Framingham Pediatrics | Bronchiolitis

Bronchiolitis is a viral infection of the very small airways (the bronchioles) of the lungs. While it can be caused by many different viruses, the most common cause is RSV, or Respiratory Syncytial Virus. Bronchiolitis is most common during the winter. It usually occurs in young children, although the same virus tends to cause a mild cold in older children and adults. Because bronchiolitis is a viral infection, antibiotics will not be helpful. 

What follows is a review of the signs, symptoms and management of bronchiolitis. 

Signs & symptoms

• Wheezing – a high-pitched whistling noise heard (usually with a stethoscope) when your child breathes.  Below is a link to hear what wheezing sounds like: 
  • Lung sounds reference guide
• Fast breathing
  • 0-12 months – more than 60 breaths per minute  
  • 1-3 years – more than 40 breaths per minute
  • 4-12 years – more than 30 breaths per minute
  • 13+ years – more than 20 breaths per minute 
• Fever
• Runny or congested nose

Management

Bronchiolitis is a virus that resolves without treatment.  Below are some suggestions to keep your child more comfortable.

• Breathing cool moist air is helpful for soothing a cough.  Consider letting your child breath in the steam from a shower and/or using a cool mist humidifier in his or her bedroom 
• A bulb syringe and saline (salt water) nose drops may be helpful for nasal congestion. Saline can be purchased at the pharmacy.  Saline nose sprays may be used in older children.  Never use other nose drops or sprays in young children without consulting your provider. 
• Allow for smaller more frequent feeds and plenty of rest time while feeding
• Sometimes your provider will prescribe a medication to help open the small airways of the lungs.  If this is the case, be sure to give the medication as directed
• As always, do not let anyone smoke near your child. Tobacco smoke can make the symptoms of any infection worse Over-the-counter cough and cold medication is not recommended or helpful in children with bronchiolitis

When to call

 Call our office immediately if your child's breathing seems faster and/or more labored or if you notice that the skin between his ribs sinks in more when he or she breathes. Also call us if he or she is breathing faster than usual (see the above guidelines) or he or she cannot eat or drink anything. Finally, let us know if your child has a persistent fever or if he or she is simply not getting better after several days.

Takeaway message

Bronchiolitis is a viral illness that most commonly and severely affects infants and young children.  There are many ways to help your child be more comfortable.  As always, call your doctor if you have any concern about your child’s breathing.

Additional resources

For more information:

• click bronchiolitis from the American Academy of Pediatrics
• click RSV see the following link from the American Academy of Pediatrics