Severe Bronchiolitis: What to Know

Bronchiolitis is usually a viral illness of the smallest breathing tubes. Swelling and mucus can cause a runny nose followed by cough, fever, wheezing, faster breathing, and difficulty feeding. A baby may take shorter feeds, have fewer wet nappies, or become unusually sleepy. Clinicians judge severity by watching breathing effort, oxygen level, hydration, alertness, and feeding, rather than by the sound of the cough alone.

Offer smaller feeds more often and keep the child upright while awake and supervised. Clear visible nasal mucus gently if it interferes with feeding. Keep the environment smoke-free and check the child regularly, including during sleep. A child health consultation can assess breathing and hydration. Hospital care may involve oxygen, fluids, or nebuliser treatment when clinically indicated; antibiotics do not treat the usual viral cause unless another infection is identified.

Call emergency services if the child has pauses in breathing, blue or grey lips, severe pulling in beneath the ribs, grunting, collapse, or is difficult to wake. Seek urgent assessment if breathing is steadily worsening, feeds are much smaller, wet nappies are reduced, or the child appears exhausted. Young infants and children with heart, lung, or immune problems may need earlier medical advice.

How hard is my child working to breathe? Is hydration adequate? What feeding pattern should I use? Which signs mean emergency care? Could oxygen, fluids, or nebuliser treatment help?