Bronchiolitis

Bronchiolitis

Bronchiolitis

Bronchiolitis (brong-kee-oh-LYE-tiss) is an infection of the respiratory tract. It happens when tiny airways called bronchioles (BRONG-kee-olz) get infected with a virus. They swell and fill with mucus, which can make breathing hard.

Bronchiolitis is more common during the winter months. Most cases can be managed at home.

What Are the Signs & Symptoms of Bronchiolitis?

The first symptoms of bronchiolitis are usually the same as those of a cold:

  • stuffy nose and congestion
  • runny nose
  • cough
  • fever

Usually, symptoms get better on their own. But sometimes the cough might get worse and a child may start wheezing or have noisy breathing.

Who Gets Bronchiolitis?

Bronchiolitis:

  • most often affects infants and young children because their small airways can easily get blocked
  • is most common during the first 2 years of life, especially in very young babies
  • is more common in premature babies, children with lung or heart problems, and kids with weak immune systems

Kids who go to childcare, have siblings in school, or are around secondhand smoke have a higher risk for bronchiolitis. Older kids and adults can get bronchiolitis, but the infection usually is mild.

What Causes Bronchiolitis?

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. Sometimes, the common cold and the flu also can cause it.

How Is Bronchiolitis Diagnosed?

When they suspect bronchiolitis, doctors listen to the child's chest and check oxygen levels with a pulse oximeter.

Usually, no tests are needed. The doctor may use a swab to get a sample of mucus from the nose for testing. This helps with identifying the type of virus causing the problem.

A chest X-ray might be done if the child's oxygen level is low or the doctor suspects pneumonia.

How Is Bronchiolitis Treated?

Most cases of bronchiolitis are mild and don't need specific medical treatment. Antibiotics can't help because viruses cause bronchiolitis. Antibiotics work only against bacterial infections.

Treatment focuses on easing symptoms. Kids with bronchiolitis need time to recover and plenty of fluids. Make sure your child gets enough to drink by offering fluids in small amounts often.

You can use a cool-mist vaporizer or humidifier in your child's room to help loosen mucus in the airway and relieve cough and congestion. Clean it as recommended to prevent buildup of mold or bacteria. Avoid hot-water and steam humidifiers, which can cause scalding.

To clear nasal congestion, try a nasal aspirator and saline (saltwater) nose drops. This can be especially helpful before feeding and sleeping.

Talk to the doctor before giving your child any medicine. For babies who are old enough, you may be able to give medicine to help with fever and make your child more comfortable. Follow the package directions about how much to give and how often. But cough and cold medicines should not be given to any babies or young kids. When in doubt, call your doctor.

Babies who have trouble breathing, are dehydrated, or seem very tired should be checked by a doctor. Those with serious symptoms may need care in a hospital to get fluids and, sometimes, help with breathing.

Is Bronchiolitis Contagious?

Viruses that cause bronchiolitis spread easily through the air when someone coughs or sneezes. Germs can stay on hands, toys, doorknobs, tissues, and other surfaces. People can be contagious for several days or even weeks.

How Long Does Bronchiolitis Last?

Bronchiolitis usually lasts about 1–2 weeks. Sometimes it can take several weeks for symptoms to go away.

When Should I Call the Doctor?

Bronchiolitis often is a mild illness. But sometimes it can cause severe symptoms. When it does, kids need treatment in a hospital.

Get medical care right away if a baby:

  • has fast, shallow breathing and you can see the belly moving up and down quickly
  • has labored breathing, when the areas below the ribs, between the ribs, and/or in the neck sink in as a child breathes in
  • has flaring nostrils
  • is very fussy and can't be comforted
  • is very tired or won't wake up for feedings
  • has a poor appetite or isn't feeding well
  • fewer wet diapers or peeing less than usual
  • has a blue color to the lips, tongue, or nails

You know your child best. Call your doctor right away if something doesn't seem right.

