Bronchiolitis

Written by S King Deputy Sister Paediatrics November 2011 Reviewed by: C. Kavanagh (Consultant – Paediatrics) March 2015 Next Review Due: March 2018

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BRONCHIOLITIS

This leaflet gives information to parents/ carers whose child has been diagnosed as having bronchiolitis. What is Bronchiolitis? Bronchiolitis is a common respiratory condition affecting babies and young children. It affects up to one in three babies, commonly during the winter months (November to March) in the UK. It is caused by inflammation of the small airways in the lungs called the bronchioles, which restricts the amount of air able to enter the lungs, making it more difficult for your child to breathe and feed. Babies at greater risk of developing severe bronchchiolits include premature babies and babies with existing medical heart or lung conditions. In most cases it is not a severe illness; however 3% of babies who are under one year of age and have bronchiolitis are admitted to hospital every year in the UK. What is the cause of Bronchiolitis? Bronchiolitis is caused by viruses. The most common virus that causes bronchiolitis is Respiratory Syncytial Virus (RSV) and is responsible for 80% of cases of bronchiolitis in babies and young children. Other viruses that can cause bronchiolitis include the Adenovirus and Rhinovirus. Can I prevent Bronchiolitis? No. the viruses that cause bronchiolitis in babies and young children also causes coughs and colds in older children and adults, so it is very difficult to prevent. What is the difference between Bronchiolitis and Bronchitis? Bronchiolitis should not be confused with bronchitis. Bronchitis is a condition that affects both adults and children. It occurs when an infection causes the bronchi (the larger airways in the lungs) to become irritated and swollen (inflamed), which causes more mucus than normal to be produce. The body will try and get rid of the extra mucus by coughing. Bronchiolitis is an inflammation of the smallest airways in the lungs (the bronchioles) which also produce thick sticky mucus, making it more difficult for babies and young children to breathe.


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What are the symptoms of Bronchiolitis? Bronchiolitis starts with cold like symptoms such as a runny nose,

rasping and persistent dry cough. Your baby may develop a mild temperature for two or three days. If

your baby has a temperature give him/her Paracetamol (Calpol ™). You must follow the instructions on the bottle carefully.

Fast breathing, difficulty breathing and wheezing (high pitched whistle noise) may develop.

Sometimes, in very young babies, bronchiolitis may cause them to have brief pauses in their breathing.

As breathing becomes more difficult, your baby may not be able to take their usual amount of milk either by breast or bottle. You may notice fewer wet nappies than usual.

Your baby may be sick after feeding and become irritable. You may notice your baby’s ribs are more noticeable due to the

increased effort of breathing. Bronchiolitis is caused by a virus so antibiotics will not help. Make sure your baby is not exposed to tobacco smoke. Passive

smoking can seriously damage your baby’s health. It makes breathing problems like bronchiolitis worse.

How long does Bronchiolitis last?

Most babies with bronchiolitis get better within 2 weeks. They may still have a cough for a few more weeks.

Your baby can go back to nursery as soon as they are well enough (that is feeding normally and with no difficulty breathing).

There is usually no need to see your GP if your baby is recovering well. If you are worried about your baby’s progress, discuss this with your GP or health visitor.

When should I get advice? F.A.C.T Babies who have a more severe case of bronchiolitis usually exhibit four specific symptoms, the most significant of which is a distinctive rasping cough Fast breathing: shallow, quick breaths not taking in much air Appetite: inability to feed normally Cough: distinctive rasping cough Temperature: high temperature will usually accompany cold like symptoms of a runny nose Contact your GP if: Your baby exhibits all of the above symptoms or,

You are worried about your baby Your baby is having difficulty breathing Your baby is taking less than half his/her usual feeds over two or

three feeds, or has no wet nappies for 12 hours Your baby has a high temperature Your baby seems very tired and irritable.


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Dial 999 for an ambulance if:

Your baby is having a lot of difficulty breathing, is pale or sweaty.

Your baby’s tongue or lips look blue. There are long pauses in your baby’s breathing.

Hospital treatment for Bronchiolitis About 2 in 10 babies and young children with bronchiolitis may need hospital admission. When in hospital

Your baby will be examined by a doctor and assessed regularly by a nurse.

Your baby’s oxygen levels will be checked using an oximeter placed on their finger or foot. It measures the oxygen levels in your baby’s blood, and helps doctors and nurses assess your babies breathing.

If your baby needs help to breathe or feed he/she will probably need to stay in hospital.

One parent/carer will be able to stay with your baby while he/she is in hospital.

If your baby’s oxygen levels are low (below 92%) they will be given oxygen either via a face mask or small tubes placed in their nose.

To confirm the cause of the bronchiolitis, some mucus from your baby’s nose will be taken to determine the virus causing the illness. This is important so that babies can be nursed in separate rooms or bays to stop the virus spreading to other children.

If your baby has problems feeding he/she may need to be fed through a feeding tube. This is a fine, plastic tube passed through your baby’s nose or mouth into their stomach.

Some babies may need to be given a drip to make sure they are getting enough fluids.

Seriously ill babies may require more high dependency care or even intensive care for help with their breathing. (see CPAP information leaflet)

Your child may be given Paracetamol especially if they have a high temperature.

Your child will be nursed in a separate room, maybe with other babies who have the same type of virus.

You will need to wash your hands, or use hand gel frequently when caring for your child.

Visiting restrictions may be recommended to prevent the spread of infection.


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Prevention The viruses that cause bronchiolitis are very common and easily spread. It is therefore, not possible to prevent the condition altogether, but there are some simple steps to reduce the chances of your child getting bronchiolitis. If your child already has bronchiolitis then these simple steps can help prevent the infection spreading further:

Wash your hands regularly with soap and water- especially before and after you touch your baby. Make sure siblings and visitors wash their hands too.

Cover your child’s mouth and nose when they cough or sneeze. Try to keep away from other children and adults who have cold like

symptoms or are unwell. Wash or wipe toys regularly to prevent the spread of germs. Ensure your baby is kept away from tobacco smoke. Never allow

anyone to smoke around your baby. After leaving hospital

Your child will be discharged from hospital when oxygen treatment has stopped for at least 12 hours and they are feeding well.

After discharge if you become worried about your baby see your GP or Health Visitor.

Long term effects of having had Bronchiolitis

Your baby may have a cough and wheeze for some time after the first infection

Most babies recover well from bronchiolitis and do not have any long term breathing problems or ill health

However, RSV bronchiolitis may cause recurrent wheezing with each cold your child has. You child may need medication/ inhalers if the wheezing persists and causes breathing difficulties.

Bronchiolitis

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