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Bronchiolitis in children: What parents need to know
Bronchiolitis is a common lung infection in children. It mainly affects infants under the age of two, and usually occurs in the first year of life. Here, I’ll discuss the causes, symptoms, and treatment of bronchiolitis, including possible vaccine options.
What causes bronchiolitis in children?
Bronchiolitis is caused by a viral infection, usually the respiratory syncytial virus (RSV). Children are most vulnerable to RSV in winter months, due to the colder temperatures and spending more time indoors. The virus spreads quickly from one person to another through coughs and sneezes.
Other viruses that can cause bronchiolitis include adenovirus and influenza. The following factors may put your child at greater risk of getting the condition:
- being born too early (prematurity)
- being born with a heart condition or having a lung condition
- exposure to tobacco smoke
If your child gets bronchiolitis, the lining of their small airways become inflamed. This can cause the lining of the airways to swell and produce mucus or fluid, making it hard for them to breathe normally.
What are the symptoms of bronchiolitis?
Bronchiolitis in children usually begins with an initial period of feeling generally unwell, also known as the ‘coryzal prodrome’. This lasts between one and three days. During this period, your child may have a blocked or runny nose, mild fever, and difficulty breathing. After this period, here are some of the main symptoms to look out for.
- Persistent cough. Your child may develop a cough that gets worse over several days.
- Rapid breathing (tachypnoea). They may breathe faster or heavier.
- Wheezing. You may notice a wheezing or crackling sound when your child breathes. This happens when their airways are blocked with mucus. You may also notice behaviours such as grunting and nasal flaring. This is likely to be worse when their breathing is more difficult.
- Fever. Your child may have a temperature of 38°C or more. This normally happens in the first few days and goes away quite quickly.
- Poor feeding. You may notice a change in your child’s feeding habits. For example, they may show little interest in feeding.
- Irritability. The infection can cause children to become irritable or distressed.
Different viruses often cause similar symptoms, so it can be difficult to know if your child has bronchiolitis. Make sure to contact your child’s GP if they’re showing symptoms of a lung infection. A GP can help to diagnose the condition.
How can bronchiolitis be treated?
The severity of bronchiolitis can vary between children. The virus often resolves on its own after 7 to 10 days. Treatment is given to ease symptoms until the infection passes.
For milder cases, you can give your child paracetamol or ibuprofen to help bring down their fever, according to the instructions on the packet. You should also encourage your child to drink plenty of fluids to keep them hydrated.
You may need to take your child to hospital if their symptoms are severe. These include:
- difficulty breathing – breathing may be very fast, or may start and stop (apnoea)
- skin that’s slightly blue in colour
- your child is not feeding normally
Once hospitalised, your child may receive a supply of oxygen through a tube placed in their nose (nasal cannula) or via a box placed over their head. They may also be given support with feeding by giving milk or fluids through a feeding (nasogastric) tube. In some cases, fluids may be given through the vein (intravenously).
Is there a vaccine for bronchiolitis?
There are two vaccines approved to prevent lower respiratory infection in infants. These target infections caused by the RSV virus.
Palivizumab (Synagis®) is recommended for use in high-risk infants - for example, if they were born prematurely or with heart disease. The vaccine is given in monthly injections into the muscle during winter, when RSV is most common. When palivizumab is used by high-risk infants, the number of babies admitted to hospital with the condition can be reduced by half.
The nirsevimab (Beyfortus®) vaccine was recently developed to protect infants against the RSV infection. It’s given as a single dose to last the full winter season. It’s not yet available in an immunisation programme, but this has been recommended for the future.
If you want to know more about the vaccines, speak to your child’s doctor. They can discuss the options with you and give advice based on your child’s risk of developing bronchiolitis.
We now offer GP appointments for children aged between 1 and 18. Find out more about our Under 18 GP Service, call us on 0330 822 3072.
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Sources Sources
- Bronchiolitis in children: diagnosis and management. NICE: National Institute for Health and Care Excellence. Nice.org.uk, updated August 2021
- Bronchiolitis: Summary. BMJ Best Practice. bmj.bestpractice.com, updated October 2021
- Guidance: Respiratory syncytial virus (RSV): symptoms, transmission, prevention, treatment. Gov.uk, updated September 2021
- EN Erickson., RT Bhakta. & MD Mendez. Paediatric Bronchiolitis. StatPearls Publishing, January 2024
- Bronchiolitis: History and Exam. BMJ Best Practice. bmj.bestpractice.com, updated October 2021
- Cough - acute with chest signs in children. CKS. Cks.nice.org.uk, updated December 2023
- Respiratory Syncytial Virus infection. BMJ Best Practice. bestpractice.bmj.com, accessed 19 February 2024
- Faust SN., Cathie K., & Drysdale SD. Et al. The Impact of Nirsevimab on an RSV Season in All Infants: Data From The HARMONIE Study. Open Forum Infectious Diseases, Volume 10, Issue Supplement_2, https://doi.org/10.1093/ofid/ofad500.005. Oxford Academic. Academic.oup.com, November 2023
- Respiratory syncytial virus (RSV) immunisation programme for infants and older adults: JCVI full statement, 11 September 2023. Gov.uk, published September 2023
- What is the treatment for bronchiolitis? Asthma + Lung UK. Asthmaandlung.org.uk, reviewed November 2021
- Bronchiolitis. Patient. Patient.info, updated August 2023
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