Can Bronchiolitis Be Prevented?

Washing hands well and often is the best way to prevent the spread of viruses that can cause bronchiolitis and other infections.

Also:

  • Keep infants away from anyone who has a cold or cough.
  • Keep kids away from secondhand smoke.
  • Keep toys and surfaces clean.

Reviewed by: Anoop K. Palta, MD

Date reviewed: January 2020

Source: https://kidshealth.org/en/parents/bronchiolitis.html

Differential Diagnosis

  • Gastroesophageal reflux disease (GERD)

Bronchiolitis is a self-limited infectious process. It is commonly managed with supportive care, hydration, fever control, and oxygenation.

When the disorder is recognized and treated, the prognosis is excellent. The majority of children recover without any adverse effects.

Past studies suggest that infants with severe bronchiolitis will develop wheezing in the future, but this has not been borne out by longitudinal studies.

About 3% of infants will require admission to the hospital, and the mortality rates vary from 0.5% to 7%. The large variation in mortality is because of different risk factors and lack of availability of intensive care units in certain countries.

Complications include:

  • Nosocomial infection in infants who are admitted
  • Barotrauma is ventilation is required
  • Arrhythmias induced by beta-agonists
  • Nutritional deficiencies if there is persistent vomiting

If an infant has been diagnosed with severe bronchiolitis, then a pediatrician and in infectious disease expert should be consulted regarding their management.

Pearls and Other Issues

  • Bronchiolitis is a common lung infection in young individuals
  • The viral infection involves the lower respiratory tract and can present with signs of mild to moderate respiratory distress.
  • Bronchiolitis is a mild, self-limited infection in the majority of children but may sometimes progress to respiratory failure in infants.
  • The management of bronchiolitis is supportive hydration and oxygen. No specific medications treat the infection.

Bronchiolitis is a common presentation to clinicians and adds significantly to the cost of healthcare.

To lower morbidity, the diagnosis and management of bronchiolitis are best done with an interprofessional team that includes the emergency department physician, nurse practitioner, pediatrician, primary caregiver, and infectious disease consultant. The diagnosis is clinical, and in most cases, the treatment is supportive.

While most children benefit from hydration, some may require antipyretics and a cool-mist humidifier. About 1% to 3% of children with bronchiolitis may require admission for more aggressive respiratory support.

The key is the education of the caregiver. Clinicians, including the pharmacist and nurse practitioner, should educate the caregiver with regards to:

  • The positioning of the infant
  • Temperature control in the home
  • Importance of oral hydration
  • Avoiding exposure to tobacco smoke and other irritants
  • Handwashing
  • Compliance with medications

When the infant is ill, the caregiver should be educated about when to bring him or her to the hospital/clinician and not seek alternative care remedies. Follow up of the infant is necessary to ensure that improvement is taking place. Only through open communication with the interprofessional team can the outcomes be improved and complications reduced.

Outcomes

When the disorder is recognized and treated, the prognosis is excellent. The majority of children recover without any adverse effects. Past studies suggest that infants with severe bronchiolitis will develop wheezing in the future, but this has not been borne out by longitudinal studies.[11][12]

To access free multiple choice questions on this topic, click here.

