How is bronchiolitis treated?

There is no routine medicine that clears the underlying viral inflammation immediately. Care focuses on keeping the child comfortable, offering fluids, clearing nasal mucus and checking for signs that breathing or hydration is worsening.

Bronchiolitis is inflammation and narrowing of the smallest airways, usually after a viral cold. It mainly affects babies and young children. A runny nose may be followed by cough, faster breathing, chest recession or a whistling sound. Feeding can become difficult because the child has to breathe more often.

Symptoms often change over several days. A clinician may listen to the chest, observe breathing effort and ask about wet nappies, drinking and alertness. Tests are not always needed. Antibiotics do not treat viral bronchiolitis, although a clinician may consider another diagnosis if the examination suggests a bacterial infection.

Offer smaller feeds more often, and allow pauses so the child can breathe. Keep the child upright when awake and supervised, and use saline nasal drops if advised to loosen mucus before feeds. Keep smoke, strong fragrances and other airway irritants away from the child.

Check the child regularly, including during sleep, for increased work of breathing, reduced drinking and fewer wet nappies. Give fever or discomfort medicine only as directed for the child’s age and weight. Do not give cough and cold products to a young child unless a healthcare professional specifically recommends one.

If feeding is not sufficient or breathing needs closer support, a medical team may provide oxygen, fluids or other respiratory support. A nebuliser is not routinely helpful for every child, so its use depends on the clinical assessment.

Seek urgent medical help if the child is struggling to breathe, has pauses in breathing, develops blue or grey lips, is unusually floppy or difficult to wake, or cannot drink. Get prompt advice if feeds are repeatedly much smaller than usual, vomiting prevents fluids, or wet nappies become noticeably less frequent.

Arrange a same-day assessment for a baby who is getting worse, a child with persistent breathing difficulty, or any child whose fever or cough is accompanied by marked sleepiness or poor hydration. Babies born prematurely and children with heart, lung or immune conditions may need earlier review because bronchiolitis can place extra strain on breathing.

Ask what signs of breathing difficulty you should watch for, how much fluid is reasonable for your child, and when the child should be reviewed. You can also ask whether the examination suggests bronchiolitis alone, whether oxygen or fluids are needed, and which fever medicine and dose are suitable.