and are worried about your child, please call us for urgent evaluation.