1.Polack FP, Stein RT, Custovic A. The Syndrome We Agreed to Call Bronchiolitis. J. Infect. Dis. 2019 Jun 19;220(2):184-186. [PMC free article: PMC6581899] [PubMed: 30783666]2.Jo YM, Kim J, Chang J. Vaccine containing G protein fragment and recombinant baculovirus expressing M2 protein induces protective immunity to respiratory syncytial virus. Clin Exp Vaccine Res. 2019 Jan;8(1):43-53. [PMC free article: PMC6369125] [PubMed: 30775350]3.Oz-Alcalay L, Ashkenazi S, Glatman-Freedman A, Weisman-Demri S, Lowenthal A, Livni G. Hospitalization for Respiratory Syncytial Virus Bronchiolitis in the Palivizumab Prophylaxis Era: Need for Reconsideration of Preventive Timing and Eligibility. Isr. Med. Assoc. J. 2019 Feb;21(2):110-115. [PubMed: 30772962]4.Soudani N, Caniza MA, Assaf-Casals A, Shaker R, Lteif M, Su Y, Tang L, Akel I, Muwakkit S, Chmaisse A, Homsi M, Dbaibo G, Zaraket H. Prevalence and characteristics of acute respiratory virus infections in pediatric cancer patients. J. Med. Virol. 2019 Jul;91(7):1191-1201. [PubMed: 30763464]5.Supino MC, Buonsenso D, Scateni S, Scialanga B, Mesturino MA, Bock C, Chiaretti A, Giglioni E, Reale A, Musolino AM. Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. Eur. J. Pediatr. 2019 May;178(5):623-632. [PubMed: 30747262]6.Lodeserto FJ, Lettich TM, Rezaie SR. High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications. Cureus. 2018 Nov 26;10(11):e3639. [PMC free article: PMC6358040] [PubMed: 30740281]7.Stobbelaar K, Kool M, de Kruijf D, Van Hoorenbeeck K, Jorens P, De Dooy J, Verhulst S. Nebulised hypertonic saline in children with bronchiolitis admitted to the paediatric intensive care unit: A retrospective study. J Paediatr Child Health. 2019 Sep;55(9):1125-1132. [PubMed: 30645038]8.Kusak B, Grzesik E, Konarska-Gabryś K, Pacek Z, Piwowarczyk B, Lis G. Bronchiolitis in children – do we choose wisely? Dev Period Med. 2018;22(4):323-328. [PubMed: 30636229]9.Gold J, Hametz P, Sen AI, Maykowski P, Leone N, Lee DS, Gagliardo C, Hymes S, Biller R, Saiman L. Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines. Hosp Pediatr. 2019 Feb;9(2):87-91. [PubMed: 30610012]10.Picone S, Fabiano A, Roma D, Di Palma F, Paolillo P. Re-comparing of three different epidemic seasons of bronchiolitis: different prophylaxis approaches. Ital J Pediatr. 2018 Dec 12;44(1):148. [PMC free article: PMC6292081] [PubMed: 30541607]11.Clayton JA, McKee B, Slain KN, Rotta AT, Shein SL. Outcomes of Children With Bronchiolitis Treated With High-Flow Nasal Cannula or Noninvasive Positive Pressure Ventilation. Pediatr Crit Care Med. 2019 Feb;20(2):128-135. [PubMed: 30720646]12.Luo G, Stone BL, Nkoy FL, He S, Johnson MD. Predicting Appropriate Hospital Admission of Emergency Department Patients with Bronchiolitis: Secondary Analysis. JMIR Med Inform. 2019 Jan 22;7(1):e12591. [PMC free article: PMC6362392] [PubMed: 30668518]

Source: https://www.ncbi.nlm.nih.gov/books/NBK441959/

Acute bronchiolitis in infants, a review

Bronchiolitis

Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with this condition.

In this article we present a summary of the epidemiology, pathophysiology and diagnosis, and focus on guidelines for the treatment of bronchiolitis in infants. The cornerstones of the management of viral bronchiolitis are the administration of oxygen and appropriate fluid therapy, and overall a “minimal handling approach” is recommended.

Inhaled adrenaline is commonly used in some countries, but the evidences are sparse. Recently, inhalation with hypertonic saline has been suggested as an optional treatment. When medical treatment fails to stabilize the infants, non-invasive and invasive ventilation may be necessary to prevent and support respiratory failure.

It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.

Keywords: Bronchiolitis, Infant, Treatment

Bronchiolitis is an acute lower respiratory tract infection in early childhood caused by different viruses, with coughing, wheeze and poor nutrition as the major symptoms [1-3].

