What parents need to know about bronchiolitis

Bronchiolitis is a common viral infection of the lower respiratory tract that happens in most young children who are less than two years old. It predominantly occurs in the winter months between October to March. We spoke to one of our leading paediatricians Dr Pramod Nair all about the condition, including how to recognise if your child has it and whether there any long-term complications from the virus.

What causes bronchiolitis?

Bronchiolitis is commonly caused by a virus called respiratory syncytial virus (RSV) but can be caused by other viruses as well. Babies often present initially with cold-like symptoms followed by wheezing, breathing difficulty, mild fever, cough and feeding difficulties. It usually resolves spontaneously over five to seven days.
 

Is it a serious condition?

Usually, it is not a serious condition although it can be serious in the very young (less than one-month-old), premature babies, babies with chronic lung disease/ congenital heart defects or immunological problems. Between 2-3% of babies would need hospital admission, which is usually because they need support with breathing or feeding.
 

What are the signs of bronchiolitis?

The signs that could suggest that your child is seriously unwell are:
 

• Reduced feeding (less than 60% of normal fluid intake)
• Significant work in order to breathe (respiratory rate more than 70/min, chest indrawing, nasal flare)
• No urine output for 12 hours
• Lethargy
• Poor cry
• Blueness of lips and skin.
   

How did my child get it?

Bronchiolitis is community-acquired through air droplets or contact. It is difficult to prevent, however, standard hygiene practices such as handwashing are helpful.

Is it treatable?

There is no curative treatment for bronchiolitis and at home, this is managed with ensuring your child is able to keep in enough fluids and is comfortable. It resolves spontaneously but in some children, extra support with breathing or feeding is needed as an interim measure.
 

What is the treatment?

In the hospital, we use oxygen (to keep oxygen saturations above 92%), feeding tubes, IV fluids and breathing support devices to support if needed as a temporary measure until your child recovers from the infection.
 

What should I ask my paediatrician?

You should ask your paediatrician the following questions:
 

• Does my child need admission?
• Is my child’s case serious?
• Would he/ she need support with feeding?
• When can he/she go home?
• What signs do I need to keep an eye at home?
   

Are there any long-term complications?

Usually not, however, in some children it can cause long-term wheezing which can even last many weeks (post bronchiolitic wheeze) but this is not serious. In the acute stage, some children would need support in paediatric intensive care and this could sometimes have long-term implications. Overall, most children recover uneventfully.
 

Any new advances?

Lots of trials have happened in the past but the outcomes from this research have suggested that, currently, there is no treatment that cures the condition and nebulisers, inhalers, steroids, saline do not help.

There are lots of newer non-invasive respiratory support devices available which are being used in the hospital like CPAP, Vapotherm, High flow oxygen etc. These help to prevent deterioration in a seriously unwell child.

There are currently lots of vaccines being tested for preventing bronchiolitis. Palivizumab is a monoclonal antibody that is being given to babies with chronic lung disease and significant congenital heart defects to prevent RSV infection. It involves monthly injections between October to March.

If you are worried that your child is experiencing bronchiolitis, you can book an appointment with Mr Nair via his Top Doctor’s profile here.

You can read more about the condition in the NICE guidelines here.