Is this your child's symptom?
- Your child has been diagnosed with bronchiolitis
- It's an infection of the smallest airways in the lungs
- Caused by a virus called RSV
- Wheezing during the first 2 years of life is often caused by bronchiolitis
- You wonder if your child needs to be seen again
Symptoms of Bronchiolitis
- Wheezing is the main symptom that helps with diagnosis. Wheezing is a high-pitched purring or whistling sound.
- You can hear it best when your child is breathing out.
- Rapid breathing at a rate of over 40 breaths per minute.
- Tight breathing (having to work hard to push air out).
- Coughing (may cough up very sticky mucus).
- Fever and a runny nose often start before the breathing problems.
- The average age for getting bronchiolitis is 6 months (range: birth to 2 years).
- Symptoms are like asthma.
- About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times.
Cause of Bronchiolitis
- A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus.
- The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter.
- People do not develop life-long immunity to the RSV virus. This means they can be infected many times.
Trouble Breathing: How to Tell
Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:
- Struggling for each breath or short of breath.
- Tight breathing so that your child can barely speak or cry.
- Ribs are pulling in with each breath (called retractions).
- Breathing has become noisy (such as wheezes).
- Breathing is much faster than normal.
- Lips or face turn a blue color.
Diagnosis of Bronchiolitis
- A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope.
Prevention of Spread to Others
- Cover the nose and mouth with a tissue when coughing or sneezing.
- Wash hands often. After coughing or sneezing are important times.
When to Call for RSV-Bronchiolitis
Call 911 Now
- Severe trouble breathing (struggling for each breath, can barely speak or cry)
- Passed out or stopped breathing
- Lips or face are bluish when not coughing
- You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
- Trouble breathing. Exception: if it happens only when coughing.
- Lips or face have turned bluish, but only during coughing
- Ribs are pulling in with each breath (retractions)
- New harsh sound with breathing in (called stridor)
- Wheezing (purring or whistling sound) is worse than when seen
- Breathing is much faster than when seen
- Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, no tears.
- Not alert when awake ("out of it")
- High-risk child (such as chronic lung disease) and getting worse
- Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
- Age less than 6 months old and worse in any way
- Fever over 104° F (40° C)
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
- Nonstop coughing spells
- Trouble feeding worse than when seen
- Earache or ear drainage
- Fever lasts more than 3 days
- Fever returns after being gone more than 24 hours
- You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
- Coughing causes vomiting 3 or more times
- Mild wheezing sounds lasts more than 7 days
- Cough lasts more than 3 weeks
- You have other questions or concerns
Self Care at Home
- Bronchiolitis same or better than when last seen
Care Advice for Bronchiolitis
- What You Should Know About Bronchiolitis:
- Bronchiolitis is common during the first 2 years of life.
- Most children just have coughing and fast breathing.
- Some develop wheezing. This means the lower airway is getting tight.
- If you were given a follow-up appointment, be sure to keep it.
- Here is some care advice that should help.
- Asthma Medicines:
- Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines.
- If one has been prescribed for your child, give it as instructed.
- Keep giving the medicine until your child's wheezing is gone for 24 hours.
- Coughing Fits or Spells:
- Breathe warm mist (such as with shower running in a closed bathroom).
- Give warm clear fluids to drink. Examples are apple juice and lemonade.
- Amount. If 3 - 12 months of age, give 1 ounce (30 mL) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
- Reason: Both relax the airway and loosen up any phlegm.
- Homemade Cough Medicine:
- Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using the these tips:
- Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
- Age 1 year and older: Use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough. If you don't have any honey, you can use corn syrup.
- Nasal Saline To Open a Blocked Nose:
- Your baby can't nurse or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus.
- Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. If under 1 year old, use bottled water or boiled tap water.
- Step 1: Put 3 drops in each nostril. (If age under 1 year old, use 1 drop).
- Step 2: Suction each nostril out while closing off the other nostril. Then, do the other side.
- Step 3: Repeat nose drops and suctioning until the discharge is clear.
- How often: Do nasal saline when your child can't breathe through the nose. Limit: No more than 4 times per day.
- Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
- Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction.
- If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
- Smaller Feedings:
- Use small, frequent feedings whenever your child has the energy to drink.
- Reason: Children with wheezing don't have enough energy for long feedings.
- Offer enough fluids to prevent dehydration.
- Avoid Tobacco Smoke:
- Tobacco smoke makes coughs and wheezing much worse.
- Don't let anyone smoke around your child.
- What to Expect:
- Wheezing and rapid breathing most often improve over 2 or 3 days.
- Mild wheezing sounds can last up to 1 week.
- Coughing may last 3 weeks.
- Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein.
- Return to Child Care:
- Your child can return to child care after the wheezing and fever are gone.
- Call Your Doctor If:
- Trouble breathing occurs
- Wheezing gets worse (becomes tight)
- Trouble feeding occurs
- Fever lasts more than 3 days
- You think your child needs to be seen
- Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 07/16/2019
Last Revised: 03/14/2019
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.