Bronchiolitis and Lower Respiratory Infections in Children

Bronchiolitis is an infection of the lower respiratory tract that usually affects infants and children younger than two. Bronchiolitis develops when a virus moves from the nose and throat into the lungs, leading to swelling in the smaller airways or bronchioles of the lung. This causes obstruction of air in the smaller airways.

Bronchiolitis is not the same as bronchitis, which affects the larger tubes that lead into your lungs. Bronchiolitis is more serious because it is an infection of smaller tubes deeper in the lungs.

The most common cause of bronchiolitis is a virus, most frequently the respiratory syncytial virus (RSV). However, many other viruses have been involved, including:

• Parainfluenza virus
• Adenovirus
• Influenza
• Human metapneumovirus

It is rarely caused by bacteria, usually mycoplasma pneumoniae.

Initially, the virus causes an infection in the upper respiratory tract, and then spreads downward into the lower tract. The virus causes inflammation and even death of the cells inside the respiratory tract. This leads to obstruction of airflow in and out of the child's lungs.

View this video with a transcript

• Bronchiolitis usually occurs in the winter and early spring.
• The most common age group affected by bronchiolitis is 3 to 6 months of age, but occurs in children up to 24 months.
• The following risk factors increase the likelihood that a child will develop bronchiolitis:
  • Having older children in the home
  • Day care attendance
  • An infant that is not breastfed
  • Exposure to smoke

Your child will have a lot of mucus in the nose and lungs. The following are the most common symptoms of bronchiolitis. However, each child may experience symptoms differently. Symptoms may include:

• Common cold symptoms, including:
  • Runny nose
  • Congestion
  • Fever, a sign of the body fighting the infection
  • Harsh cough that often worsens as the condition progresses because of the swelling of the breathing tubes 
• Changes in breathing patterns (the child may breathe fast or hard; you may hear wheezing, or a high-pitched sound)
• Decreased appetite (infants may not eat well)
• Fussiness
• Vomiting, especially after coughing

The symptoms of bronchiolitis may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

Bronchiolitis is usually diagnosed solely on the history and physical examination of the child. Many tests may be ordered to rule out other diseases, such as pneumonia or asthma. In addition, the following tests may be ordered to help confirm the diagnosis:

• Chest X-rays. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a 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.
• Nasopharyngeal swab. This is done for respiratory syncytial virus (RSV) and other respiratory viruses. These tests yield rapid results for presence of RSV or other viruses. This is needed for babies who require admission so that their care team can practice the appropriate infection precautions.

Bronchiolitis usually lasts several weeks. Typically symptoms gets worse for the first 3 to 5 days as the infection moves from the nose into the lungs. It may be a gradual 2 weeks or longer until the infection is gone and symptoms may go up and down

Most cases of bronchiolitis are mild and can be treated at home. Antibiotics are ineffective in the treatment of bronchiolitis because it is caused by a virus, not a bacterial infection.

The treatment for bronchiolitis is typically supportive care and observation based on their age, overall health and medical history, and severity of their illness. Most babies will get better on their own and won’t need to see the doctor or go to the emergency room.

When should you call the doctor for your child’s respiratory infection?

You should call your pediatrician if:

• Your child is extremely cranky or tired
• Your child has trouble breathing that isn’t improving with suctioning
• Your child is not drinking enough

You should also call your doctor if you just feel something isn’t right – trust your gut.

Typically, your pediatrician will recommend common at-home treatments such as:

• Encouraging fluid intake
• Frequent suctioning (with a bulb syringe) of your child's nose and mouth (to help get rid of thick secretions)
• Giving acetaminophen (Children's or Infants' Tylenol) for fever if your child is uncomfortable. Do not give a child aspirin, because this medication has been linked to Reye syndrome, a disease of the brain and liver.

Always consult your child's doctor for advice before giving any over-the-counter (OTC) cold and cough medicines to children younger than 6 years of age.

Some infants, if they are having severe breathing problems, may be treated in the hospital. While in the hospital, treatment may include:

• Intravenous (IV) fluids if your child is unable to drink well
• Oxygen therapy and a ventilator may be needed
• Frequent suctioning of your child's nose and mouth (to help get rid of thick secretions)

The best way to prevent bronchiolitis is consistant hand-washing. An injection may be given to help decrease the chances of getting respiratory syncytial virus (RSV). The medication is called palivizumab (Synagis) and recommended only for high-risk infants, including premature infants (age at birth less than 35 weeks) and infants with chronic lung disease during RSV season. Specific recommendations regarding who should receive this immunoglobin are made by the American Academy of Pediatrics and can be discussed with your child's doctor.

Remember, respiratory infections and bronchiolitis in kids are very common. Most of the time, sick babies will need lots of extra tender loving care, but these infections will clear on their own after a few weeks.