What is acute bronchiolitis?
Acute bronchiolitis is a common respiratory tract infection involving the smallest breathing tubes in the lungs called the bronchioles.
A virus usually causes the illness. Respiratory syncytial virus (RSV) is most common, but parainfluenza virus and adenovirus can also do it.
The viruses are spread from person to person by sneezing and coughing, and by direct hand-to-hand contact.
Exposure to cigarette smoke and being around many children or in an enclosed environment, such as in a day care center, increases the risk of infection and illness.
Bronchiolitis is most common in winter and early spring, and may occur in minor epidemics.
Children under 2 years are especially prone to bronchiolitis. It is most common in males between 2 and 6 months old and in children who have not been breastfed.
Babies who are born prematurely are also at increased risk.
Symptoms and Signs
The disease starts out as an upper respiratory infection (URI) such as a common cold. The child will have a runny, stuffy nose and sneezing, but then, after a few days, fever and a harsh, tight cough appear.
The child will develop rapid breathing, and may use extra breathing muscles, especially in the neck, between the ribs and below the rib cage. The child will usually have difficulty with breathing out (exhalation) and wheezing may occur.
Very young children who develop bronchiolitis may have problems sleeping and eating. Large amounts of thick secretions in the airway may lead to vomiting or mucous in the stool.
Breathing difficulty is one of the most worrisome complications of bronchiolitis. The breathing of children under 6 months old may be severely affected, and a doctor should be contacted if there is any sign of labored breathing. In addition, how much food and liquids are taken by mouth tends to go down due to difficulty breathing and the vomiting that frequently occurs in connection with attacks of coughing. Increased mucus formation in the airways may plug up areas of the lungs, leading to collapse and inflammation of the lung tissue, and sometimes bacterial infection (pneumonia).
Treatment / What you should do
If you suspect that your child has bronchiolitis, you should contact your doctor.
If your child has difficulty breathing, such as rapid breathing (60-80 times a minute), is using extra breathing muscles, has short breathing pauses, or is having difficulty with exhalation, you should contact the doctor or call 911 immediately.
You should also contact your doctor or call 911, if your child's skin color becomes pale or blue, if your child's general condition is significantly reduced, or if your child has a rising fever.
You must also contact your doctor if your child is drinking or eating less than normal. If your child is not drinking much and shows signs of dehydration, you should contact your doctor right away.
Smaller children with severe breathing problems may need treatment with a medicine that is breathed in to help open their airways.
In some cases, hospitalization is necessary so that extra oxygen can be given to make breathing easier or intravenous fluids can be used to treat dehydration. Antibiotics usually are only given in serious cases where a bacterial infection is suspected at the same time.
If your child has mild bronchiolitis and your doctor decides that he does not need to be hospitalized, there are some measures you can take at home to relieve the symptoms.
A cool mist vaporizer, or humidifier, in the bedroom often makes it easier to breathe.
Raising the head end of an infant's bed, or placing an extra pillow under the head of an older child, makes it easier for the child to breathe.
Make sure that your child gets enough to drink since this will make the mucus in the respiratory passages less thick, and easier to cough up.
Give your child saline nose drops so that it becomes easier to breath through the nose if there is nasal congestion. It is important for you to act calmly with your child so that he or she could does not become more anxious, making breathing even more difficult.
Give acetaminophen if your child has a fever or discomfort, since this can improve how he feels and often makes it easier to drink so he doesn't become dehydrated.
It is difficult to totally keep your child away from the viruses that cause bronchiolitis.
Fortunately, not all children with bronchiolitis are affected enough to require medical attention.
If your child has this illness, you should avoid contact with other infants until any fever is gone and he or she feels well enough. Frequent hand washing, avoiding people with colds and avoiding exposure to cigarette smoke will reduce the risk of infection and sickness.
Children with a high risk for developing bronchiolitis, such as children born prematurely or those with known lung or heart diseases, will be offered a medicine that helps protect against RSV in order to reduce the risk of developing bronchiolitis. Such medication is given in the form of monthly injections, and it is given only to selected groups of high-risk children. If you think your child is a candidate for this medicine, you should discuss this with your child's doctor.
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