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Cough and Wheeze (Bronchiolitis)

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Key Points
  • Bronchiolitis is a common viral infection that affects the lungs of children under 2 years old
  • Bronchiolitis causes children to wheeze, cough and work harder to breath
  • Most children with bronchiolitis can be managed at home
  • Children, especially less than 6 months old, should seek medical attention if they are having difficulty breathing, difficulty feeding or seem more sleepy than usual
What Is It?

Bronchiolitis is a viral infection that affects the lower part of the lungs. The infection makes the small airways (‘bronchioles’) swell and fill with mucus. The bronchioles become narrow, making it hard for your child to breathe. The infection leads to wheezing, lots of coughing and some difficulty breathing.

Bronchiolitis usually affects young children under the age of two. Many viruses can cause this infection, but the most common is ‘Respiratory Syncytial Virus’ or RSV. RSV outbreaks happen between November and April each year, with a peak in January and February. Your child can get RSV infections many times, but as they get older the symptoms become milder.

Symptoms

At first, your child can have common cold symptoms, including:

  • Runny nose
  • Mild cough
  • Fever
  • Low energy
  • Decreased appetite

About one to three days after the start of cold symptoms, the infection can spread to the small airways of the lungs causing bronchiolitis symptoms. Your child may have:

  • Worsening cough
  • More frequent coughing
  • Wheezing
  • Fast breathing
  • Indrawing (The skin being sucked in at the neck, collarbones or between the ribs with each breath)
  • Vomiting after coughing
  • Decreased appetite
  • Difficulty breast or bottle feeding (especially babies less than 6 months old)

Bronchiolitis can be more severe in some children, especially if:

  • They were born prematurely (before 34 weeks gestation)
  • They are a young infant (under 3 months)
  • They have a history of asthma or lung problems
  • They have a history of heart problems

If your child has any symptoms of bronchiolitis, they should be seen and examined by a health care professional.

Treatment

Bronchiolitis is a viral infection that lasts for 7 to 10 days. In some children the cough may continue for a few weeks even though they are feeling better.

Children with bronchiolitis can usually be managed at home. There is no medication that treats the infection. Antibiotics will NOT work since this is a viral infection.

At Home

  1. Coughing
    • Keep your child sitting or upright because it is easier for them to breathe in this position
    • Cool mist humidifiers in your child's room can help lessen their congestion. Use humidifiers as directed by the manufacturer and keep out of reach of children.
    • Over the counter cough medications can have harmful side effects in children. They are NOT recommended in children under six years of age.
  2. Nasal congestion:
    • Cleaning out your child’s nose makes breathing and feeding easier
    • Use an over the counter salt water nose spray (eg: Hydrasense ™). Spray or drop salt water in each nostril and suck out the mucous. We do not advise making your own salt water solution at home
    • Clean their nose before feeds and bedtime, or as often as they need during the day
  3. Eating and drinking:
    • Your child may not want to eat much when they are sick, and that is ok
    • Encourage your child to drink clear fluids. Babies less than 6 months old should continue to breast or bottle feed as usual
    • Your child may not want to drink like they usually do, but continue to offer small amounts of fluids throughout the day so they stay hydrated
  4. Fever and discomfort:
    • You may give Acetaminophen (Tylenol® or Tempra®) or Ibuprofen (Advil® or Motrin®) to keep your child comfortable. Use as directed on the packaging or instructed by a health care provider.

In Hospital

In the hospital, doctors and nurses will do many things to help your child’s breathing and keep them comfortable. This can include:

  1. Keeping them calm and sitting up to make their breathing easier
  2. Listening to their lungs and watching their breathing
  3. Gently suctioning your child’s nose with salt water drops
  4. Giving your child some extra oxygen to breathe in to make sure there is enough oxygen in their blood
  5. Trying inhalers (puffers) of either Salbutamol (Ventolin™) or Epinephrine. These medicines can help some children breath easier by opening up their small airways

How Can I Prevent It From Spreading?

Bronchiolitis is very contagious. It is spread through close contact with someone who is sick and coughing or sneezing around you. Touching toys or sharing food with someone who is sick can spread the virus.

Children with bronchiolitis are contagious for almost a week after they first get sick. You should keep your child at home if they are coughing a lot or having any trouble breathing.

Other tips to prevent spreading the virus:

  • Keep your child away from young babies (less than three months) for as long as you can while they are coughing
  • Hand washing is important to stop the spread of infections. Teach children to wash their hands before and after eating, coughing or sneezing
  • Avoid exposing young babies and children to cigarette smoke. Smoking has been linked to higher risk of infection

Cough and Wheeze (Bronchiolitis)

Seek Immediate Medical Attention if:

  • Your child is breathing very fast
  • Your child looks very uncomfortable when breathing
  • Your child is having trouble breathing: look for pulling of the skin around the neck and between the ribs or more wheezing while breathing
  • Your child looks blue around the lips
  • Your child is very sleepy and difficult to wake up
  • Your child is having difficulties feeding and is becoming dehydrated

Know Your Options

Know Your Options It can be scary when your child is sick. But in most cases, you don’t need to go to the emergency department. If you’re unsure, we’re here to help.

Health LinkStollery HospitalAlberta Children's Hospital