Symptoms of Bronchiolitis in Babies

Bronchiolitis usually begins with symptoms that are very like a normal cold, such as cough and runny nose. Over the next few days, these symptoms develop. Bronchiolitis typically causes a slight fever along with a persistent, dry cough. Your child's breathing may become faster than normal and you might be able to hear a wheezing sound. Young babies can also have difficulty breathing and trouble feeding when they have bronchiolitis.

You might see some or all of the following symptoms of bronchiolitis in babies:

  • Blocked or runny nose
  • Mild fever
  • Dry, rasping cough that persists for up to three weeks
  • Wheezing or noisy breathing
  • Very brief pauses in breathing
  • Not wanting to feed as much as usual
  • Fewer wet nappies due to drinking less
  • Vomiting after feeding
  • Being more irritable than usual

The symptoms are usually at their worst between days three and five of the infection and then start to get better gradually. In most cases the symptoms are fairly mild and improve in about two to three weeks. However, you should always keep a close eye on your baby when he or she is ill so that you can seek medical advice if the symptoms get worse. Bronchiolitis in babies can cause more severe symptoms in some cases.

Causes of Bronchiolitis in Babies

Bronchiolitis is caused by a number of different respiratory viruses. The commonest is called respiratory syncytial virus (RSV) that most of us are exposed to in early childhood. Like other viruses, RSV spreads in coughs and sneezes and is most easily caught in the winter months. When a child who lacks immunity to the virus is infected, it can cause inflammation in the smallest airways that supply the lungs. Since these tubes are called bronchioles, the infection is known as bronchiolitis. The inflamed bronchioles swell up, which makes them narrower, preventing air from moving as easily in and out of the lungs. This causes the coughing and breathing difficulties that are characteristic of bronchiolitis.

Unfortunately, as with the common cold, there are different strains of RSV. This means that a child can be infected by RSV more than once and other viruses can also cause bronchiolitis. However, older children and adults rarely develop bronchiolitis even when they are exposed to RSV, because their lungs and immune systems are more mature. The virus will simply cause cold-like symptoms or a mild cough without affecting the bronchioles. Babies will therefore grow out of bronchiolitis and should only experience milder symptoms if they are infected with similar viruses in the future.

Since bronchiolitis is caused by viruses, it can easily spread between people. Every cough releases tiny droplets of moisture that each contain many copies of the virus that caused the infection. The droplets can be breathed in by other people or they may settle on nearby surfaces. Some viruses such as RSV can survive on surfaces for up to 24 hours. Anyone who touches those surfaces can then transfer to virus to their own eyes, nose or mouth and become infected.

The symptoms usually appear a few days after coming in contact with an infected person and children can remain infectious for up to three weeks after catching the virus. Your baby could spread the infection to other people as long as they are still coughing.

Babies will often catch the virus from other babies and children, especially if they have older siblings that attend schools or nurseries where they mix with other young children. However, viruses like RSV can also be spread by older children and adults who might only have mild symptoms. It’s best to keep young babies away from anyone with cold-like symptoms as much as possible. For example, you should ask any one who is ill to avoid visiting (especially when your baby is a newborn) or holding the baby. It is also a good idea for guests to wash their hands before holding the baby, just in case they’re carrying any viruses.

Babies are more likely to develop bronchiolitis when they’re infected with viruses like RSV if they are exposed to second-hand smoke or were breastfed for less than two months. Some babies can also be at higher risk of complications if they develop bronchiolitis. The symptoms can be more severe in babies who are under two months old when they are infected, were born prematurely, have a chronic lung condition or are affected by congenital heart disease. You should therefore take extra precautions to avoid infections if your baby is at higher risk for any reason.

You can reduce the chances of infections such as RSV spreading by:

  • Avoiding people with infections
  • Keeping sick children home from nursery, school or other public places
  • Teaching children to cover their mouths when they cough or sneeze
  • Cleaning toys and surfaces regularly, especially when a child is ill
  • Washing hands

Complications of Bronchiolitis in Babies

In some cases, the symptoms of bronchiolitis in babies can be more serious. A small number of babies who develop bronchiolitis will experience severe breathing difficulties, which may require treatment in hospital. Other potential complications include dehydration and in rare cases, secondary infections such as pneumonia. Serious symptoms are more common when the infection occurs in very young babies, in babies who were born prematurely with underdeveloped lungs, and in young children who have a heart or lung condition.

