What should you know about cough in bronchiolitis?

Bronchiolitis usually begins with cold-like symptoms before cough, wheezing and faster breathing become more noticeable. The child may take smaller feeds because breathing and sucking are harder together. Mucus and swelling in the small airways can make breathing noisy. A cough can linger after breathing starts to improve. Infants, children born early, and children with heart, lung or immune problems may need closer observation. A clinician assesses the child's colour, breathing effort, hydration and alertness rather than judging severity by cough sound alone.

Offer smaller, more frequent feeds and keep the child upright while awake and supervised. Clear visible nasal mucus gently before feeds, and keep the room free from smoke. Check regularly for wet nappies, alertness and changes in breathing. Do not give cough medicines or antibiotics unless a clinician specifically recommends them. Nebuliser treatment is not automatically needed; its use depends on the examination and the child's response. A child health consultation can help when symptoms are changing or feeding is becoming difficult.

Get urgent help if the child is struggling for each breath, has pauses in breathing, blue or grey lips, severe chest pulling-in, unusual sleepiness, or cannot drink. Seek prompt medical advice when feeds are much smaller, wet nappies reduce, or breathing becomes steadily faster. Fever in a very young infant also deserves prompt clinical guidance. If you are unsure, watch the child's breathing when calm and contact a clinician rather than waiting for the cough to settle.

How can I count breathing safely? Is feeding adequate today? Which changes mean we should return urgently, and would any inhaled treatment help?