Bronchiolitis is a common illness of infants and young children. It occurs during winter and early spring and affects the entire respiratory tract, including the bronchioles. The bronchioles are the smallest air passages of the lungs.
Bronchiolitis usually begins as a cold, often with symptoms of fever, runny nose or nasal stuffiness, and poor appetite or difficulty with sucking in infants. After two to four days, the virus spreads to the bronchioles, causing irritation and narrowing of these air passages. This results in a whistling sound (wheeze) when breathing out.
Bronchiolitis is usually mild, and the child gets better after three or four days. However, sometimes the infection is more serious and admission to a hospital is required.
Causes of Bronchiolitis
Several different viruses that cause colds and flu-like illnesses can cause bronchiolitis. Respiratory syncytial virus (RSV) is the most frequent cause, followed by parainfluenza viruses.
Young children catch these viruses during close contact with older children, family members and others that are infected, but often have only mild illness. The virus is spread directly to mucous membranes when an infected person sneezes or coughs into another's face. It can be spread indirectly by hands that touch contaminated toys or tabletops and then touch the eyes or nose. Illness begins about three to seven days later.
Hospitalization for Bronchiolitis
Because the virus causing bronchiolitis can be spread to others, your child will be put into an isolation room. An isolation sign will be posted on the door to remind others of precautions, including the following.
- The patient room. The door to the room must remain closed.
- Hand washing. Everyone going in and out of the room must wash his/her hands. Hands must also be washed after providing direct care to the child; whenever hands are soiled by secretions or excretions; and after touching toys, medical equipment and furniture. Hand washing is the best way to prevent the spread of infection.
- Gloves, gowns and masks. Healthcare workers who provide care to multiple patients are required to wear a mask to enter the room, and they put on gloves and gowns during procedures to prevent direct contact of skin and clothing with respiratory secretions and contaminated surfaces.
- Play activities and visitors. Since isolated patients must stay in their bed area, toys and play activities will be provided in your child's room. For the protection of all children and to minimize the spread of the virus, visitors will be limited. Please speak with your child’s nurse about visitors during your child’s admission.
Feeding your baby
Most babies can feed as normal. Your baby will get plenty of liquids while in the hospital. Liquids are one of the most important things needed by a baby with bronchiolitis.
Sometimes while in the hospital, feedings may be decreased or stopped for a short time. This is done if feeding makes your child breathe harder. Feedings may also be decreased or stopped if your baby starts vomiting. If feedings are decreased or stopped for a short time, liquids may be given through a small needle that is put into a vein (IV).
Suctioning the nose
When babies have bronchiolitis, the nose often gets plugged. This can make it hard to breathe while eating. Often the nose of an infant with bronchiolitis will be suctioned before being fed. Sometimes it is hard to suction mucus out of the nose because it is very thick. When this happens, a little bit of saltwater (saline nose drops) is dropped into the nose before suctioning. While in the hospital, you will want to learn how to use a bulb suction so that you will feel comfortable suctioning your baby's nose after you go home.
Every few hours, or more often, your child's nurse or respiratory therapist will check to see how easily your baby is breathing. This assessment will help decide: 1) if extra oxygen is needed, or 2) if the baby is ready to gradually come off the extra oxygen.
A machine called an oximeter is used with these assessments. It is painless and attaches with what looks like a bandage that fits on your child’s finger or toe. The nurse or therapist will teach you what to look for so you can tell if your child is having trouble breathing.
Laboratory and other tests
Bronchiolitis does not usually require testing, but there are some individual exceptions. These tests include some blood tests and a chest X-ray. If any of these are needed, their purpose will be explained to you.
Bronchiolitis usually goes away by itself and is not usually helped by giving a lot of medicines, but there are some exceptions. A few medicines may be tried to see if they make your baby feel better. These medicines include:
- A non-aspirin fever medicine may be used if your baby is very uncomfortable or has a fever (Remember, never give aspirin to a baby unless instructed by a doctor.)
- Medicines that your baby can breathe into his/her lungs are sometimes tried and, in some cases, may work in a baby with bronchiolitis
Discharge from Hospital
Very few babies with bronchiolitis stay in the hospital more than two to three days. They usually go home when:
- Breathing is slower and easier
- They are eating well
- Any medicines or oxygen, if still needed, can be given at home
- There is someone in the home who can use a nasal bulb suction
- Your baby's doctor is comfortable with and agrees to all of the discharge plans
- A follow-up appointment with the doctor has been arranged
- And, most importantly, you are comfortable that your baby is ready for discharge
After Discharge from Hospital
- It is normal for your child to have symptoms for a few days after discharge. (Check with your child care provider to find out when your child can return. Your family may find it needs to take time off work to provide extra care for your baby.)
- Wheezing usually gets better in two to five days.
- Stuffy nose and cough may last another one to two weeks.
- Sleeping and eating routines may not return to normal for four to seven days.
- Be sure no one smokes in the house. Smoke is very bad for babies and especially bad for babies with bronchiolitis.
- For the next several weeks, be sure to wash hands frequently especially after handling your infant.
- Use saltwater nose drops and suction your baby's nose if stuffy and if plugged up before feedings or putting your baby down to sleep. You can buy saltwater nose drops at any drug store, or you can make saltwater nose drops at home.
- Don't give decongestant nose drops or any antihistamines or other cold medicines unless told to do so by the doctor.
- For more information, talk with your child's doctor or nurse. You can also find very good books on children's illnesses in bookstores or libraries.