In partnership with Primary Children’s Hospital Bronchiolitis To watch a video about Figure 1 bronchiolitis, scan this QR code with your smart phone. Bronchiole Normal airway Trachea (Brings air from the mouth) Bronchiole with infection Bronchus Mucus Bronchioles Lungs What is bronchiolitis? How does a child become infected? Bronchiolitis [BRONK-ee-o-LITE-us] is an infection of A child becomes infected with the virus by having small airways in the lungs. When you breathe in air, it contact with another infected person. The virus is enters the trachea [TRAY-kee-uh], or “windpipe.” It goes spread when a sick person coughs or sneezes near down to your lungs by entering a big tube called the another person’s face. The virus can also be spread by bronchus [BRONK-us] and branching off into smaller hands that touch things with the virus on them like tubes called bronchioles [BRONK-ee-ohls] (see Figure 1). sippy cups or toys and then touch the eyes or nose. When the bronchioles get infected, it is called Viruses can live several hours on objects. An infected bronchiolitis. person can spread a virus for many weeks. You can stop the spread of the virus by washing your hands after Bronchiolitis happens most often in children under sneezing, coughing, or blowing your nose. the age of 2 years. It is always caused by a germ called a virus. The infection causes the bronchioles to swell What are the symptoms? and fill with mucus. This blocks the flow of air through the lungs and makes it hard for your child to A child who gets bronchiolitis often starts off with breathe. Respiratory syncytial [sin-sish-uhl] virus signs of a cold, such as a runny or stuffy nose, cough, (RSV) is the most common cause of bronchiolitis. and fever. After 1 to 3 days, the virus spreads to the Other viruses that cause bronchiolitis include human bronchioles. A whistling sound called wheezing may metapneumovirus, influenza, and coronavirus, be heard when the child breathes out. among many others. 1 Treatment in most cases involves treating symptoms When to get emergency help? related to the infection. We also make sure your child receives enough oxygen and fluids. Get immediate medical attention if your child is Feeding: having trouble breathing and does the following: • Your child will be given plenty of fluids. Most babies are offered formula or breast milk. If • Breathes faster or widens their nostrils when breathing. your child is having trouble eating, feedings may be given through a nasogastric [nay-zoh-GAS-trick] • Sucks in the areas between the ribs, or above or below the rib cage. This happens as your or NG tube (a small tube placed in the nose). If child tries to get more air in the lungs. your child is having significant difficulty breathing, • Grunts and tightens the stomach muscles feedings may be briefly stopped, and fluids given when breathing. through an IV (a small tube that is put into a vein). • Drinks poorly. This may happen because your • Suctioning the nose: Infants and younger children child is working so hard to breathe that they are too young to blow their nose. Your child will have trouble sucking and swallowing. probably have a large amount of thick mucus. The • Develops a bluish tint around the lips and fingertips. nurse and respiratory therapist (RT) will help clear your child’s nose, mouth, and the back of the throat Stops breathing for short periods of time. • [KATH-et-er] This is known as apnea and is most common in with a suction bulb or catheter . It helps to babies born early or those who are less than suction before feeding, any time your child is having 2 months old. more trouble breathing, and before naps or bedtime. If If your child is having a lot of trouble breathing, the mucus is very thick, a few saline (salt water) drops they may be admitted to the hospital. into the nose may be used before suctioning. • Oxygen: Your child’s doctor, nurse, and RT will check how easy it is for your child to breathe. This will What will happen in the hospital? help to decide if your child needs oxygen or if its use The viruses that cause bronchiolitis can spread from can be reduced or stopped. Your nurse and RT will person to person. Precautions will be taken to protect teach you how to look for signs of breathing problems. your child from becoming infected with other A machine called a pulse oximeter [aak-si-muh-ter] viruses. We will also try to prevent the spread of your may be used to check oxygen levels in your child’s child’s virus to other patients. Your child will have to blood. Your child does not need to be connected to stay in their hospital room. A sign will be posted on this machine all of the time. We can check how hard the door to remind everyone of things they need to your child is working to breathe by watching. do to prevent the spread of infection. • Safe sleep: It is important to remember that the • Hand washing: Everyone going into and out of safest sleep position for your child is flat on their your child’s room must wash their hands or use hand back. Sometimes when a child is in the hospital the sanitizer. They must do this before and after touching head of their bed is raised for a short time, but your child or any object in the room. Hand washing remember to return to the usual flat bed position is the best way to prevent the spread of infection. when you get home. • Gowns, gloves, and mask: These items are • Laboratory and other tests: Bronchiolitis most required for all persons who go into your child’s often does not require tests. There may be times when room. They prevent contact with infected items and a blood test or chest x-ray is ordered. If these tests are bodily fluids. Items should be left in the room when needed, their purpose will be explained to you. no longer needed. • Medicines: Bronchiolitis goes away by itself. It is not helpful to give medicines in most cases. If medicines are used, they may include: 2 – Acetaminophen (Tylenol) or ibuprofen (Motrin, What can I do to help my Advil) is used if your child is uncomfortable or child after we go home? has a fever. While in the hospital, it will be important to learn – Breathing treatments to help make breathing how to use a nasal oral aspirator or a bulb syringe to easier. These are only recommended if your child’s suction the nose before you go home. Try the doctor thinks the breathing airway muscles are following suggestions to relieve a stuffy nose at home: having some spasm. • Clear your child’s nose with a nasal oral aspirator – Antibiotics, which treat infections caused by or suction bulb. bacteria (another type of germ), are not helpful for bronchiolitis because bacteria do not cause • Make your child’s mucus thinner by using mild bronchiolitis. Antibiotics may be used for an ear salt water nose drops. infection or pneumonia. Most of these infections – Buy drops recommended by your doctor. are caused by the same virus that caused your – Do not try to make this yourself. child’s bronchiolitis and antibiotics are not needed. – Never use over-the-counter nose drops that – It is recommended that all children over 6 months contain any medicine. receive the influenza (“flu”) vaccine. Your child • Never give your child any other kind of cold was hospitalized with bronchiolitis. Because of this medicine or decongestant without first checking reason, your child has a higher risk of having a with your child’s doctor. more serious illness if later infected with influenza. If your child has a fever, give Tylenol®. Be sure to How long will my child follow the recommended dose for your child’s age. be in the hospital? Do not give aspirin to your child. Aspirin has been associated with Reye’s syndrome, a disease that This depends on how sick your child is. It also affects the liver and the brain. depends if your child has any other health problems. The main things that will determine when your child How can I help prevent respiratory will be safe to go home are: infections like bronchiolitis? • How much oxygen your child needs. Frequent and thorough hand washing is the most • How comfortably your child is breathing. effective way to prevent the spread of the viruses that • How well your child is able to keep up with fluid cause bronchiolitis. The correct method is to apply and nutritional needs. soap to wet hands and scrub hands well for 10 to 15 • Whether or not your child’s doctors have any other seconds before rinsing. Other actions to take include: concerns that need to be monitored in the hospital. • Washing your hands before holding your child, Before leaving the hospital, your child’s care team will especially if you have been in a public place or help schedule a follow-up appointment at a Respiratory around people who are ill. Outpatient Clinic (locations are listed on page 4). • Insisting that people wash their hands before holding or touching your child. When should I call my child’s doctor? • Not allowing babies to play with ill children. Call if your child: • Keeping young babies away from places where they will • Shows any signs of having trouble breathing have contact with people who are ill.