Bronchiolitis

What is bronchiolitis?

Bronchiolitis is a viral infection that affects children younger than 2 years old. It causes the airways (bronchioles) in your child’s lungs to narrow, which makes breathing difficult. If your child develops this infection, you may notice they have symptoms similar to a common cold (runny nose, cough) in addition to noisy breathing (wheezing).

The infection is seasonal. It’s more likely to occur during the winter and early spring.

Bronchiolitis isn’t usually serious, but it can be. If your child develops this infection, monitor their breathing and contact a healthcare provider if they have trouble breathing.

How common is bronchiolitis?

Bronchiolitis is the most common lower respiratory tract infection among children younger than 2 years old.

Is bronchiolitis contagious?

The viruses that cause bronchiolitis are contagious. These viruses spread through respiratory droplets (saliva or mucus) from someone’s mouth or nose. When someone sneezes or coughs, these droplets become airborne and spread from person to person or stick to frequently touched surfaces or objects.

What is the difference between bronchiolitis and bronchitis?

Bronchiolitis and bronchitis are two conditions that both sound similar and have similar symptoms. A virus causes both conditions, which target the airways in your lungs. Bronchitis affects the bronchi, or the larger airways. Bronchiolitis affects your smaller airways (bronchioles). Bronchitis usually affects older children and adults, while bronchiolitis is more common in younger children.

What are the signs and symptoms of bronchiolitis?

Early signs and symptoms of bronchiolitis resemble those of the common cold, including:

• A runny nose.
• A slight fever (under 101 degrees Fahrenheit or 38 degrees Celsius).
• A cough.
• Fatigue.
• Fussiness or irritability (infants).

A bronchiolitis infection targets your child’s airways and can cause the following symptoms that affect their breathing:

• Rapid or shallow breathing.
• Wheezing.
• Grunting noises when they breathe.
• Flaring of the nostrils.

If your child has trouble breathing or you notice the following symptoms of severe bronchiolitis, call their healthcare provider or visit the emergency room immediately: 

• Difficulty sucking and/or swallowing (unable to feed).
• Flaring (widening) nostrils when breathing.
• Chest retracts during breathing (their skin pulls down tightly against their rib cage and makes their chest look like it’s pulling inward).
• Blue, gray or pale skin tone on their lips, fingers or toes (cyanosis).
• Dry mouth, not urinating (peeing) or crying without producing tears (dehydration).

What causes bronchiolitis?

A virus causes a bronchiolitis infection. Viruses that can lead to bronchiolitis include:

• Respiratory syncytial virus (RSV).
• Influenza (flu) virus.
• Adenovirus.
• Parainfluenza.
• Metapneumovirus.
• SARS-Cov-2 (the virus that causes COVID).

What are the risk factors for bronchiolitis?

Bronchiolitis most often affects children younger than 2 years old. Adults can get bronchiolitis, but it’s rare. Your child may be more at risk of developing severe bronchiolitis if they:

• Were born before 37 weeks of pregnancy.
• Have a congenital (present at birth) lung or heart condition.
• Have a compromised immune system.
• Live or play in group settings like daycare. 

What are the complications of bronchiolitis?

Complications of bronchiolitis include:

• Pneumonia.
• Asthma.
• Respiratory failure.

Bronchiolitis can be life-threatening if your child has severe symptoms that affect their ability to breathe. If you notice your child has difficulty breathing, contact 911 or local emergency services or visit the emergency room immediately.

How is bronchiolitis diagnosed?

Your child’s healthcare provider will diagnose bronchiolitis after a physical exam and testing. During the exam, your child’s provider will check their vital signs and temperature and listen to their breathing through a stethoscope (auscultation).

You can expect your child’s provider to ask you questions about their symptoms, like:

• How long has your child had symptoms?
• Has your child had a fever?
• Has your child been around others who were sick?

Your child’s provider may place a pulse oximeter (pulse ox) on their fingertip or toe to determine how much oxygen is in their blood (blood oxygen level).

Testing might include a nasal fluid culture, which is a swab that collects fluid from the inside of your child’s nose to detect viruses. If your child has severe symptoms, a chest X-ray might be necessary.

Do symptoms of bronchiolitis look similar to other conditions?