A substantial proportion of children will experience at least one episode with bronchiolitis, and as much as 2-3% of all children will be hospitalized with bronchiolitis during their first year of life [1-4].

Bronchiolitis is the most common reason for hospitalization of children in many countries, challenging both economy, area and staffing in paediatric departments. Respiratory syncytial virus (RSV) is the most common virus causing bronchiolitis, occurring in epidemics during winter months [1,2].

Some infants, particularly those with risk factors, will have a severe course of bronchiolitis. Bronchiolitis is the most common medical reason for admission of children to intensive care units (ICU), providing challenges regarding ventilation, fluid balance and general support [5]. This may be a particular challenge for ICUs without a specialised paediatric section.

The aim of this article is to review current knowledge of severe bronchiolitis in infancy, with emphasis on the management.

We performed a non-systematic search in PubMed up to January 2014, with the following words in different combinations; bronchiolitis, infants, children, severe, epidemiology, pathophysiology, guidelines, treatment, management, oxygen, hypertonic, saline, adrenaline, steroids, fluid, nutrition, continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), high flow nasal cannulae and ventilation. Included studies and papers were not systematically evaluated regarding design and quality. However, we have emphasised recent guidelines, Cochrane reviews and other expert reviews.

There is no uniform definition of bronchiolitis, and no definite age limitation.

In 2006, a subcommittee of the American Academy of Pediatrics (AAP) together with the European Respiratory Society (ERS) underlined that bronchiolitis is a clinical diagnosis, recognized as “a constellation of clinical symptoms and signs including a viral upper respiratory prodrome followed by increased respiratory effort and wheezing in children less than 2 years of age” [3]. In Europe, wheezing is regarded as a less important finding [2,6,7]. During recent years, several studies from Europe and the USA have included children only up to 12 months of age [2,8,9]. Children hospitalized for wheezing between 12 and 24 months of age may have a higher risk for having asthma, and with different pathophysiology and prognosis [1,2,6,10,11]. In this manuscript we will mainly focus on data from studies in infants with bronchiolitis younger than 12 months of age.

Approximately 20% of children develop bronchiolitis during their first year of life, and studies from the USA have found increasing rates of bronchiolitis (188/1000 infants in 1996/97 to 265/1000 in 2002/03) in this age group [6,12].

In a Norwegian study, the mean annual hospitalization incidence for RSV bronchiolitis was 21.

7 per 1000 for children below 12 months [13], and in a large study from England the admission rate for all infants with bronchiolitis below 12 months of age was 24.2 per 1000 [14].

Bronchiolitis is generally seasonal, appearing most frequently in epidemics during the winter months [15].

For RSV, the same seasonal pattern is observed throughout the world, with most cases occurring from October until May on the northern hemisphere [15,16].

Adults with chronic obstructive lung disease and other immunocompromised patients may have RSV infection throughout the year and represent a reservoir of the virus [17,18].

Bronchiolitis is a disease with high morbidity, but low mortality. Death from respiratory failure in bronchiolitis is rare and range for RSV bronchiolitis from 2.9 (UK) to 5.3 (USA) deaths per 100 000 children below 12 months [19,20].

Differences may be caused by diagnostic procedures as well by socioeconomic conditions. A study from the UK underlines that the mortality rate for bronchiolitis in children below 12 months is low and falling, from 21.5 to 1.

8 per 100 000 children (age 1 to 12 months) from 1979 to 2000, reflecting improvements in paediatric intensive care [21].

RSV is the most common virus involved in children with bronchiolitis. In most studies it accounts for 60–80% of the bronchiolitis cases in children below 12 months of age [1,11,22-24].

In children below 12 months of age, Rhinovirus (RV) is the second most common virus (14–30%), thereafter human bocavirus (14–15%), human metapneumovirus (3-12%), entero-, adeno-, corona and influenza viruses (1–8%).

