Along with night shifts, diaper changes, and lots of laundry, new parents will eventually have to deal with their sick baby.
One of the most common respiratory diseases that parents encounter is bronchiolitis, which 90% of children under the age of 2 will experience at least once.
Bronchiolitis is common in children, especially in autumn and winter. Almost all children get a virus that causes bronchiolitis such as RSV (respiratory syncytial virus) by age 2, and many develop bronchiolitis symptoms during their first exposure.
Bronchiolitis can range from mild to severe. Some children will experience normal cold symptoms. For others, bronchiolitis can be caused by a lack of oxygen in their system or poor nutrition. That can lead to dehydration and may require emergency care.
Bronchiolitis is one of the main reasons infants and young children are treated in our Emergency Department and, in some cases, admitted to the hospital. Still, most new parents probably haven’t heard of it.
What is Bronchiolitis?
Bronchiolitis is a respiratory infection caused by a virus. It causes coughing, wheezing and sometimes fever, followed by rapid breathing, shortness of breath, persistent cough and poor appetite. Normally, bronchiolitis is like a cold for the first three to four days, but then it can be worse. That’s when you can see that your baby is starting to breathe and breathe faster. Shortness of breath takes seven days or more, and a cough can take two to three weeks to resolve.
Children are more prone to breathing problems caused by compression because they breathe entirely through their noses. If their nasal passages are blocked, it takes more effort to get oxygen into the body.
Bronchiolitis is a clinical diagnosis based on the child’s age, symptoms and physical examination. Viral tests or chest x-rays are not necessary in most cases because they do not change treatment or outcome.
Treatment for Bronchiolitis
Bronchiolitis is caused by a virus, so unfortunately there is no medicine that can get rid of it. The most common cause of bronchiolitis is RSV, but many other viruses cause similar symptoms.
The main treatment for bronchiolitis is recommended: clearing the nasal cavity with saline and soft water, making the water warm and monitoring breathing. Medications such as albuterol or steroids are generally ineffective as bronchiolitis progresses and are not always recommended.
The best way to reduce symptoms is:
- Keep your child hydrated
- Remove their nose from the nose before sleeping and eating
Whether you’re using a bulb syringe or NoseFrida®, you’ll want to add saline to your baby’s nose before starting the drinking process. This will help loosen the nose so you can get out as much as possible. I caution parents not to overuse pacifiers because that can cause irritation and swelling in the nasal cavity.
Can Bronchiolitis Be Prevented?
In addition to hand hygiene and avoiding infected contact, there are now options to help prevent RSV that can reduce the risk of severe disease. One option is to get an RSV vaccine during pregnancy, which allows the virus to be passed on to the baby. Or, there are vaccines for babies, especially those at high risk. Talk to your doctor — whether it’s your OB/GYN during pregnancy or your pediatrician after the baby is born — to discuss a prevention plan that works best for your family.
When you need medical care
For premature babies and those in the first two months of life, this kind of disease can be very serious. Bronchiolitis can cause babies to stop breathing for a short time. A pause in breathing longer than 15 to 20 may be the first sign of illness.
Have your child see a doctor if:
- Their breathing rate is always high, for example, more than 70 breaths per minute.
- They struggle to breathe, or
- They eat poorly (less than 2/3 of what they normally have at mealtime)
Fever alone is less important than how a baby breathes and eats.
Signs of respiratory problems and bronchiolitis can be subtle
Symptoms of bronchiolitis worsen over time. Signs that a child should be screened for include:
- Retractions – bees in the skin under and around the ribs and in the neck above the collar bone
- Nasal congestion – when the nose increases during breathing
- Stumbling
Those breathing issues along with poor nutrition can make it necessary for a child to be admitted to the hospital due to low oxygen and/or dehydration. A newborn should be screened immediately if:
- It seems boring
- Stop breathing
- Have blue or pale skin
To be safe, if you have a child who is 2 months old or older and is showing symptoms of bronchiolitis, a pediatrician should examine him as soon as possible.
Is your child breathing fast?
Babies are built to breathe faster than older children, but when their breathing becomes slow, it’s time to seek medical attention. To find out if your child is breathing fast, count his or her breathing rate. In other words, count how many times they breathe per minute. Make sure your baby is calm and not feverish now when you take the breath to make sure you get an accurate reading.
There is reason to be concerned if your child is constantly breathing more than 70 times per minute. The increased breathing rate, and the child not eating as usual, is the reason to take them to the emergency department.
This is an example of my middle son when he had bronchiolitis. Watch this video with audio to learn how I count her breathing rate and other symptoms to watch for. He is now in the eighth grade and is doing well.
https://www.youtube.com/watch?v=y4OkwQq-_a0
You may have seen devices you can buy online called pulse oximeter monitors, which are supposed to measure the oxygen in your baby’s blood. Unfortunately, the information they provide is often inaccurate and does not assess the risk of the disease.
Watching a baby struggle to breathe can be scary. That concern shows that you are careful and concerned about yourself. Most babies recover well with time and supportive care, and parents play a big role by clearing the nose, preparing food, and knowing when to ask for help.
For more information about bronchiolitis, listen to this podcast featuring Dr. Sobolewski: Is it Bronchiolitis? Signs, symptoms and when to seek care.
