Bronchiolitis (Child)

The lungs have many small breathing tubes. These tubes are called bronchioles. If the lining of these tubes get inflamed, and swollen, the condition is called bronchiolitis. It occurs most often in children up to age 2. It's most often caused by a virus, such as the flu (influenza) virus or the respiratory syncytial virus.

Bronchiolitis often occurs in the winter. It starts with a cold. Your child may first have a runny nose, mild cough, fever, and a cough with mucus. After a few days, the cough may get worse. Your child will start to breathe faster, wheeze, and grunt. Wheezing is a whistling sound caused by breathing through narrowed airways. In severe cases, breathing can stop for short periods.

Bronchiolitis is treated by helping your child's breathing. The doctor may suction mucus from your child's nose and mouth. They may give medicines for a cough or fever. Children who have trouble breathing or eating may need to stay in the hospital for 1 or more nights. They may get I.V. (intravenous) fluids or oxygen. Symptoms usually get better in 2 to 5 days. But they may last for weeks. Antibiotic medicines are usually not needed for this illness. Your child may need antibiotics if they get a bacterial infection, such as pneumonia or an ear infection.

Babies under 12 weeks of age or children with a chronic illness are at higher risk for severe bronchiolitis. Complications can include dehydration and pneumonia. A child who has bronchiolitis is more likely to have bouts of wheezing when they are older.

Follow these guidelines when caring for your child at home:

• Your child's doctor may prescribe medicines to treat wheezing. Follow all instructions for giving these medicines to your child.
• Use children's acetaminophen for fever, fussiness, or discomfort, unless another medicine was prescribed. In babies over 6 months of age, you may use children's ibuprofen or acetaminophen. If your child has chronic liver or kidney disease, talk with your child's doctor before using these medicines. Also talk with the doctor if your child has ever had a stomach ulcer or digestive bleeding. Never give aspirin to anyone younger than 18 years of age who is ill with a viral infection or fever. It may cause a serious condition called Reye syndrome. This can cause severe liver or brain damage.
• Wash your hands well with soap and clean, running water before and after caring for your child. This will help prevent spreading the infection. Teach your children when, how, and why to wash their hands. Be a role model by correctly washing your own hands. Encourage adults in your home to wash hands often.
• Give your child plenty of time to rest.
  • Have your toddler or older child (older than 1 year) sleep in a slightly upright position. This is to help make breathing easier. If possible, raise the head of the bed slightly. Or raise your older child's head and upper body up with an extra pillows. Talk with your doctor about how far to raise your child's head.
  • Never use pillows with a baby younger than 12 months. Also never put a baby younger than 12 months to sleep on their stomach or side. Babies younger than 12 months should sleep on a flat surface on their back. Don't use car seats, strollers, swings, baby carriers, and baby slings for sleep. If your baby falls asleep in one of these, move them to a flat, firm surface as soon as you can.
• Help your older child blow their nose correctly. Your child's doctor may recommend saline nose drops to help thin and remove nasal secretions. Saline nose drops are available without a prescription. You can also use 1/4 teaspoon of table salt mixed well in 1 cup of water. You may put 2 to 3 drops of saline drops in each nostril before having your child blow their nose. Always wash your hands after touching used tissues.
• For younger children, suction mucus from the nose with saline nose drops and a small bulb syringe. Talk with your child's doctor or pharmacist if you don't know how to use a bulb syringe. Always wash your hands before and after using a bulb syringe or touching used tissues.
• To prevent dehydration and help loosen lung secretions in toddlers and older children, have your child drink plenty of liquids. Children may prefer cold drinks, frozen desserts, or ice pops. They may also like warm soup or drinks with lemon and honey. Don't give honey to a child younger than 1 year old.
• To prevent dehydration and help loosen lung secretions in babies under 1 year old, have your child drink plenty of liquids. Use a medicine dropper, if needed, to give small amounts of breast milk, formula, or oral rehydration solution to your baby. Give 1 to 2 teaspoons every 10 to 15 minutes. A baby may only be able to feed for short amounts of time. If you are breastfeeding, pump and store milk to use later. Give your child oral rehydration solution between feedings. This is available from grocery stores and drugstores without a prescription.
• To make breathing easier during sleep, use a cool-mist humidifier in your child's bedroom. Clean and dry the humidifier daily to prevent bacteria and mold growth. Don't use a hot-water vaporizer. It can cause burns. Your child may also feel more comfortable sitting in a steamy bathroom for up to 10 minutes.
• Over-the-counter cough and cold medicine don't help ease symptoms. These medicines can also cause serious side effects, especially in babies under 2 years of age. Don't give OTC cough and cold medicines to children under 6 years unless your doctor has specifically advised you to do so.
• Keep your child away from cigarette smoke. Tobacco smoke can make your child's symptoms worse. Don't let anyone smoke in your house or in your car.
• Respiratory syncytial virus (RSV) immunization is available for mothers during pregnancy or babies before their first RSV season. Ask your doctor for more information.

Follow up with your doctor or as advised.

If your child had an X-ray, it will be reviewed by a specialist. You will be told of any new findings that may affect your child's care.

For a usually healthy child, call your child's doctor right away if any of these occur:

• Fever (see Children and fever, below)
• Your child loses their appetite or feeds poorly
• Your child has an earache, sinus pain, a stiff or painful neck, headache, repeated diarrhea, or vomiting
• A new rash appears
• Your child has new symptoms or you are concerned about their recovery

Call 911 if any of these occur:

• Increasing trouble breathing
• Fast breathing:
  • Birth to 6 weeks: over 60 breaths per minute
  • 6 weeks to 2 years: over 45 breaths per minute
  • 3 to 6 years: over 35 breaths per minute
  • 7 to 10 years: over 30 breaths per minute
  • Older than 10 years: over 25 breaths per minute
• Blue, purple, or gray tint to the lips or fingernails
• Signs of dehydration, such as dry mouth, crying with no tears, or urinating less than normal; no wet diapers for 8 hours in infants
• Unusual fussiness, drowsiness, or confusion

Use a digital thermometer to check your child's temperature. Don't use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.
• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The doctor may want to confirm with a rectal temperature.
• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.
• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The doctor may want to confirm with a rectal temperature.
• Mouth (oral). Don't use a thermometer in your child's mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker's directions for correct use. Insert it gently. Label it and make sure it's not used in the mouth. It may pass on germs from the stool. If you don't feel okay using a rectal thermometer, ask the doctor what type to use instead. When you talk with any doctor about your child's fever, tell them which type you used.

Below are guidelines to know if your young child has a fever. Your child's doctor may give you different numbers for your child. Follow your doctor's specific instructions.

Fever readings for a baby under 3 months old:

• First, ask your child's doctor how you should take the temperature.
• Rectal or forehead: 100.4°F (38°C) or higher
• Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

• Rectal, forehead, or ear: 102°F (38.9°C) or higher
• Armpit: 101°F (38.3°C) or higher

Contact the doctor in these cases:

• Repeated temperature of 104°F (40°C) or higher in a child of any age
• Fever of 100.4° F (38° C) or higher in baby younger than 3 months
• Fever that lasts more than 24 hours in a child under age 2
• Fever that lasts for 3 days in a child age 2 or older