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How to recognise bronchiolitis in children?

Updated: December 2018

What is bronchiolitis?

You may have often heard the term bronchitis before, but what is bronchiolitis? The two terms (bronchitis and bronchiolitis) often can be confused when you first hear them.

We refer to bronchiolitis as an inflammation of the bronchioles, the smallest branches of the bronchi. Bronchiolitis most often occurs in babies and toddlers under 2 years, as their immune system is still developing and is particularly vulnerable.

Symptoms of bronchiolitis include laboured and shallow breathing, slightly elevated fever and an accelerated heartbeat. The disease typically occurs in the winter months.

Causes of bronchiolitis

Bronchiolitis is usually caused by a viral infection, often by respiratory syncytial virus (RSV).  Transmission of the pathogens is caused by droplet infection. The viruses enter the nasal mucosa from the inhaled air. As the pathogens can survive for up to several hours outside the body, these are also transmitted by touching objects, such as toys in the nursery. Viruses are transferred from the hands to the respiratory tract. Therefore, it is important to pay attention to hygiene and hand washing when dealing with babies.

Bronchiolitis symptoms

With bronchiolitis, various symptoms affect the respiratory tract. Fever, respiratory distress and a sore throat are some most common symptoms of bronchiolitis. A slightly elevated fever is often observed. The fever makes patients feel tired and washed out.

Bronchiolitis in infants and babies is also similar to a common cold. Children have no appetite and a runny or blocked nose. Their temperature is slightly elevated, between 37.5 and 38 °C, and they have a dry cough.

If the symptoms worsen after a few days, this could indicate bronchiolitis. Breathing in babies is rapid, shallow and strained, their heart rate increases and coughing intensifies. Feeding may become more difficult or the baby may refuse food altogether.

As it is a viral infection, treatment with medication will not help. However, recovery can be supported by relieving the symptoms. In very rare cases (less than 2%), babies and toddlers must be treated in the hospital.

Since severe bronchiolitis causes serious respiratory problems, as a parent you should pay particular attention to the following symptoms. Consult a doctor immediately in the case of:

  • Dehydration. Your baby has consumed less than half what they usually would in 24 hours and has had no wet nappy for six hours. When dehydrated, your baby will also have a dry mouth and lips.
  • Your baby is very lethargic and sleepy.
  • Their fever has risen to over 38 °C.
  • Respiratory distress: Your baby breathes in and out with a wheezing, whistling sound, and their nostrils inflate as they breath. The skin below the costal arch, on the collarbone or between the ribs is visibly sucked in during breathing.
  • The child’s lips and fingernails turn blue.
  • Breathing is accelerated. Your baby breathes faster than 60 times per minute.
  • Breathing is sometimes interrupted and stops for a few seconds.
  • Your baby's abdominal muscles contract when breathing.

Diagnosing bronchiolitis

Bronchiolitis can be diagnosed by a doctor based on the sounds in the upper body, which are determined by tapping the upper body or listening with a stethoscope. In some cases, an x-ray is carried out.

Treatment for children with bronchiolitis

Bronchiolitis treatment is aimed at easing the symptoms, because there is no treatment for neutralizing the viruses. Children with mild bronchiolitis symptoms can be treated at home, while treatment in the hospitals are meant for those with severe symptoms.

Bronchiolitis home treatment can be done by a parent of the child and include the following:

  • Staying upright to ease the patient’s breathing
  • Drinking plenty of fluids to prevent dehydration
  • Keeping the home environment moist, possibly by using a humidifier, and with comfortable temperature
  • Ensuring a smoke-free environment to prevent the lungs from getting irritated
  • Taking fever relievers for infants and young children if needed, such as paracetamol or ibuprofen, with exceptions to aspirin, antibiotics and corticosteroids
  • Using a nasal suction device or a nasal aspirator to remove excess mucus and relieve a blocked nose
  • Using hypertonic saline, which is tested to be safe and effective in infants, for reducing the bronchiolitis symptoms. Hypertonic saline can be taken through inhalation, using a nebuliser.
  • In rare exceptional cases, hospital treatment is required
  • Receiving extra oxygen if low levels of oxygen in the blood are present
  • Feeding via a nasogastric tube if the child experiences a difficulty eating or drinking

Prevention

As bronchiolitis is a droplet infection, attention should be paid to hygiene when handling babies and toddlers.


References:

Knott, L. (2015). Bronchiolitis. Retrieved from Patient: https://patient.info/health/bronchiolitis-leaflet

Lenney, W., Boner, A., Bont, L., Bush, A., Carlsen, K.-H., Eber, E., . . . de Benedictis, F. (2009). Medicines used in respiratory diseases only seen in children. European Respiratory Journal, 34(3), 531-551.

National Health Service. (2015). Treating bronchiolitis. Retrieved from NHS Choices: http://www.nhs.uk/Conditions/Bronchiolitis/Pages/Treatment.aspx

Ralston SL, Lieberthal AS, Meissner HC, et al. (2014). Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502.

Nonnenmacher (2018). Bronchiolitis. Retrieved from medlexi.de/Bronchiolitis

Merz, S. & Antwerp, F. (2018). Bronchiolitis. Retrieved from flexikon.doccheck.com/de/Bronchiolitis

Baby Center Germany (2017). Bronchiolitis. Retrieved from www.babycenter.de/a8358/bronchiolitis