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What to know about bronchiolitis | Ask the Pediatrician

Bronchiolitis affects mostly kids under 2. Here's how to recognize and deal with it.

Tis the season for coughing and wheezing, runny noses and chills. Tending to kids with respiratory illness symptoms is just a (less glamorous) part of parenting. But between COVID, parainfluenza, RSV and a high number of pediatric hospitalizations for respiratory illnesses this year, it can come with an extra dose of worry. Most cases resolve themselves with care, but children do need to be watched for more concerning symptoms. With an infant or young child, after three to five days a respiratory infection can turn into “bronchiolitis,” a lower respiratory tract infection that mostly affects children under 2 years old.

Let’s talk about bronchiolitis, caring for your little one, when to call your pediatrician, and what severe symptoms to watch for.


What is bronchiolitis?

Bronchiolitis is a viral infection that affects tubes in the lungs called the “bronchioles.” When infected, they get swollen and full of mucus. That makes it hard to breathe.

Bronchiolitis is the leading cause of hospitalization in infants and young children. RSV (respiratory syncytial virus) is the most common cause, but it’s also caused by many other respiratory viruses including influenza and parainfluenza, rhinovirus (which you likely think of as the common cold), and COVID infections.


What should I look for with bronchiolitis?

Bronchiolitis usually develops following one to three days of common virus symptoms including stuffy or runny nose, cough, fever higher than 100.4 ºF, decreased appetite or difficulty eating. The symptoms can progress to more severe coughing, wheezing and congestion, and sometimes difficulty breathing. Keep in mind that symptoms can get worse before they get better and they can last a full two weeks.

Many children with bronchiolitis do not need to see a doctor. If you’re concerned about your child’s symptoms from a respiratory illness, get in touch with your pediatrician early on to help monitor your child’s breathing and follow up over the course of the illness.

Recently, area hospitals have been seeing limited pediatric bed space because of bronchiolitis and respiratory illnesses including RSV and flu. Contact your pediatrician first if you have questions, unless it’s a life-threatening emergency or symptoms are severely affecting your baby or child’s ability to drink, eat and breathe. Watch for these signs or symptoms of worsening illness:

  • If you see increased rate of breathing, worsening chest retractions, nasal flaring, a decreased ability to feed or decreased urine output, contact your provider or call the nurse consulting line.
  • A child who is grunting, appears to be tiring, stops breathing, or has cyanosis (blue tinged skin) needs urgent medical attention.

How is bronchiolitis treated?

There is no cure for bronchiolitis, so treatment is aimed at the controlling symptoms like difficulty breathing and fever. Antibiotics, cough medicines, decongestants, and sedatives are not recommended. For home treatment:

  • Reduce the fever: Acetaminophen (for children at all ages) and ibuprofen (for children six months and older) can be given to help reduce a fever. Aspirin should not be given to any child.
  • Encourage fluids: Your child might not be drinking or eating normally. Offer fluids frequently and watch for signs of dehydration like a child is refusing fluids or has fewer wet diapers than normal.
  • Deal with the snot: Nasal suction is key even if it sounds unpleasant. Infants and toddlers can be treated with nasal saline drops to loosen phlegm, and then use a nasal aspirator to remove nasal secretions. It’s called a ‘snot sucker’ and it works! An older child can use saline nose spray and blow their nose to remove phlegm.


How do I avoid bronchiolitis?

All of these viruses are contagious. Thanks (?!) to the pandemic, we’ve gotten very familiar with the simple daily measures we can take to avoid viruses; let’s keep it up.

  • Hand washing: RSV and other viruses can last on hands and surfaces for several hours. Keep on the frequent handwashing for kids and adults, and wash hands or use an alcohol-based hand sanitizer before handling an infant.
  • Stay home: Many of these illness from RSV to Covid to even some allergies have common symptoms. It might not be clear what infection your child has, so keep your kids at home if they are experiencing symptoms.
  • Get those flu shots and COVID vaccines/boosters: Anyone 6 months and older is eligible for the flu vaccine. The updated Pfizer-BioNTech Covid booster is recommended for anyone 5 years or older who received an initial vaccination or booster shot at least two months ago. Even if you or your child has had Covid, it’s important to still get vaccinated as natural immunity declines over time.


Read more about RSV from a Kaiser Permanente colleague here [link to Seattle’s Child RSV article ].

More from Dr. Block and Kaiser Permanente in Seattle’s Child:


About the Author

Susanna Block

Dr. Susanna Block, MD, MPH, is a pediatrician with Kaiser Permanente in Seattle and lives with her family in Queen Anne.