Bronchiolitis: symptoms, care and when to seek help

Bronchiolitis is a viral chest infection that causes swelling and mucus in the smallest breathing tubes.

It mainly affects babies and young children because their airways are narrow. As those small tubes become irritated, breathing can become noisy or more effortful. The illness often begins like a cold and then moves into the chest. Respiratory syncytial virus is one virus that can cause it.

A cough and wheezing are very common presentations of bronchiolitis. A fever can also occur. Your child may have a blocked or runny nose, feed less than usual, seem unsettled, or breathe faster than normal.

Seek urgent medical help if a child is struggling to breathe, has pauses in breathing, has blue or grey lips or skin, is unusually floppy or difficult to wake, or is taking very little fluid. These signs need prompt assessment.

Viruses spread through droplets and hands after coughing, sneezing or touching contaminated surfaces. A child can pick up the virus from close contact with someone who has cold-like symptoms. Antibiotics do not treat the viruses that cause bronchiolitis.

Congestion and a mild cough may appear first. Breathing and feeding can become harder as airway swelling develops, then gradually ease as the infection settles. Coughing may linger after other symptoms improve. Keep watching breathing, alertness and fluid intake rather than relying on one symptom alone.

Very young babies and children born early may become unwell more quickly. Extra caution is also sensible for children with heart or lung conditions, weakened immunity, or feeding difficulties. Avoiding tobacco smoke around children can reduce airway irritation.

A clinician usually assesses the pattern of symptoms, listens to the chest and observes breathing effort. They may check temperature, hydration and oxygen levels. Tests are not always needed; the purpose of assessment is to identify children who need support with breathing or fluids.

Many children can be cared for at home with frequent fluids or shorter, more regular feeds, rest and attention to comfort. Keep the nose clear enough for feeding where possible, and follow advice on suitable fever relief. Do not give cough or cold medicines unless a clinician says they are appropriate for your child.

Hospital care may be needed when a child needs oxygen, help with feeding, or close monitoring. A nebuliser is not a routine home treatment for every child with bronchiolitis; a clinician decides whether any inhaled treatment is appropriate.

Wash hands before touching a baby, clean frequently handled surfaces and keep people with cold symptoms from close face-to-face contact where practical. Do not share cups, cutlery or towels during an illness. These measures help limit the spread of many respiratory viruses.

Arrange a child health consultation if you are worried about breathing, feeding, sleepiness or symptoms that are worsening. For severe breathing difficulty, pauses in breathing, blue or grey colour, or poor responsiveness, seek emergency care immediately.