Dual infections are reported in 20–30% of children, but does not seem to be associated with increased severity [6,11,22,25].

The infection starts in the upper respiratory tract, spreading to the lower airways within few days.

The inflammation in the bronchioles is characterized by a peribronchial infiltration of white blood cell types, mostly mononuclear cells, and oedema of the submucosa and adventitia [2,6].

Damage may occur by a direct viral injury to the respiratory airway epithelium, or indirectly by activating immune responses [6].

Oedema, mucus secretion, and damage of airway epithelium with necrosis may cause partial or total airflow obstruction, distal air trapping, atelectasis and a ventilation perfusion mismatch leading to hypoxemia and increased work of breathing [1,2]. Smooth-muscle constriction seems to play a minor role in the pathologic process of bronchiolitis [2].

Bronchiolitis often starts with rhinorrhoea and fever, thereafter gradually increasing with signs of a lower respiratory tract infection including tachypnoea, wheezing and cough. Very young children, particularly those with a history of prematurity, may appear with apnoea as their major symptom [2,6]. Feeding problems are common.

On clinical examination, the major finding in the youngest children may be fine inspiratory crackles on auscultation, whereas high-pitched expiratory wheeze may be prominent in older children [2]. By observation, the infants may have increased respiratory rate, chest movements, prolonged expiration, recessions, use of accessory muscles, cyanosis and decreased general condition.

No formal scoring system for the severity of bronchiolitis exists, but a suggestion for the grading into mild, moderate and severe bronchiolitis guidelines from New Zealand and Scotland is given in Table 1[7,26].

Assessment of the severity of bronchiolitis in infants half the normal < half the normal Respiratory rate < 2 months > 60/min >60/min >70/min > 2 months > 50/min Chest wall recessions Mild Moderate Severe Nasal flare or grunting Absent Absent Present Sp02 >92% 88-92%

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230018/

What Is Bronchiolitis?

Bronchiolitis

  • Symptoms
  • Causes
  • Prevention
  • Diagnosis
  • Treatment

Bronchiolitis is a common lung infection among infants. It can cause coughing, wheezing, and a hard time with breathing. While most cases can be treated at home, it’s also the leading reason infants are admitted to a hospital.

Adults can get it, too, but it’s very rare and usually related to other infections or injuries.

It happens when small breathing tubes in the lungs called bronchioles become infected. This causes the tubes to clog up with mucus so there’s not enough room for air to get in and the lungs.

It usually affects children younger than 2 years old in winter and early spring.

The first signs look a lot a cold. Your child may have the following symptoms:

  • Runny nose
  • Cough
  • Fever
  • Stuffy nose
  • Less appetite

The symptoms may get worse over the next few days, including faster breathing. If you see signs that your child is having trouble breathing, call her doctor at once or seek medical care if your call isn’t answered. Otherwise, here are some other things to watch for:

  • Wheezing (a high-pitched, whistling sound when exhaling)
  • Fast breathing (more than 60 breaths a minute)
  • Labored breathing and grunting
  • Trouble drinking, sucking, swallowing
  • Signs of dehydration such as dry mouth, crying without tears, not peeing as often
  • Vomiting
  • Sluggish or tired appearance
  • Constant coughing
  • Pause in breathing for more than 15 seconds (called apnea)

Call 911 and get emergency medical care if these things happen:

  • Your child has severe trouble breathing.
  • She seems confused or sluggish.
  • Her lips, fingertips, ears, tongue, the tip of her nose or the inside of her cheek have a blue tint.

Bronchiolitis is usually caused by a viral infection. Many different viruses can be the culprit, including the flu, but the most common in children is what’s called respiratory syncytial virus, or RSV.

Outbreaks of this virus happen every winter, and most children have had it by the time they turn 3. They may only get mild symptoms, but in severe cases it can cause bronchiolitis or pneumonia.

