Bronchiolitis

What is bronchiolitis?

Bronchiolitis is a lung infection caused by a virus. The average age of children who get bronchiolitis is 6 months. They are never older than 2 years.

The symptoms of bronchiolitis include:

• wheezing (making a high-pitched whistling sound when breathing out)
• breathing rapidly at a rate of over 40 breaths per minute
• tight breathing (having to push the air out)
• coughing (may cough up very sticky mucus)
• a fever and a runny nose that precede the breathing problems and cough.

The symptoms are similar to asthma.

What is the cause?

The wheezing is caused by the narrowing of the smallest airways in the lung (bronchioles). This narrowing results from inflammation (swelling) caused by a virus, usually the respiratory syncytial virus (RSV). RSV occurs in epidemics every winter. While infants with RSV develop bronchiolitis, children over age 2 years and adults usually just develop cold symptoms.

The virus is in nasal secretions of infected people. It is spread by an infected person who sneezes or coughs less than 6 feet away from someone else or by contact with his or her hands after touching the nose or eyes.

People do not develop permanent immunity to RSV, which means that they can be infected by it many times.

Why was my child admitted to the hospital?

Main complication: _____________________________________________.

___ Needs oxygen.

___ Needs suctioning of the airways.

___ Needs antibiotic or other medicine.

___ Needs IV fluids.

___ Other reasons: ______________________________________________.

How long will it last?

Wheezing and tight breathing (trouble breathing out) become worse for 2 or 3 days and then begin to improve. Overall, the wheezing lasts approximately 7 days and the cough about 14 days.

The most common complication of bronchiolitis is an ear infection, which occurs in about 20% of infants. Bacterial pneumonia is an uncommon complication. Only 1% or 2% of children with bronchiolitis are hospitalized.

What are the requirements for discharge?

• _____________________________________________________
• _____________________________________________________
• _____________________________________________________

How can I take care of my child?

• Medicines

  About 1/3 of children with bronchiolitis are helped by asthma medicines. Your health care provider may prescribe medicine for your child.

  Your child's medicine is __________________. Give _____ every ____ hours. Continue the medicine until your child's wheezing is gone for 24 hours.

• Other medicines

  For pain or fever over 102°F (39°C) give:

  ____ mg of acetaminophen every 4 to 6 hours OR

  ____ mg of ibuprofen every 6 to 8 hours

  ______________________________________________________________

  ______________________________________________________________

• Warm fluids for coughing spasms

  Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer warm lemonade or apple juice if your child is over 4 months old.

  In addition, breathing warm, moist air helps to loosen the sticky mucus that may be choking your child. You can provide warm mist by placing a warm, wet washcloth loosely over your child's nose and mouth. Or you can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.

• Humidity

  Dry air tends to make coughs worse. Use a humidifier in your child's bedroom.

• Suction of a blocked nose

  If the nose is blocked up, your child will not be able to drink from a bottle or to breast-feed. Most stuffy noses are blocked by dry or sticky mucus. Suction alone cannot remove dry secretions. Warm tap-water or saline nosedrops are better than any medicine you can buy for loosening up mucus. Place three drops of warm water or saline in each nostril. After about one minute, use a soft rubber suction bulb to suck out the mucus. You can repeat this procedure several times until your child's breathing through the nose becomes quiet and easy.

• Feedings

  Encourage your child to drink enough fluids.

  Eating is often tiring, so offer your child breast milk, formula, or regular milk (if he is over 1 year old) in smaller amounts at more frequent intervals. If your child vomits during a coughing spasm, feed him or her again.

• No smoking

  Tobacco smoke aggravates coughing. Children who have an RSV infection are much more likely to wheeze if they are exposed to tobacco smoke. Don't let anyone smoke around your child. In fact, try not to let anybody smoke inside your home.

• Additional instructions

  _______________________________________________________

  _______________________________________________________

  _______________________________________________________

When should my child be seen again?

___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

___ A follow-up appointment is not necessary. Call the doctor if you have any concerns.

When should I call my child's health care provider?

Call IMMEDIATELY if:

• Breathing becomes labored or difficult.
• The wheezing becomes severe (tight).
• Breathing becomes faster than 60 breaths per minute (when your child is not crying).

Call within 24 hours if:

• Any fever lasts more than 3 days.
• Your child is drinking much less or having fewer wet diapers.
• The cough lasts more than 3 weeks.
• You have other questions or concerns.