For some of you with children 2 years of age or younger, you may have come across this frustrating illness.
Bronchiolitis is a viral illness common to children younger than 2 years of age. It refers to inflammation of the bronchioles (smaller airways of the lungs). I like to think of it as a cold that you also get in your lungs. When a child has bronchiolitis, all that congestion and discharge and “goop” from his or her nose and sinuses is also present in the lungs.
What Should I Expect?
Children with bronchiolitis present very much like they have a cold. They start out with cold symptoms: cough, runny nose, congestion, fever. After a couple days, their symptoms may worsen — persistent fever, worsening cough, lethargic — prompting a visit to the office.
One of the biggest issues with bronchiolitis is breathing. Because all that “goop” is in the lungs, children with bronchiolitis sometimes have to work harder to breathe. They may breathe faster or show signs of working harder to breathe (ribs showing with breathing, chest sucking in while belly sticks out). Parents will often report noisy breathing, but this can sometimes be from sinus congestion as well (as with colds). Children with bronchiolitis may wake up frequently at night and have poor feedings.
Great. Now What?
The good news is that bronchiolitis is a viral illness — so antibiotics will not make a difference — and usually resolves within a week. It’s also similar to a cold in terms of being contagious. The treatments are similar to colds as well: humidifier at night, nasal saline for younger infants, encourage fluids, etc.
The most common complications are dehydration and breathing concerns. Hydration can often be maintained with slow and frequent sips of fluids appropriate for age. Breathing concerns require prompt evaluation in the office or ER.
What Should I Be Watching For?
Children should remain well hydrated — at least 3 wet diapers per day if younger, mouth and lips not persistently dry, making tears if crying. Fevers should not last more than 5 days, and should be controlled with medication. (When controlled, a fever should reduce, and the child should perk up, in-between fevers). Signs of lethargy — extremely tired at unusual times, difficulty waking up, not alert or making eye contact — or worsening symptoms typically require evaluation in the office or ER.
The biggest potential complication from bronchiolitis is trouble breathing. This will almost always require evaluation in the office or ER. Sometimes we can give a breathing treatment in the office to help with symptoms, but it may require ER evaluation and hospital stay. The biggest risk is that children will get tired from working so hard to breathe for too long.
Hopefully this helps you understand one of the more common and frustrating illnesses of pediatrics. As usual, if you have any questions, please let us know. That’s why we’re here!
Dr. Chris Deskins is a former Kids Plus provider.