Bronchiolitis

Bronchiolitis is a common cause of respiratory distress during the winter months in babies, particularly those under 6 months of age.

This page gives general information about causes, symptoms, treatment and prevention in at risk infants.

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What is Bronchiolitis?

It is an illness that causes respiratory distress (breathing problems) in infants, particularly those under 6 months.

Signs you may see of respiratory distress in your baby include:

  • grunting noise as your baby breathes out
  • flaring of the nostrils
  • ribs become prominent with each breath
  • abdomen moving out with breathing

Babies will often also have poor feeding.

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What causes it?

It is usually caused by a virus called RSV, or Respiratory Syncitial Virus. Occasionally, other viruses, such as parainfluenzae or human metapneumovirus, may cause a similar illness. Bronchiolitic epidemics occur in the winter months.

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What symptoms do babies have?

A baby will often have a mild fever and a runny nose for a couple of days. Then he will develop cough and difficulty in breathing. You will see some signs of respiratory distress as he breathes.

Sometimes babies are unable to feed properly because they are having so much breathing difficulty. Feeding takes energy and when babies are struggling to breathe they have no energy left for feeding.

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What is the treatment for Bronchiolitis?

In most cases, no specific treatment is necessary.

  • In a few babies, medicines to stop wheezing help. This is more often in older infants or those with recurrent wheeze
  • Occasionally, babies need help with feeding. For example, a tube placed through the nose into the stomach may be needed so the baby doesn't have to expend energy sucking
  • Some babies need extra oxygen - the oxygen saturation is measured by a probe on the finger and if the oxygen level is less than 92%, supplemental oxygen will be needed
  • A few babies will need help with breathing. CPAP is a type of artificial ventilation that helps babies with severe bronchiolitis

These babies are generally admitted to hospital.

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Do all babies need to be admitted to hospital?

No. Most babies will have minor symptoms and will get better by themselves. Only babies who have a lot of difficulty breathing or feeding will need to be admitted.

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What symptoms should make me worried enough to bring my baby to hospital?

Your baby may need hospital care if:

  • he is having difficulty feeding
  • he is struggling with his breathing
  • he changes colour (especially if he goes blue)
  • he has short periods when he stops breathing
  • he already has lung disease and is having breathing problems
  • he already has heart disease and is having breathing problems
  • he already has a problem with his immunity and is having breathing problems

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Are there treatments to prevent Bronchiolitis?

There are some treatments that in some cases prevent RSV Bronchiolitic hospital admissions, (for example, Palivizumab). However, these medicines are not straightforward to give, and decisions regarding their use need to be made by the pediatric specialist.

They are best reserved for infants who have been born prematurely and who have chronic lung disease.

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Can babies get the RSV infection again?

Yes. However, as we get older, the infection generally causes less severe symptoms. Older children who get RSV often get symptoms of the common cold.

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Does Bronchiolitis cause any long-term effects?

Yes. It can cause wheezing (asthma). If there is not a history of asthma in the family, most children will 'grow out' of their wheezing tendency by the age of 13 years. If there is a family history of asthma, the asthma symptoms are likely to continue longer.

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What can I do help my baby after an episode of Bronchiolitis?

Make sure your baby avoids passive smoking. Exposure to tobacco smoke really exacerbates respiratory symptoms in babies.

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References

  • Meates-Dennis M. Chapter in Evidence-based Pediatrics and Child Health. 2nd ed. BMJ Publishing Group. 2004.pp 319 - 329
  • Lozano JM. Bronchiolitis. Clinical Evidence. BMJ Publishing Group. 2006
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Last reviewed 5 June 2011

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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