Somerset Pediatrics
Bronchiolitis
What is it?
Bronchiolitis is the leading cause of hospitalization for infants in the United States
with over 100,000 admissions annually. It is usually seen from December through
April. It is a viral infection that begins as an upper respiratory infection and then
progresses to involve the lower small airways of the lung, known as bronchioles.
These tiny airways become swollen and filled with mucus, making it difficult to
breathe. Small infants and babies are more susceptible to severe disease
secondary to the very small diameter of these airways.
The most common cause of bronchiolitis is respiratory synctial virus, or RSV. This is
a common wintertime virus in the Northern Hemisphere. Other viruses such as
influenza (flu), rhinovirus and human metapneumovirus (HMPV) can also cause
bronchiolitis.
Infants with a history of prematurity, congenital disorders (problems they are
born with) such as congenital heart or lung disease, or live in homes with
smokers are at higher risk of severe bronchiolitis.
What are the Signs and Symptoms?
Bronchiolitis often begins as a typical cold with runny nose, congestion, cough,
sneezing, and fever. It then progresses to involve the lower airways. The child
may have difficulty breathing, fast breathing, wheezing, nostril flaring and/or
chest muscles “pulling in” called retractions. Some infants can become
dehydrated from vomiting or refusal to drink because of nasal blockage. The
illness can be prolonged, lasting two – three weeks.
How is it treated?
The primary treatment for bronchiolitis is “supportive.” This includes keeping the
nasal passages open with saline (salt water) drops and a suction bulb. It is
important to try to keep the baby hydrated. Offering infants smaller volumes of
milk more frequently is often helpful while they are ill. It is important that infants
and babies avoid being exposed to smoke. This will further irritate the airways
and make it more difficult for the child to breathe. The use of a cool-mist
vaporizer can also be helpful in keeping the air moist and loosening up
secretions. Fever can be treated with appropriate dosing of acetaminophen
and/or ibuprofen. It is important to watch for signs of breathing difficulty, i.e. fast
breathing, sinking of chest or “pulling” of the neck muscles. Hospitalization may
be required if the infant needs frequent intensive nasal suctioning, intravenous
fluids and/or supplemental oxygen. A few infants require assisted breathing
support with a ventilator until they are improved.
Unfortunately, there are no treatments that have been shown to shorten the
duration of bronchiolitis. Children are often given “breathing treatments” of
medicines such as albuterol or epinephrine. These may help a very small
percentage of infants breathe easier. Antibiotics have no role since bronchiolitis
is a viral disease, not a bacterial disease. Other treatments such as over-thecounter cold remedies are not recommended, and infant preparations have
recently been withdrawn from the market.