Bronchiolitis is an infection of the lower respiratory tract that usually affects children under 2 years of age. There is swelling in the smaller airways or bronchioles of the lung, which blocks air in the smaller airways.
The most common cause of bronchiolitis is a virus, most frequently the respiratory syncytial virus (RSV). However, many other viruses have been involved, including:
It is rarely caused by bacteria, usually mycoplasma pneumoniae.
Initially, the virus causes an infection in the upper respiratory tract, and then spreads downward into the lower tract. The virus causes inflammation and even death of the cells inside the respiratory tract. This leads to blockage of airflow in and out of the child's lungs.
Bronchiolitis usually occurs in the winter and early spring.
The most common age group affected by bronchiolitis is children under 2 years of age.
The following risk factors increase the likelihood that a child will develop bronchiolitis:
Exposure to smoke
Day care attendance
Having older children in the home
An infant that is not breastfed
The following are the most common symptoms of bronchiolitis:
Common cold symptoms, including:
Cough (the cough may become more severe as the condition progresses)
Changes in breathing patterns (the child may be breathing fast or hard; you may hear wheezing, or a high-pitched sound)
Decreased appetite (infants may not eat well)
The symptoms of bronchiolitis may look like other conditions or medical problems. Always consult your child's health care provider for a diagnosis.
Bronchiolitis is usually diagnosed solely on the history and physical exam of the child. In some cases, tests may be done to rule out other diseases, such as pneumonia or asthma such as:
Chest X-rays. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Blood tests/blood gases
Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
Nasopharyngeal swab. This is done for respiratory syncytial virus (RSV) and other respiratory viruses. These tests yield rapid results for presence of RSV or other viruses.
Most cases are mild and can be treated at home. Because there is no cure for the disease, the goal of treatment is to relieve symptoms. Antibiotics are not used, unless there is also a bacterial infection. . Some infants with severe breathing problems, are treated in the hospital. While in the hospital, treatment may include:
Intravenous (IV) fluids if your child is unable to drink well
Oxygen therapy and a ventilator may be needed
Frequent suctioning of your child's nose and mouth (to help get rid of thick secretions)
Breathing treatments, as ordered by your child's doctor
If your child's is at home, the following treatment may be recommended:
Suctioning (with a bulb syringe) of your child's nose and mouth (to help get rid of thick secretions) especially prior to feedings
Elevating your child's head while sleeping. Don't use pillows with infants.
Acetaminophen (Children's or Infants' Tylenol) for fever, as ordered by your child's health care provider. Do not give a child aspirin, because this medication has been linked to Reye syndrome, a disease of the brain and liver.
The best way to prevent bronchiolitis is cleaning hands with alcohol-based hand cleaner before and after touching your child.
During RSV season, palivizumab shots are recommended for high-risk infants. High risk infants include those born early (prematurely), or those with lung, heart, or immune system diseases. Talk to your child's health care provider about whether or not your child is at risk and should receive the shots.