Bronchiolitis is contagious. Viral infections spread through droplets in the air, so you can contract it the same way you get infected with colds or flus.

While it’s hard to stop a viral infection, you can lower your child’s chance of getting it if you:

  • Stay away from others who are sick.
  • Practice good handwashing.
  • Disinfect surfaces, toys and objects that you and your kids often touch.
  • Avoid smoking in the home, because it raises risks of breathing issues.
  • Schedule a flu shot, which is recommended for everyone older than 6 months.

Children under age 2 who have risk factors for RSV (premature birth or certain types of heart disease or chronic lung disease) could get a palivizumab (Synagis) shot. This medicine protects the lungs from RSV infection.

When you see your doctor, he’ll ask about your child’s symptoms and medical history. He’ll ly give her a physical exam. He may use a stethoscope to listen to her breathing and count the breaths per minute.

Doctors rarely order X-rays or blood tests for bronchiolitis. But if your child’s symptoms are severe or it’s unclear what’s causing them, she may get these tests:

  • Chest X-ray: This is done to look for possible signs of pneumonia.
  • Blood tests: Blood is taken to check the white blood cell count (these are cells that fight infection).
  • Pulse oximetry: A sensor is taped to your child’s finger or toe to measure how much oxygen is in her blood.
  • Nasopharyngeal swab: Your doctor will insert a swab into her nose to get a sample of mucus that will be tested for viruses.

There is no cure. It usually takes about 2 or 3 weeks for the infection to go away. Antibiotics and cold medicines are not effective in treating it.

Most children with bronchiolitis can be treated at home. There, you should watch to see if your child’s symptoms get worse or she has breathing problems.

Your doctor may suggest these home treatments:

  • Give her plenty of liquids.
  • Use nose drops or sprays to help with a runny nose.
  • Use a bulb syringe, which is an at-home method to remove mucus from the nose.
  • Prop up her head with an extra pillow (but don’t do this if she’s under a year old).

About 3% of children with bronchiolitis need to go to a hospital. If your child does, the treatments may include:

  • Fluid and nutrition given through a tube into a vein (IV)
  • Oxygen therapy to help your child breathe
  • Suctioning of her nose and mouth to take out mucus

Typically, most kids feel better and can go home in about 2 to 5 days. If your child’s case is more severe, and she needs a machine to help her breathe, it could mean a longer stay — about 4 to 8 days.

SOURCES:

Mayo Clinic: “Bronchiolitis.”

Boston Children’s Hospital: “Bronchiolitis in Children.”

UpToDate: “Bronchiolitis in Adults,” “Bronchiolitis (and RSV) in infants and children (Beyond the Basics).”

Cleveland Clinic: “Bronchiolitis,” “Respiratory Syncytial Virus (RSV).”

American Academy of Pediatrics: “Bronchiolitis.”

CDC: “Protect Against Respiratory Syncytial Virus.”

© 2019 WebMD, LLC. All rights reserved.

Source: https://www.webmd.com/lung/what-is-bronchiolitis

Articles

Bronchiolitis
ABOUT CAUSES DIAGNOSIS TREATMENT

Bronchiolitis is an infection of the lungs. It’s when your child has swelling in the smaller airways (bronchioles) of the lung. This swelling blocks air in the smaller airways.

Bronchiolitis usually happens in the winter and early spring. It most often affects children younger than 2 years old.

The most common cause of bronchiolitis is a virus. At first, the virus causes an infection in the upper respiratory tract. This includes the nose, mouth, and throat. It then spreads downward into the windpipe (trachea) and lungs (lower respiratory tract). The virus causes inflammation and even death of the cells inside the respiratory tract. This blocks airflow in and the child’s lungs.

Bronchiolitis is most often caused by the respiratory syncytial virus (RSV). But these other viruses can also cause it:

  • Rhinovirus
  • Parainfluenza virus
  • Adenovirus
  • Influenza
  • Human metapneumovirus

In rare cases, bronchiolitis may be caused by bacteria.

