Bronchiolitis in Babies: Symptoms, Causes, Treatment, More

Does your baby have a bad cold? Listen carefully to their breathing. If they wheeze, grunt, or have a raspy, dry cough, they may have bronchiolitis.

Though it may start as an upper respiratory virus, bronchiolitis travels lower in the body and causes inflammation in the bronchioles. Bronchioles are small airways in the lungs.

Bronchiolitis is most common in babies and toddlers younger than age 2, according to 2022 research.

While the cough tends to go away in a couple of weeks, caregivers should look out for red flags that may mean the condition is progressing, according to the National Health Service (NHS).

For example, a fever lasting 2 or 3 days or one that’s higher than 102°F (38.8°C) — or higher than 100.4°F (38°C) in babies under 3 months old — is a reason to call the pediatrician, according to Harvard Health.

Medical emergency

Bronchiolitis may require a trip to the emergency room if your child has any of the following signs:

  • trouble breathing, rapid breathing, or pauses in breathing
  • trouble feeding due to excessive coughing
  • change of skin color to pale or blue
  • sweaty or clammy skin

Here’s more about what causes this health condition, what symptoms should prompt a visit to your baby’s doctor, and how you can treat most cases at home.

Initial signs of bronchiolitis include general cold symptoms like a stuffy nose, cough, and fever. These symptoms tend to worsen by days 3 to 5 and then continue on for 2 to 3 weeks, according to the NHS.

Other symptoms include:

  • aspiring cough
  • shortness of breath
  • labored breathing
  • wheezing

Bronchiolitis itself is not contagious but the viruses that cause it are contagious.

For example, RSV tends to circulate in cooler weather, usually in the fall, winter, and early spring months, per Harvard Health. Once a child has RSV, they may be contagious for a few days and have a cough for up to 3 weeks. Even if your baby’s symptoms have gone away, they may still be contagious.

It’s important to note that babies and children are exposed to many viruses. As a result, it’s possible for a child to get bronchiolitis more than once in a year.

Children under 2 years old are at risk of developing bronchiolitis. Of them, babies between 3 and 6 months old are at the highest risk.

Other risk factors include:

  • being breastfed or chestfed for fewer than 2 months
  • having exposure to secondhand smoke
  • Having older siblings in day care or school who are frequently exposed to viruses

While most cases of bronchiolitis aren’t severe, some babies may be more likely to deal with complications. This primarily includes babies who:

Pneumonia and dehydration are two possible complications your baby may have with bronchiolitis. It’s important to contact their pediatrician right away if you notice any signs of these medical issues.

Pneumonia is an infection that develops in the lungs. The alveoli are sacs in the lungs that typically fill with air. With pneumonia, they fill with fluid and pus, making breathing difficult. Symptoms may include rapid breathing and chest retractions (drawing in) with inhalation.

Dehydration may develop if your child is vomiting or unable to take in enough fluids. Symptoms in young children include dry mouth, dry skin, fatigue, and lack of urination (fewer wet diapers). In babies, dehydration may also cause the soft spot on their head (fontanelle) to sink.

Experts also see some association between bronchiolitis and asthma, but it’s unclear whether the condition causes asthma or if babies who are already susceptible to asthma get bronchiolitis more easily.

Bronchiolitis tends to heal on its own with rest, hydration, and other comfort measures. Healthcare professionals do not recommend antibiotics for treatment unless the condition progresses to pneumonia or another bacterial infection.

Bronchiolitis in babies treatment at home

At home, you’ll want to keep your child as comfortable as possible. This means providing a soothing atmosphere for rest and finding ways to relieve congestion and cough.

You might try:

  • give your child fluids like breast milk, formula, or water to stay hydrated
  • using a cool mist humidifier to add moisture to your child’s room, which helps with coughing
  • running a hot shower and taking your child into the steamy bathroom to loosen a cough
  • clearing your baby’s nasal congestion with a bulb syringe
  • raising up your child’s head during the day when they are lying down and awake (but never elevate their head in any way when they are asleep)
  • treating any fever or pain as directed by a pediatrician

medical treatment

If your child isn’t getting better with home treatment, you’ll want to contact their pediatrician. You’ll likely need to make an appointment to see if the bronchiolitis has progressed into other conditions, like pneumonia.

Medical treatment may involve antibiotics for pneumonia. According to the World Health Organization (WHO)the medication of choice is amoxicillin taken orally (by mouth).

Hospitalization is another option for the most severe cases, per the American Lung Association. If your baby is admitted to the hospital, it will be to address dehydration, feeding trouble, or breathing concerns.

Most cases of bronchiolitis will get better on their own within 2 to 3 weeks (or 4 weeks in some cases), according to the NHS. But you should still consider taking your baby to the doctor if symptoms continue for more than 1 week.

You should also make an appointment with a pediatrician if your baby:

  • has a persistent fever
  • has a loss of appetite
  • has trouble feeding
  • is vomiting

Other signs your little one may need medical attention include:

  • fatigue
  • irritability
  • signs of dehydration, such as:
    • no tears
    • dry mouth
    • lethargy

A pediatrician may diagnose bronchiolitis after hearing what symptoms your child has, noting how long they’ve been going on, and performing a physical exam. Be sure to bring to the appointment any notes on specific symptoms that give you concern.

The pediatrician will listen to your child’s lungs for certain noises like wheezing or crackling as they breathe. According to the NHS, further testing isn’t needed unless there are signs of other medical conditions, like asthma or cystic fibrosis.

Tests might include:

Pneumonia is an infection in the lungs where the alveoli fill with fluid or pus. Bronchiolitis is inflammation of the bronchioles, the small airways of the lungs. Both conditions cause cough, mucus, and other respiratory symptoms in the lungs.

Pneumonia can develop as a complication of bronchiolitis. It often requires antibiotics to get better and can lead to further complications in young children. Bronchiolitis that does not advance to pneumonia should heal on its own.

Bronchitis and bronchiolitis share many characteristics. Both usually start with a virus. Both also cause coughing.

Bronchitis is an inflammation of the bronchi, the large airways of the lungs. Bronchiolitis, on the other hand, is the inflammation of the small airways.

Another key difference is that bronchiolitis tends to affect young children and babies; bronchitis is more common in older kids and adults.

RSV, the virus that most often causes bronchiolitis, is very contagious. Preventing spread may be difficult, especially with young children and babies.

You might try:

  • Frequently washing your baby’s hands when they are exposed to other children or adults who may be sick
  • asking people who come into your home to wash their hands before holding or playing with your child
  • Encouraging family members to cover coughs and sneezes (doing a “vampire cough”)
  • switching from cloth to paper tissues and tossing them out as soon as they’re used
  • frequently washing toys, surfaces, utensils, dishes, and more in your home
  • keeping babies under 2 months old away from people with symptoms, particularly in RSV season

Speak with your child’s doctor if your little one is at high risk of becoming very ill from bronchiolitis.

Some infants who are at higher risk for complications of bronchiolitis are given specific antibody injections between late fall and spring (RSV season), according to the American Academy of Pediatrics.

It can be scary when your baby has a cold, especially if they have a productive cough or are wheezing. Trust your instincts and consider getting your child checked out if their cough has lasted more than a 1 week or if you have other concerns about their health.

Otherwise, do your best to keep your child well-rested, hydrated, and calm. Most cases of bronchiolitis will go away on their own in a few weeks without medical intervention.

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