Bronchiolitis

Overview

Bronchiolitis is a common chest infection in babies and young children. It affects the small breathing tubes in the lungs called bronchioles. The tubes get swollen and filled with mucus, making it harder for your child to breathe.

Yes, bronchiolitis is very common. Nearly all children will get it at least once before they are 2 years old. It is most common in the winter months.

Bronchiolitis mostly affects babies and young children under 2 years old. Babies under 6 months are most likely to become seriously ill, especially if they were born prematurely or have heart, lung, or immune problems.

Symptoms

Common symptoms

• Runny or blocked nose
• Mild cough
• Mild fever
• Feeding less than usual
• Faster or harder breathing
• Mild wheezing (whistling sound when breathing)
• Being irritable or unsettled
• Tiredness and low energy

Symptoms in children

• Symptoms usually start like a cold, with a runny nose and cough.
• Your child may develop a slightly hoarse voice or a croupy cough.
• Breathing can become quicker and more effortful, and a wheeze may appear.
• Your child may want smaller, more frequent feeds and may be less interested in food.
• Some children have pauses in breathing, especially if they were born early.

Symptoms in older adults

• Bronchiolitis is very rare in older adults. It mainly affects babies.
• An older adult with symptoms like a bad cough and breathlessness might have a different chest infection, such as bronchitis or pneumonia.
• If an older adult has a persistent cough, fever, or difficulty breathing, they should see a healthcare professional promptly.

Causes

Main causes

• They are nearly always caused by a virus, most commonly the respiratory syncytial virus (RSV).
• Other viruses can also cause it, such as rhinovirus (the common cold virus), influenza, or adenovirus.
• The virus spreads through tiny drops from coughs and sneezes, or by touching dirty surfaces.

Risk factors

• Being younger than 6 months
• Being born prematurely (before 37 weeks)
• Having a heart or lung condition
• Having a weakened immune system
• Living with someone who smokes
• Being exposed to smoke during pregnancy
• Being around older siblings or in childcare, where viruses spread easily

When to see a doctor

See a doctor urgently if:

• Your child is having trouble breathing or breaths much faster than normal.
• Your child is feeding very poorly or has signs of dehydration (fewer wet nappies, dry mouth, sunken eyes).
• Your child has a high fever that does not come down with recommended fever care.
• Your child is very sleepy or hard to wake.

Book a routine appointment if:

• Your child has a cough that lasts longer than 3 weeks.
• You are worried about any symptom, even if your child seems generally okay.
• Your child is also unwell in other ways, such as vomiting or a rash.

Diagnosis

A doctor or nurse usually makes the diagnosis by asking about your child's symptoms and listening to their chest with a stethoscope. In most cases, a simple clinical check is enough and no tests are needed.

Tests that may be done

• Pulse oximetry – a small clip on the finger or toe to measure how much oxygen is in the blood
• A nose or throat swab – to confirm which virus is causing the illness
• A chest X-ray – only if the doctor is worried about complications or a different diagnosis

What to expect at your appointment

The doctor will watch your child's breathing, check their oxygen levels, and ask about feeding and wet nappies. If your child needs hospital care, they may be admitted overnight for oxygen, fluids, and monitoring. Most children do not need to stay in hospital.

Treatment

Bronchiolitis is caused by a virus, so antibiotics do not help. Treatment is all about supporting your child until the infection clears. Most children only need care at home, but some need extra help in hospital.

Self-care at home

• Keep your child upright to help them breathe more easily, for example while feeding or resting.
• Offer small, frequent feeds – breast milk or formula is fine for babies.
• Clear a blocked nose with saline (salt water) drops and a gentle suction bulb, as advised by a pharmacist or nurse.
• Hold your child close and comfort them, so they stay calm.
• Keep a cool-mist humidifier or a bowl of water near the cot to moisten the air (never use a hot steam humidifier).
• Keep the room at a comfortable temperature and don't over-dress your child.
• Never smoke or let others smoke near your child.

Medical treatments

If your child needs hospital care, treatment focuses on helping their breathing. This may include extra oxygen through small tubes, suction to clear mucus from the nose and airways, and fluids given through a tube into a vein if your child is not drinking enough. Fever can be managed with simple measures and medication if recommended by a healthcare professional. Antibiotics are only used if there is a separate bacterial infection.

When is surgery considered?

Surgery is not used to treat bronchiolitis. It is not needed in any stage of this condition.

Living with this condition

Caring for a child with bronchiolitis can be exhausting. Keep a close eye on their breathing, feeding, and wet nappies each day. Write down any changes and don't be afraid to call your GP or health visitor for advice.

Lifestyle tips

• Wash your hands often with soap and water, especially after nappy changes.
• Clean toys and surfaces that your child touches.
• Keep your child away from other sick people and crowded indoor places until they are better.
• Make the home smoke-free, and do not let anyone smoke near your child.
• Provide a quiet, calm environment so your child can rest.

Diet and exercise

For babies, keep offering breast milk or formula regularly, even if they take less than normal. If your child is on solid foods, offer light foods like soup or mashed vegetables. Do not worry about normal exercise – a child with bronchiolitis needs rest, not activity. You can return to usual play once they are better.

Mental health and emotional wellbeing

Watching your child struggle to breathe is frightening. It is normal to feel anxious and stressed. Take breaks when you can, and remember that this phase will pass. If you feel overwhelmed, talk to your GP, health visitor, or a trusted friend.

Prevention

It is not always possible to prevent bronchiolitis, but you can reduce the risk by keeping your baby away from people with colds, washing hands regularly, and cleaning surfaces. Do not expose your baby to tobacco smoke, and if possible, breastfeed, as breast milk helps protect against infections.

Vaccines

There is no routine vaccine that protects everyone against bronchiolitis. However, some countries offer preventive medicines for babies at high risk, such as those born very early or with heart/lung problems. Ask your healthcare provider about what might be available in your area.

Screening programmes

There is no routine screening test for bronchiolitis in healthy children. Screening is only considered for specific research or very high-risk groups under specialist care.

Complications

If left untreated

• Dehydration from poor feeding
• Difficulty breathing that may require hospital care
• Pneumonia or another secondary infection
• Severe pauses in breathing in premature babies or those under 6 weeks
• In rare cases, respiratory failure, where breathing becomes so difficult that urgent support is needed

Long-term outlook

The outlook is very good. Most children recover completely within a few weeks with no lasting effects. Some children continue to have a wheeze or cough for a few weeks, but this usually clears. Severe complications are rare, especially with careful monitoring and early medical help.

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