All young children are at risk for bronchiolitis. The illness can spread easily through droplets in the air from coughing, sneezing, and talking. But some children have a higher chance of developing it. These are children who:

  • Were born too early (premature)
  • Have been exposed to tobacco smoke
  • Go to daycare
  • Have other serious health conditions
  • Have older children in the home
  • Are not breastfed

Bronchiolitis may at first be mistaken for a common cold. It starts out with many of the same symptoms. But your child may have a cough and other breathing problems that get worse over time. Below are the most common symptoms of bronchiolitis:

  • Runny nose
  • Congestion
  • Fever
  • Cough
  • Fast or hard breathing
  • Wheezing
  • Loss of appetite
  • Irritability
  • Vomiting

These symptoms often last about a week. They may look other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

Your child’s healthcare provider can diagnose bronchiolitis with a health history and physical exam of your child. In some cases, your child may need tests to rule out other diseases, such as pneumonia or asthma. These tests include:

  • Chest X-rays. This test makes images of internal tissues, bones, and organs.
  • Blood tests or blood gases. A blood test may help see if the infection is caused by a virus or bacteria.
  • Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To get this measurement, the healthcare provider puts a small sensor ( a bandage) on your child's finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
  • Swab of the nose and throat (nasopharyngeal swab). This test can quickly spot RSV and other viruses.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Most cases are mild and can be treated at home. There is no cure for the illness. So the goal of treatment is to ease symptoms. Antibiotics are not used unless your child has a bacterial infection.

Some babies with severe breathing problems are treated in the hospital. While they are in the hospital, treatment may include:

  • IV (intravenous) fluids if your child can't drink well
  • Extra oxygen and a breathing machine (ventilator) to help with breathing
  • Frequent suctioning of your child’s nose and mouth to help get rid of thick mucus
  • Breathing treatments, as ordered by your child’s healthcare provider

If your child is at home, the following treatment may be helpful:

  • Drinking lots of fluids
  • Suctioning your child’s nose and mouth with a bulb syringe to help get rid of thick mucus, especially before feedings
  • Raising your child’s head while sleeping. Don’t use pillows with babies.
  • Giving acetaminophen for fever, if directed
  • Use a cool-mist vaporizer in your child's room at night

Don’t give aspirin or medicine that contains aspirin to a child younger than age 19 unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder. It most often affects the brain and the liver.

Most children who have bronchiolitis will get well without any problems. But those born early or who have other health problems are more ly to have complications from the condition. These may include:

  • Pauses in breathing (apnea)
  • Breathing failure

You can help prevent the spread of bronchiolitis. Wash your hands or use an alcohol-based hand cleaner before and after touching your child. While your child has symptoms, keep him or her away from other children.

Your child may also need a palivizumab shot. During RSV season, these shots are recommended for high-risk babies. High-risk babies include those born early or those with lung, heart, or immune system diseases. Talk with your child’s healthcare provider to see if the shot is right for your child.

Call if your child:

  • Has trouble breathing
  • Turns blue in color, especially the lips and fingertips
  • Is breathing very fast

Call your child’s healthcare provider right away if your child’s symptoms get worse, or if he or she:

  • Can't keep liquids down
  • Is not eating or drinking

Key points about bronchiolitis in children

  • Bronchiolitis is an infection of the airways in the lungs.
  • It’s often caused by a virus, often the respiratory syncytial virus (RSV).
  • The first symptoms may look a common cold. But a child develops a cough, wheezing, and breathing problems.
  • Most cases are mild and can be treated at home.

    Children with severe breathing problems are often treated in the hospital.

  • Bronchiolitis can be prevented with proper handwashing. Your child may get a palivizumab shot if he or she is at high risk for an RSV infection.

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Source: https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/b/bronchiolitis-in-children.html

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