Bronchiolitis

What is bronchiolitis?

Bronchiolitis occurs when the smallest airways of the lungs get infected, becoming swollen and filled with mucus. This blocks the flow of air, making it harder for a baby to breathe. In countries with temperate climate, bronchiolitis commonly occurs in autumn and winter. In warm countries such as Malaysia, it tends to occur during the rainy season.

One of the common causes of bronchiolitis is respiratory syncytial virus (RSV). RSV can also lead to colds, ear infections, croup, and pneumonia.

How will I know if my baby has bronchiolitis?

Bronchiolitis is usually slightly worse than a heavy cold. The first symptoms will probably be similar to a common cold:

• runny or stuffy nose;
• dry cough;
• mild fever of between 37.5 degrees C and 38 degrees C;
• loss of appetite.

After two or three days your baby’s symptoms will peak and may worsen:

• his cough may become more persistent;
• his breathing may become faster, sounding shallow and laboured;
• his heartbeat may be much faster than normal;
• he may have trouble feeding, and refuse feeds.

When should I take my baby to the doctor?

If you're not sure whether your baby has bronchiolitis or a common cold, see your doctor. Your baby’s symptoms can be worrying, but be reassured that most cases of bronchiolitis are not serious and can be treated at home.

About two per cent of babies develop severe bronchiolitis, which may need treatment in hospital. Contact your doctor straight away if you notice that your baby:

• has had less than half of his usual amount of milk over the past 24 hours;
• shows signs of dehydration, such as no wet nappy for six hours or more and a dry mouth and lips;
• has a temperature that rises above 38 degrees C;
• seems sleepy and lethargic;
• is struggling to breathe (see below).

A severe case of bronchiolitis can cause breathing difficulties, so keep an eye on your baby for signs he is having trouble breathing. Phone for an ambulance or take your baby to accident and emergency (A&E) if:

• he is wheezing (a coarse, whistling sound as he breathes);
• his nostrils are flared;
• the skin between his ribs, above his collarbone, or below his rib cage appears to suck in with each breath;
• he grunts, or tightens his tummy muscles when breathing;
• his lips and fingernails are blue;
• he is breathing faster than 60 breaths per minute;
• he stops breathing for a few seconds at a time.

Some babies are more at risk than others of developing severe bronchiolitis. Take your baby to a doctor as soon as possible if you think he has bronchiolitis and:

• he is under three months old;
• he was premature at birth;
• he has had health problems since birth, such as a lung or heart condition;
• he has a weakened immune system;
• he has needed extra oxygen in the past.

How is bronchiolitis treated?

Most cases of bronchiolitis should get better on their own within a week or two. For a mild case, your doctor will advise some home treatments similar to those for a common cold:

• Encourage your baby to take extra breast or bottle feeds. If your baby is formula-fed or on solids he can have water too. He may not want to feed for long if his breathing is laboured, so offer short, frequent feeds. This will prevent him from becoming dehydrated and bring down his fever if he has one.


• You can give your baby infant paracetamol or ibuprofen, but only if he is three months or older. Check the dosage information on the packet, or ask your doctor or pharmacist if you’re unsure about how much to give your baby. Paracetamol or ibuprofen will help to bring down your baby’s fever and relieve his sore throat, which may help him to feed more easily.


• If your baby is having trouble feeding with a stuffy nose, hold or sit him as upright as possible during feeds. You can also try nasal saline drops, which may help to unblock his nose. You can buy these from your pharmacy. Apply the drops to each of his nostrils 15 minutes before a feed.


• Breathing in steam may help to loosen your baby’s blocked airways and relieve his cough. However, don’t put your baby close to hot, steamy water as there is a risk of him being scalded. A safer option is to take your baby into the bathroom with you. Turn on the hot water or shower, close the door, and sit in the steamy room for a few minutes. Remember to change him into dry clothes afterwards.

Don't give your baby any over-the-counter cough and cold medicines. They should not be given to children under six, because of the risk of side-effects.

If you baby has severe bronchiolitis he may also need to go to hospital for two or three days to help him get over the worst of the illness. He may be given oxygen to help him breathe, and be fed through a tube if he isn’t feeding well and is dehydrated. If your baby’s bronchiolitis is very severe he could be in hospital for a while.

Can bronchiolitis cause any complications?

After having bronchiolitis, some babies may be more likely to have a wheezy chest or cough, particularly while they have a cold. Asthma and other breathing problems later in life have also been linked with bronchiolitis.

Very rarely, babies with bronchiolitis can develop pneumonia, an infection of the lungs. Also, babies with a lung or heart condition may find bronchiolitis makes their condition much worse.

How can I prevent my baby from getting bronchiolitis?

Since it's passed on by touching, bronchiolitis spreads like wildfire through nurseries, offices and even homes. The virus can live on hands and surfaces for up to six hours, so practising good hygiene may help to prevent your baby catching it. Wash your hands frequently with warm water and soap, and insist that anyone else holding your baby has clean hands, too. Keep your baby away from anyone with a cold, and steer clear of crowds.