Is this your child’s symptom?

• Your child has been diagnosed with bronchiolitis
• It’s an infection of the smallest airways in the lungs
• Caused by a virus called RSV (respiratory syncytial virus)
• Wheezing during the first 2 years of life is often caused by bronchiolitis
• You wonder if your child needs to be seen again

Symptoms of Bronchiolitis

• Wheezing is the main symptom that helps with diagnosis. Wheezing is a high-pitched purring or whistling sound.
• You can hear it best when your child is breathing out.
• Rapid breathing at a rate of over 40 breaths per minute.
• Tight breathing (having to work hard to push air out).
• Coughing (may cough up very sticky mucus).
• Fever and a runny nose often start before the breathing problems.
• The average age for getting bronchiolitis is 6 months (range: birth to 2 years).
• Symptoms are like asthma.
• About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times.

Cause of Bronchiolitis

• A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus.
• The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter.
• People do not develop life-long immunity to the RSV virus. This means they can be infected many times.

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

• Struggling for each breath or short of breath.
• Tight breathing so that your child can barely speak or cry.
• Ribs are pulling in with each breath (called retractions).
• Breathing has become noisy (such as wheezes).
• Breathing is much faster than normal.
• Lips or face turn a blue color.

Diagnosis of Bronchiolitis

• A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope.

Prevention of Spread to Others

• Cover the nose and mouth with a tissue when coughing or sneezing.
• Wash hands often. After coughing or sneezing are important times.

When to Call for Bronchiolitis-RSV

Call 911 Now

• Severe trouble breathing (struggling for each breath, can barely speak or cry)
• Passed out or stopped breathing
• Lips or face are bluish when not coughing
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Trouble breathing, but not severe
• Lips or face have turned bluish, but only during coughing
• New harsh sound with breathing in (called stridor)
• Wheezing (purring or whistling sound) is worse than when seen
• Breathing is much faster than when seen
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, no tears.
• High-risk child (such as chronic lung disease) and getting worse
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Age less than 6 months old and worse in any way
• Fever over 104° F (40° C)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Nonstop coughing spells
• Trouble feeding worse than when seen
• Earache or ear drainage
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Coughing causes vomiting 3 or more times
• Mild wheezing sounds last more than 7 days
• Cough lasts more than 3 weeks
• You have other questions or concerns

Self Care at Home

• Bronchiolitis same or better than when last seen

Care Advice for Bronchiolitis

1. What You Should Know About Bronchiolitis:
   • Bronchiolitis is common during the first 2 years of life.
   • Most children just have coughing and fast breathing.
   • Some develop wheezing. This means the lower airway is getting tight.
   • If you were given a follow-up appointment, be sure to keep it.
   • Here is some care advice that should help.
2. Asthma Medicines:
   • Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines.
   • If one has been prescribed for your child, give it as instructed.
   • Keep giving the medicine until your child’s wheezing is gone for 24 hours.
3. Coughing Fits or Spells:
   • Breathe warm mist (such as with shower running in a closed bathroom).
   • Give warm clear fluids to drink. Examples are apple juice and lemonade.
   • Age less than 6 months, only give breast milk or formula.
   • Amount. If 6 – 12 months of age, give 1-2 teaspoons (5-10 mL) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
   • Reason: Both relax the airway and loosen up any phlegm.
4. Homemade Cough Medicine:
   • Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using these tips:
   • Age 6 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-2 teaspoons (5-10 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
   • Age 1 year and older: Use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough. If you don’t have any honey, you can use corn syrup.
5. Nasal Saline to Open a Blocked Nose:
   • Your baby can’t nurse or drink from a bottle if the nose is blocked. Suction alone can’t remove dry or sticky mucus.
   • Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don’t have saline, you can use a few drops of bottled water or clean tap water. If under 1 year old, use bottled water or boiled tap water.
   • Step 1: Put 3 drops in each nostril. (If age under 1 year old, use 1 drop).
   • Step 2: Suction each nostril out while closing off the other nostril. Then, do the other side.
   • Step 3: Repeat nose drops and suctioning until the discharge is clear.
   • How often: Do nasal saline when your child can’t breathe through the nose. Limit: No more than 4 times per day.
   • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
   • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction.
6. Humidifier:
   • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
7. Smaller Feedings:
   • Use small, frequent feedings whenever your child has the energy to drink.
   • Reason: Children with wheezing don’t have enough energy for long feedings.
   • Offer enough fluids to prevent dehydration.
8. Avoid Tobacco Smoke:
   • Tobacco smoke makes coughs and wheezing much worse.
   • Don’t let anyone smoke around your child.
9. What to Expect:
   • Wheezing and rapid breathing most often improve over 2 or 3 days.
   • Mild wheezing sounds can last up to 1 week.
   • Coughing may last 3 weeks.
   • Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein.
10. Return to Child Care:
    • Your child can return to child care after the wheezing and fever are gone.
11. Call Your Doctor If:
    • Trouble breathing occurs
    • Wheezing gets worse (becomes tight)
    • Trouble feeding occurs
    • Fever lasts more than 3 days
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 01/16/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

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