Bronchiolitis has symptoms that are similar to other respiratory infections like bronchitis and pneumonia. It may seem like asthma, which can cause wheezing and trouble breathing. You might wonder if your child breathed in (aspirated) something other than air.

Any time that you notice that your child has problems breathing, you should call their healthcare provider. They’ll be able to diagnose one breathing issue from another.

How is bronchiolitis treated?

Treatment for bronchiolitis focuses on symptom relief, including:

• Antipyretic (fever reducer) medications.
• Antiviral medications (like oseltamivir for the flu).

Bronchiolitis doesn’t always need treatment, so talk to your child’s provider if they have symptoms. Antibiotics won’t help because they’re ineffective at treating viral infections.

Your child may need to stay in the hospital if they have trouble breathing. Your child may need oxygen therapy or intravenous (IV) fluids in the hospital.

At-home bronchiolitis treatment

In addition to monitoring your child’s breathing during their illness, you can help your child feel better at home by:

• Encouraging your child to get plenty of rest.
• Feeding your child multiple small meals throughout the day if they don’t have an appetite for a full meal during regular meal times.
• Giving your child plenty of fluids to prevent dehydration. Breast milk or formula is appropriate for children younger than 1 year. Infants can drink electrolyte beverages like Pedialyte®.
• Setting up a humidifier near your child. Moist, wet air helps loosen mucus.
• Using saline nose drops and a nasal suction to relieve a stuffy nose.
• Giving your child a fever reducer like acetaminophen (Tylenol®) as directed by their healthcare provider. Giving aspirin to children can increase their risk of developing Reye’s syndrome.

How long does bronchiolitis last?

Most children diagnosed with bronchiolitis feel better within one week. Their breathing may improve after a few days, and most symptoms should clear up after about a week. Rarely, mild symptoms may persist for another week or two. Your child may cough for up to a month.

Can bronchiolitis be prevented?

It’s difficult to prevent bronchiolitis since the viruses that cause it are common. You can take steps to lower your child’s risk of developing bronchiolitis by:

• Avoiding others who are sick.
• Practicing good handwashing.
• Washing and sanitizing frequently touched surfaces or objects like toys.
• Not sharing cups, forks or spoons.

Until your child is better, keep them home from daycare or other environments where they’re in close contact with others. The virus that caused their illness is contagious. 

What can I expect if my child has bronchiolitis?

Your child may have symptoms for up to a week if they have bronchiolitis. During their illness, they may have trouble eating full meals or lose their appetite. To help your child eat when they don’t want to, try feeding them multiple small meals throughout the day instead of larger meals less often. It’s important to keep your child hydrated since they’re at a high risk of dehydration during their illness.

To alleviate your child’s symptoms, talk to their healthcare provider to see what’s safe for your child to take, like over-the-counter (OTC) medications to reduce a fever. Don’t give your child aspirin, as it can lead to Reye’s syndrome.

If your child has symptoms that don’t improve after one week or get worse, contact their healthcare provider. If your child has trouble breathing, contact emergency services or visit the emergency room immediately.

Some children develop asthma as they grow if they had bronchiolitis when they were infants. While less common, some children may develop pneumonia after bronchiolitis.

Can you have bronchiolitis more than once?

Yes. Since there are many viruses that can cause bronchiolitis, your child can develop the infection more than once.

When should I see a healthcare provider?

Call your child’s healthcare provider if your child:

• Is extremely tired, lethargic or sluggish.
• Has a blue, gray or pale color to their skin, fingertips or lips.
• Has symptoms that get worse.

Don’t be afraid to call a healthcare provider if your child doesn’t seem to be getting better or if you’re worried about something.

Call 911, your local emergency services number or take your child to the emergency room if they have trouble breathing. A sign of this is when your child’s nostrils flare or their chest retracts when they try to breathe.

What questions should I ask my child’s healthcare provider?

Questions to ask your child’s healthcare provider include:

• Should I give my child medication? If so, for how long and at what times of the day?
• When will my child start to feel better?
• Will I need to bring my child back for a follow-up visit?
• Should I keep my child home from school or daycare?
• Which over-the-counter pain relievers do you recommend?
• Which symptoms should I look out for?