One of the conditions we see a lot of in paediatric emergency departments over the winter is bronchiolitis, which affects around one in three children in the UK during their first year of life. The last couple of years have had a slightly more unusual, out-of-season pattern, most likely due to social distancing initially, and then the restarting of nurseries the following year.
Bronchiolitis is an inflammatory condition of the small airways of the lungs caused by viruses –most commonly RSV (respiratory syncytial virus) – leading to swollen airways and mucus production. It is an important condition to know about as even though most infants develop a mild form, others can be severely unwell and need hospital treatment.
Symptoms of bronchiolitis
- Early symptoms are similar to a cold so runny nose and cough
- Dry and persistent cough
- Difficulty feeding
- Rapid or noisy breathing, wheezing.
Most children will have a mild condition, with peaking of symptoms on days 3 to 4, with the cough self-resolving within 2 to 3 weeks. However, there are some signs and symptoms to watch out for that require medical attention.
You should dial 999 for an ambulance if:
- there are any concerns with fast or difficulty in breathing
- there are any long pauses in your baby’s breathing (apnoea)
- there are any signs of blueness of tongue or lips (cyanosis).
Seek medical help
You should also seek medical assistance if:
- there is a persistent fever, or any fever in babies less than 3 months old
- your child has taken less than half of their usual feeds over the last 2 to 3 feeds or they have had dry nappies for 12 hours or more
- your child seems very tired or irritable
- you are worried.
Children at particular risk of severe bronchiolitis include those under six weeks of age, premature babies, any babies with heart or lung problems and those with an underlying immunodeficiency.
How is bronchiolitis managed in hospital?
Whilst there is no direct treatment, there are several supportive measures including:
oxygen support (via tubes or masks); breathing support if there is persisting difficulty; feeding and nutritional support; treatment of dehydration and sepsis.
What can you do at home?
- Wash hands regularly
- Wash or wipe toys and surfaces
- Keep infected children at home until well
- Keep new-born babies away from people with colds or flu
- Avoid smoking around your baby
- Babies with additional risk factors may be offered the palivizumab vaccination.
To manage symptoms:
- Give paracetamol or ibuprofen if there is fever (seek help If there is fever under 3 months old)
- Offer smaller but more frequent feeds and drinks if there is difficulty in feeding and keep an eye on the number of wet nappies
- Saline drops may help keep the nose clear.
Dr. Yuheng Zhou
Teddington Resident & Paediatric Consultant