Bronchiolitis

What is bronchiolitis?

Bronchiolitis is an infection of the smallest breathing passages in the lungs (the bronchioles) which causes them to become inflamed. These small airway passages can become swollen and can produce sticky secretions, which makes it more difficult to breath. Babies and toddlers under the age of 2 are more commonly affected than other age groups.

The infection is passed by direct or close contact and is infectious while the virus is active. This is usually for about 3 to 8 days.

What causes bronchiolitis?

The main cause of bronchiolitis is a virus called respiratory syncytial virus (RSV). It is spread by close contact, through tiny droplets of liquid from coughs and sneezes. It is much more common over the winter months, when nearly all children may become exposed to it.

What are symptoms of bronchiolitis?

The infection frequently starts with a simple cough or cold, which may then get worse over a few days.

Most adults and school children will only have cold like symptoms such as runny nose or sore throat, but in children under 2 years the chest is often affected.

Children under 2 years have smaller breathing tubes than adults, and so the inflammation caused by the virus affects them much more.

• Breathing rate may be more rapid than usual. Your child may look short of breath or have noisy breathing.
• You child may have a cough and sound snuffly.
• It may be difficult for your child to take usual amounts of feed by bottle or breast. Your baby may also vomit some of their feed.
• If breathing and feeding becomes more difficult, your child may look pale, sweaty and tired.

How will my child be affected by bronchiolitis?

The infection often begins slowly and frequently starts with a simple cough or cold. This can progress into bronchiolitis. Most adults and older children (of school age) may only have cold like symptoms such as runny nose, sore throat. If your child is under the age of 2 their chest and lungs may be affected.

Children under 2 years old have smaller breathing tubes in their lungs. When their symptoms start, it can cause the inflammation and affect a small child much more than an older child or adult who have larger breathing tubes.

Their lungs will also start to make more mucus which makes breathing air through these small tubes harder. This can make them cough and wheeze. It can also make your child’s breathing rate quicker and increase their effort in getting air in to their lungs.

Even though your child may be improving, they may still have some symptoms of cough, cold or wheeze for several days or weeks after their acute episode. This should settle in due course.

How is bronchiolitis treated?

Most children under 2 years old do not need any special treatment and will get better on their own. Most young children will be fine at home and should be well fed and have enough fluids.

If your child is poorly and needs to be taken to the hospital, they may need additional support to help them breathe such as oxygen from a mask or tubes.

If your child has not been feeding well or needs some more support feeding, your child may have some extra fluids (oral, NG or IV). You can get advice from the infant feeding team as well.

How can I look after my child at home?

Most children do not need any specific treatment and get better on their own. As RSV is a virus, antibiotics do not help.

If you child is being breastfed or bottle fed, try giving them smaller feeds more frequently. Some additional water or juice may stop them from becoming dehydrated.

Do not smoke at home. Inhaling smoke from cigarettes or other tobacco products may aggravate your child’s symptoms. Passive smoking can affect the lining of your child’s airways, making them less resistant to infection. Smoke remains on your clothes even if you smoke outside. Speak to your GP if you would like help with stopping smoking.

Even though your child may be well enough at home, they may continue to have a cough for a few weeks. Providing your child is well and is feeding well there is no need for concern. The cough will gradually disappear by itself and does not need any special treatment. Cough medicines are usually ineffective.

When should I take my child to see the doctor?

You should take your child to see a doctor:

• if your child is not feeding enough (they have taken less than half their usual amount during the last 2 or 3 feeds)
• if your child has not had a wet nappy for 12 hours or more
• if you worried about your child’s breathing such as breathing very fast, struggling to breathe or any pauses in their breathing
• if your child seem very tired or miserable

If your child is unwell enough to have to stay in the hospital they may require additional support to help them breathe such as oxygen through a mask or help with feeding – this will be discussed with you by the doctors or nurses.

What tests will be done for my child?

During winter time, the hospital will do special rapid tests on your child. This includes suspected bronchiolitis. To do this rapid test a staff member will get a mucus sample using a technique called nasal pharyngeal aspirate (NPA). This sample will be sent to the laboratory for testing.

Outside winter times, the same tests will be done by the laboratory, but results may take a little longer to get back.

The most common type of virus is Respiratory Syncytial Virus (RSV).

When your child is admitted to hospital we will not know straight away what type of virus they have until results are available.

Usually your child will be admitted into one of the available RSV admission beds on M1 ward.

Once the result is available, depending whether your child has RSV positive or RSV negative bronchiolitis they will then be cohort nursed.

What is cohort nursing?

The aim of cohort nursing is to reduce the risk to other children with underlying health problems who do not have bronchiolitis.

Cohort nursing involves your child being nursed with others who have the same type of bronchiolitis in either a 4 or 6 bedded bay or a single room.

This may involve your child staying on M1 ward or being moved to a cohort bay on another ward. If this needs to happen, we will discuss it with you and explain at that time.

How can I reduce the risk of my child getting bronchiolitis?

This may be difficult as the virus can be anywhere and it is possible to get bronchiolitis more than once. The main thing to do is to try and reduce contact with other people who have coughs or colds and reduce their exposure to cigarette and cigar smoke.

Make sure that their environment at home is as clean as possible whilst there are symptoms in your home environment and continue to keep clean whilst symptoms continue.

Make sure that you wash your hands frequently to reduce the risk of spreading these viruses and bacteria if you do accidently touch them. The virus can live for up to 30 minutes on your hands.

It is important that you wash and dry your hands thoroughly after handling tissues, the toilet, baby nappy changes and before you eat.

Please do not enter other bed areas of the ward and stay within the bay or room your child’s bed is in.

We do encourage a parent or carer to be stay with your child but it is also important to keep other visitors including children under 5 years of age to a minimum. If you have any questions about visiting please speak to the nurses in charge on the ward.