What should you know about adenovirus bronchiolitis?

Adenovirus can inflame the narrow breathing tubes deep in a young child's lungs. Swelling and mucus make air movement harder, which may produce wheezing or a crackling sound and increase the effort needed to breathe. The illness may begin with cold-like symptoms before breathing or feeding becomes more difficult. Antibiotics do not treat adenovirus because it is a virus.

Symptoms can change over the course of the illness, so watch the child's breathing, alertness, fluid intake, and wet nappies or trips to the toilet rather than focusing on cough alone. A clinician can examine the child and decide whether any tests or monitored care are needed.

Offer breast milk, formula, or other suitable fluids in small, frequent amounts if normal feeds are tiring. Keep the child upright while awake and clear nasal secretions gently before feeds when a blocked nose interferes with drinking. Avoid cigarette smoke, shisha smoke, incense, and strong fumes around the child.

Use fever medicine only in a child-appropriate product and dose advised by a clinician or pharmacist. Do not give leftover antibiotics or start a nebuliser medicine without an assessment. Nebuliser treatment is not automatically required for bronchiolitis; a clinician should decide whether it suits the child's examination and medical history.

Seek urgent medical care if the child has pauses in breathing, blue or grey lips, severe chest pulling between or beneath the ribs, grunting, marked difficulty breathing, or is unusually difficult to wake. Contact a clinician promptly if feeds have fallen substantially, there are clearly fewer wet nappies or toilet trips, the mouth is dry, vomiting prevents fluids staying down, or breathing is becoming faster or harder.

Babies, children born prematurely, and children with heart, lung, immune, or neurological conditions may need assessment earlier because they can have less reserve when breathing or feeding is affected. If you are unsure whether the effort of breathing is normal, arrange a child health assessment rather than waiting for the cough to settle.

Ask how to judge the child's work of breathing, what fluid intake and urine output are acceptable for their age, and which fever medicine and dose are suitable. You can also ask whether the examination suggests another cause of wheezing, whether oxygen or observation is needed, and what specific change should trigger a return visit.