Bronchiolitis

Bronchiolitis is an illness of infants affecting the entire respiratory tract. This includes the smallest air passages in the lungs (the bronchioles). It is caused by several different viruses which cause ‘colds’ in adults. Respiratory syncytial virus, often called RSV, is the most frequent cause. Bronchiolitis occurs during the first 18 months of life, peaking at about six months of age. Young children catch these viruses through close contact with others who are infected.

 

How Do You Catch It?

shutterstock_174856946The virus is spread when infected mucous is sneezed or coughed into another child’s face or onto table tops or objects such as toys. Infection occurs when the child touches these surfaces and then his/her eyes or nose. Illness begins about 3 to 7 days later.

The illness

Bronchiolitis usually starts as a runny nose, sneezing and a moist cough, accompanied by a fever. After 2 to 4 days the virus spreads down to the bronchioles. These tiny tubes become inflamed with mucus, making it more difficult for the infant to breathe in and out and producing a wheezy sound when breathing. The best way to describe a wheeze is to hold a moist sponge to your ear and squeeze it. That is very similar to what is happening in the small tubes of the lungs. Infants may have difficulty feeding, especially for prolonged periods. Restless sleep with frequent awakening is common.

Wheezing usually gets better after 3 to 5 days; however, nasal stuffiness may last longer and cough may persist for another 1 or 2 weeks. There are a small number of infants who will continue to wheeze and cough for several weeks and sometimes months after the illness. Although frustrating the long-term outlook for these ‘happy wheezers’ is good.

When to seek help
Occasionally affected infants will need some help with breathing in the form of oxygen. This can be difficult to judge so if concerned present to the GP or emergency department. If the infant is using lots of energy to breath, and is therefore unable to feed, or sleep  oxygen may be required. Generally the indication for treatment is the following criteria. shutterstock_221078332

  • Unable to feed or sleep due to effort required to breathe.
  • Increasing difficulty breathing such as significant sucking in of the spaces between the ribs with each breath. This is called intercostal retraction, and rapid rate of breathing.
  • Young infants in particular less than 6 months of age need to be seen
  • Difficulty staying asleep and quite lethargic

Treatment
Most infants with bronchiolitis do not need specific medications but rather require patience and care to make breathing and feeding less difficult. Use of a vaporizer has not been shown to help. keep nasal secretions moist and the nasal passages clear with saline drops especially prior to feeding and sleeping.  Elevating the head of the bed or crib during sleep may also improve the clogging of the nasal passages. If your infant appears to have difficulty feeding, offer smaller feedings more frequently. It is more important to drink liquids than to eat solid food during the early part of the illness. Panadol can be used to settle and for discomfort. Asthma medications have generally no benefit in those under the age of 12 months. Prednisolone, has not been shown to be of any benefit. Because bronchiolitis is caused by viruses, antibiotics are of no use. (Occasionally antibiotics are used for ear infections though)

The daycare guidelines indicate that a child with bronchiolitis should be excluded until the secretions have resolved.

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