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What is bronchiolitis?

Bronchiolitis is an infection of the lower respiratory tract that usually affects children under 2 years of age. There is swelling in the smaller airways or bronchioles of the lung. This blocks air in the smaller airways.

What causes bronchiolitis?

The most common cause of bronchiolitis is a virus, most often the respiratory syncytial virus (RSV). However, many other viruses have been involved, including:

  • Parainfluenza virus

  • Adenovirus

  • Influenza

  • Human metapneumovirus

It is rarely caused by bacteria, usually mycoplasma pneumoniae.

Initially, the virus causes an infection in the upper respiratory tract, and then spreads downward into the lower tract. The virus causes inflammation and even death of the cells inside the respiratory tract. This leads to blockage of airflow in and out of the child's lungs.

Facts about bronchiolitis

  • Bronchiolitis usually happens in the winter and early spring.

  • The most common age group affected by bronchiolitis is children under 2 years of age.

  • The following risk factors increase the likelihood that a child will develop bronchiolitis:

    • Exposure to smoke

    • Day care attendance

    • Having older children in the home

    • An infant that is not breastfed

What are the symptoms of bronchiolitis?

The following are the most common symptoms of bronchiolitis:

  • Common cold symptoms, including:

    • Runny nose

    • Congestion

    • Fever

    • Cough (the cough may become more severe as the condition progresses)

  • Changes in breathing patterns (the child may be breathing fast or hard; you may hear wheezing, or a high-pitched sound when the child breathes in)

  • Decreased appetite (infants may not eat well)

  • Irritability

  • Vomiting

The symptoms of bronchiolitis may look like other conditions or medical problems. Always talk with your child's healthcare provider for a diagnosis.

How is bronchiolitis diagnosed?

Bronchiolitis is usually diagnosed solely on the history and physical exam of the child. In some cases, tests may be done to rule out other diseases, such as pneumonia or asthma such as:

  • Chest X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Blood tests/blood gases

  • Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a bandage) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

  • Nasopharyngeal swab. This is done for respiratory syncytial virus (RSV) and other respiratory viruses. These tests yield rapid results for presence of RSV or other viruses.

Treatment for bronchiolitis

Most cases are mild and can be treated at home. Because there is no cure for the disease, the goal of treatment is to relieve symptoms. Antibiotics are not used, unless there is also a bacterial infection. Some infants with severe breathing problems are treated in the hospital. While in the hospital, treatment may include:

  • Intravenous (IV) fluids if your child is unable to drink well

  • Oxygen therapy and a ventilator may be needed

  • Frequent suctioning of your child's nose and mouth (to help get rid of thick secretions)

  • Breathing treatments, as ordered by your child's healthcare provider

If your child's is at home, the following treatment may be recommended:

  • Drinking fluids

  • Suctioning (with a bulb syringe) of your child's nose and mouth (to help get rid of thick secretions) especially prior to feedings

  • Elevating your child's head while sleeping. Don't use pillows with infants.

  • Acetaminophen for fever, as ordered by your child's healthcare provider. Do not give a child aspirin, because this medicine has been linked to Reye syndrome, a disease of the brain and liver.

Prevention of bronchiolitis

The best way to prevent bronchiolitis is cleaning hands with alcohol-based hand cleaner before and after touching your child.

During RSV season, palivizumab shots are recommended  for high-risk infants. High risk infants include those born early (prematurely), or those with lung, heart, or immune system diseases. Talk to your child's healthcare provider about whether or not your child is at risk and should receive the shots.

Online Medical Reviewer: Blaivas, Allen J., DO
Online Medical Reviewer: Holloway, Beth Greenblatt, RN, M.Ed.
Date Last Reviewed: 11/1/2016
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