Bronchiolitis is a common, seasonal viral respiratory tract infection in infancy accounting for the majority of hospital admissions in children less than 1 year of age. Supportive care is the mainstay of treatment and usually takes the form of ensuring adequate fluid intake and control of any difficulty breathing. Sometimes children with bronchiolitis will need additional oxygen to make sure that the oxygen levels in the blood are at an adequate level.
Why are babies affected by Bronchiolitis?
Bronchiolitis is usually caused by a virus, which in older children would cause nothing more than cold like symptoms. In very young infants the airways are smaller than in older children. If these airways become infected with a viral infection, this can result in inflammation with the production of secretions which interfere with the smooth flow of air in and out of the lungs. This results in the increased work of breathing that is seen in this disease.
Following an episode of bronchiolitis, a child may have a persistent residual cough for upto 3 weeks but there should not be any signs of difficulty in breathing with this cough.
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The vast majority of cases of bronchiolitis are relatively mild. Most babies will start with symptoms of a cold such as a runny nose and cough. Patients are usually seen by their GP and if they are feeding well and not demonstrating too much in the way of difficulty in breathing then they can be managed at home with the support of your GP. If the patient requires assessment by a paediatrician they will be referred to the hospital. It is important to note that in most cases of bronchiolitis the disease will be at its peak between the 3rd and 5th day from the onset of symptoms and patients are sometimes admitted for observation only.
If the child is unwell enough to require hospital admission then they are given supportive treatment to ensure adequate fluid intake and also given oxygen if they are felt to need it.
Sometimes an inhaler or a nebuliser is tried. Although there isn’t strong evidence that these help, it is often tried and may help in some cases.
The recent guidelines from NICE do not recommend using salbutamol (ventolin), ipratropium bromide (atrovent), hypertonic saline or antibiotics in bronchiolitis. You can access these recommendations using the following link: Bronchiolitis, NICE guidelines
Very few cases require anymore support but in some cases CPAP or vapotherm is used. This blows air and oxygen up the babies nose and into the lungs. This helps keep the airways open and can improve the oxygen levels in the blood stream.