Along with sleepless nights, diaper changes, and loads of tiny laundry, new parents will eventually have to deal with their baby getting sick.
One of the most common respiratory illnesses parents encounter is bronchiolitis, which 90% of kids under age 2 will get at least once.
Bronchiolitis is extremely common in young children, especially in the fall and winter. Almost all children are exposed to bronchiolitis-causing viruses such as RSV (respiratory syncytial virus) by age 2, and many develop bronchiolitis symptoms during their first exposure.
Bronchiolitis can range from mild to severe. Some children will experience common cold symptoms. For others, bronchiolitis can cause a lack of oxygen in their system or poor feeding. That can lead to dehydration and may require emergency care.
Bronchiolitis is one of the top reasons babies and young toddlers are treated in our Emergency Department and, in some cases, admitted to the hospital. Still, many new parents have probably never heard of it.
What Is Bronchiolitis?
Bronchiolitis is a respiratory illness due to viruses. It initially causes a cough, congestion and sometimes fever, followed by rapid breathing, wheezing, a persistent cough and poor feeding. Typically, bronchiolitis seems like a cold for the first three to four days, but then it can become more serious. That’s when you may notice your child start to wheeze and have faster breathing. The wheezing lasts seven or more days, and the cough can take two to three weeks to resolve.
Infants are more susceptible to breathing issues caused by congestion because they breathe almost entirely through their noses. If their nasal passages are clogged, it takes more effort to get oxygen in the body.
Bronchiolitis is a clinical diagnosis based on a child’s age, symptoms and physical exam. Routine viral testing or chest X-rays are not needed in most cases because they do not change treatment or outcomes.
Treatment for Bronchiolitis
Bronchiolitis comes from a virus, so unfortunately there is no medication that can get rid of it. The most common cause of bronchiolitis is RSV, but many other viruses cause similar symptoms.
The main treatments for bronchiolitis are supportive: clearing nasal congestion with saline and gentle suctioning, ensuring hydration and monitoring breathing. Medications such as albuterol or steroids generally do not change how bronchiolitis progresses and are not routinely recommended.
The best ways to relieve the symptoms are to:
- Keep your child hydrated
- Get the mucus out of their nose before naps and feedings
Whether you use a bulb syringe or NoseFrida®, you’ll want to add saline drops to your child’s nose before you start the sucking process. This will help loosen the mucus so you can get as much out as possible. I caution parents not to overuse the sucking tools because that can lead to irritation and swelling in the nostrils.
Can Bronchiolitis Be Prevented?
In addition to hand hygiene and avoiding sick contacts, there are now options to help prevent RSV that can reduce the risk of severe illness. One option is to get an RSV vaccine during pregnancy, which allows protective antibodies to pass to the baby. Or, there are preventive antibody shots for infants, especially those at higher risk. Talk to your doctor — either your OB/GYN during pregnancy or your pediatrician after birth — to discuss a prevention plan that works well for your family.
When To Seek Medical Attention
For premature babies and those in the first two months of life, an illness like this can be very serious. Bronchiolitis can cause young babies to stop breathing for short periods of time. Pauses in breathing greater than 15 to 20 seconds can be the first sign of illness.
Have your baby seen by a doctor if:
- Their breathing rate is consistently high, for example, over 70 breaths per minute,
- They are working hard to breathe, or
- They are feeding poorly (less than 2/3 of what they typically have during a feeding)
Fever alone is less important than how well a baby is breathing and eating.
Signs of trouble breathing in bronchiolitis can be mild
The symptoms of bronchiolitis often get worse as time goes on. Signs of a child who should be evaluated include:
- Retractions — sucking in of the skin below and around the ribs and in the neck above the collar bones
- Nasal flaring — when the nostrils enlarge during breathing
- Grunting
Those breathing issues along with poor feeding can lead to the need for a child to be admitted to the hospital due to low oxygen levels and/or dehydration. An infant should be evaluated right away if they:
- Appear to be tiring
- Stop breathing
- Have blue or pale skin
To be safe, if you have a baby who is 2 months old or younger and is showing signs of bronchiolitis, have them checked by your pediatrician as soon as possible.
Is your baby breathing too fast?
Babies are built to breathe faster than older kids, but when their breathing becomes too fast, it’s time to seek medical care. To find out if your baby is breathing too fast, count their respiratory rate. In other words, count how many times they’re breathing per minute. Make sure your child is calm and doesn’t currently have a fever when you count the breaths to ensure you get an accurate reading.
There is reason to be concerned if your child is breathing consistently more than 70 times per minute. An increased breathing rate, along with a baby who is not eating as much as they normally do, is reason to bring them to the emergency department.
Here is an example of my middle son when he had bronchiolitis. Watch the video with sound and to learn how I counted his respiratory rate and other symptoms to watch for. He is in eighth grade now and doing just fine.
You may have seen tools you can buy online called pulse oximeter monitors, which are supposed to measure the oxygen in your child’s blood. Unfortunately, the information they provide is not always accurate, and doesn’t assess the risks of the illness.
Watching a baby work hard to breathe can be scary. That worry shows you are attentive and caring. Most babies recover well with time and supportive care, and parents play a huge role by clearing the nose, supporting feeding, and knowing when to seek help.
For more information on bronchiolitis, listen to this podcast featuring Dr. Sobolewski: Is It Bronchiolitis? Signs, Symptoms and When to Seek Care.
