Bronchiolitis in young children and infants.

Symptoms

For the first few days, the signs and symptoms of bronchiolitis are similar to those of a cold:

• Runny nose
• Stuffy nose
• Cough
• A slight fever (not always present)

After this, there may be a week or more of difficulty breathing or a whistling noise when the child breathes out (wheezing).

Many infants also have an ear infection (otitis media).

When to see a doctor

If it’s difficult to get your child to eat or drink and his or her breathing becomes more rapid or labored, call your child’s doctor. This is especially important if your child is younger than 12 weeks old or has other risk factors for bronchiolitis — including premature birth or a heart or lung condition.

The following signs and symptoms are reasons to seek prompt medical attention:

• Audible wheezing sounds
• Breathing very fast — more than 60 breaths a minute (tachypnea) — and shallowly
• Labored breathing — the ribs seem to suck inward when the infant inhales
• Sluggish or lethargic appearance
• Refusal to drink enough or breathing too fast to eat or drink
• Skin turning blue, especially the lips and fingernails (cyanosis)

Causes

Bronchiolitis occurs when a virus infects the bronchioles, which are the smallest airways in your lungs. The infection makes the bronchioles swell and become inflamed. Mucus collects in these airways, which makes it difficult for air to flow freely in and out of the lungs.

Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by 2 years of age. Outbreaks of RSV infection occur every winter, and individuals can be reinfected, as the previous infection does not appear to cause lasting immunity. Bronchiolitis also can be caused by other viruses, including those that cause the flu or the common cold.

The viruses that cause bronchiolitis are easily spread. You can contact them through droplets in the air when someone who is sick coughs, sneezes, or talks. You can also get them by touching shared objects — such as utensils, towels or toys — and then touching your eyes, nose or mouth.

Risk factors

Bronchiolitis typically affects children under the age of 2 years. Infants younger than 3 months of age are at the greatest risk of getting bronchiolitis because their lungs and immune systems aren’t yet fully developed.

Other factors that are linked with an increased risk of bronchiolitis in infants and with more-severe cases include:

• Premature birth
• Underlying heart or lung condition
• Depressed immune system
• Exposure to tobacco smoke
• Never having been breast-fed (breast-fed babies receive immune benefits from the mother)
• Contact with multiple children, such as in a child care setting
• Spending time in crowded environments
• Having siblings who attend a school or get child care services and bring home the infection

Complications

Complications of severe bronchiolitis may include:

• Blue lips or skin (cyanosis), caused by lack of oxygen
• Pauses in breathing (apnea), which is most likely to occur in premature babies and in babies within the first two months of life
• Dehydration
• Low oxygen levels and respiratory failure

If these occur, your child may need to be in the hospital. Severe respiratory failure may require that a tube be inserted into the windpipe (trachea) to help the child’s breathing until the infection has run its course.

If your baby was born prematurely, has a heart or lung condition, or has a depressed immune system, watch closely for beginning signs of bronchiolitis. The infection can quickly become severe. In such cases, your child will usually need hospitalization.

Prevention

Because the viruses that cause bronchiolitis spread from person to person, one of the best ways to prevent it is to wash your hands frequently — especially before touching your baby when you have a cold or other respiratory illness. Wearing a face mask at this time is appropriate.

If your child has bronchiolitis, keep him or her at home until the illness is past to avoid spreading it to others.

Other commonsense ways to help curb infection include:

• Limit contact with people who have a fever or cold. If your child is a newborn, especially a premature newborn, avoid exposure to people with colds, especially in the first two months of life.
• Clean and disinfect surfaces. Clean and disinfect surfaces and objects that people frequently touch, such as toys and doorknobs. This is especially important if a family member is sick.
• Cover coughs and sneezes. Cover your mouth and nose with a tissue. Then throw away the tissue and wash your hands or use alcohol-based hand sanitizer.
• Use your own drinking glass. Don’t share glasses with others, especially if someone in your family is ill.
• Wash hands often. Frequently wash your own hands and those of your child. Keep an alcohol-based hand sanitizer handy for yourself and your child when you’re away from home.
• Breast-feed. Respiratory infections are significantly less common in breast-fed babies.

Vaccines and medications

There are no vaccines for the most common causes of bronchiolitis (RSV and rhinovirus). However, an annual flu shot is recommended for everyone older than 6 months.

Infants at high risk of RSV infection, such as those born prematurely or with a heart or lung condition or who have a depressed immune system, maybe given the medication palivizumab (Synagis) to decrease the likelihood of RSV infections.

Source: Mayoclinic