The possible complications of bronchiolitis in babies include:

  • Dehydration if your baby isn’t getting enough fluids or is unable to keep them down
  • Cyanosis, which turns the lips and skin a bluish colour when babies aren’t getting enough oxygen
  • Severe respiratory failure if babies aren’t able to breathe unaided
  • Secondary infections causing pneumonia

Although these kinds of complications are rare, it is important to be aware of them so that you can seek help when necessary. Additional treatment is sometimes required to help babies who have more severe symptoms or who are experiencing complications linked to bronchiolitis.

Bronchiolitis doesn’t usually cause any long-term problems, but the effects can sometimes linger for a while after the infection has cleared up. The delicate cells lining the airways can take some time to recover, so your child may continue to cough or wheeze for up to a few months, even when the other symptoms have disappeared.

Some evidence suggests that there could be a link between bronchiolitis in babies and asthma in older children. Babies who develop bronchiolitis may be more likely to be affected by asthma. However, the connection is still not fully understood and many babies who have bronchiolitis won’t develop asthma at all.

When to See a Doctor?

Although bronchiolitis is usually a mild condition, it can sometimes cause more serious symptoms. If your child has a very severe cough, a high fever, and breathing difficulty, or the symptoms have lasted longer than a few weeks, you should seek medical advice. You should definitely see a doctor if your child is having difficulty breathing or is showing signs of dehydration, such as infrequent urination.

Signs you need to see a doctor for bronchiolitis in babies include:

  • Persistent fever above 38 degrees Celsius
  • Taking less than half the usual amount during the last few feeds
  • Not having a wet nappy for more than 12 hours
  • Breathing very fast
  • Seeming unusually tired or irritable

If your baby is finding it difficult to breathe, if their breathing stops occasionally, or if you notice a blue colour around the lips or tongue, you should seek urgent medical care by calling 999 for an ambulance. You should also seek emergency care if your baby is unresponsive or unable to stay awake.

Respiratory symptoms that require emergency medical care for bronchiolitis in babies include:

  • Very rapid breathing
  • Pauses in breathing that can be frequent short pauses or less frequent longer pauses
  • Struggling or working very hard to breathe, which can cause grunting sounds or make the muscles under the ribs very visible as they suck in with each breath
  • Pale or bluish skin, usually around the lips

If your baby is less than three months old or has any underlying health problems, then it is particularly important to see a doctor if you’re concerned about an infection like bronchiolitis as the risk of complications can be higher.

Diagnosis and Treatment of Bronchiolitis

It is usually possible to diagnose bronchiolitis based on your child's symptoms and a physical examination including listening to the chest with a stethoscope. If the cause of the infection is confirmed as bronchiolitis, your doctor will usually be able to give you some advice on managing the symptoms at home.

Sometimes additional tests may be required to confirm the diagnosis of bronchiolitis in babies. The doctor may need to take a sample of mucus from your child’s nose or a blood or urine sample. These samples can be tested to identify the specific virus or bacteria that is causing the infection. A pulse oximeter test may also be performed to check the oxygen levels in your baby’s blood. It involves clipping a small electronic device onto your baby’s toe or finger and it is completely painless and non-invasive. The results can reveal how severely your baby’s airways have been affected and if they might need additional support.

Bronchiolitis can usually be treated in the same way as the flu. You should make sure that your child is drinking plenty of fluids. You might want to use infant paracetamol or ibuprofen to relieve the symptoms and bring the fever down if your child is distressed. Keeping your child in an upright position can help but be careful not to leave a very young baby alone or in an upright position for too long. Using an air humidifier can also help to soothe the symptoms of bronchiolitis, as air that is too dry can be more irritating to the airways.

If your child has bronchiolitis, it is important to take precautions to prevent the infection from spreading further, particularly to other young children or babies who are at risk of developing this condition if they catch RSV. You should make sure that you are washing your own hands and your child's hands frequently. Toys and surfaces also need to be washed often to get rid of any germs. It is also best to keep infected children at home until the symptoms clear up.

In some cases, bronchiolitis will need to be treated in hospital. If your child is experiencing breathing problems or other severe symptoms, your doctor may want to admit them for treatment. Your baby may need a face mask or nasal tube to ensure that he or she is getting enough oxygen. The hospital will also be able to provide nutrition through a feeding tube or IV if your baby is having trouble feeding. Most children who are admitted into hospital with bronchiolitis will be able to go home in a few days, once their condition has improved.

Bronchiolitis in babies is usually mild but it is important to be aware of the signs that your baby needs to see a doctor. It is always best to seek medical advice if you’re concerned about a respiratory infection. You can easily make an appointment with Professor Habibi if you think that your baby has bronchiolitis and you need advice on managing the symptoms.

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