Bronchiolitis is a common respiratory infection that primarily affects infants and young children under two years of age. This condition causes inflammation and congestion in the small airways (bronchioles) of the lungs, making it difficult for children to breathe properly. Understanding the symptoms of bronchiolitis is crucial for parents and caregivers, as early recognition can help ensure timely medical attention and proper care for affected children.
Most cases of bronchiolitis occur during the winter months and are caused by viral infections, with respiratory syncytial virus (RSV) being the most common culprit. While bronchiolitis can be concerning, knowing what symptoms to look for can help you respond appropriately and seek medical care when necessary.
1. Persistent Cough
One of the earliest and most noticeable symptoms of bronchiolitis is a persistent cough. This cough typically starts mild but can gradually worsen over several days as the infection progresses.
The cough associated with bronchiolitis is often dry initially but may become more frequent and forceful as inflammation increases in the airways. Parents may notice that the cough sounds harsh or is accompanied by a rattling sound in the chest. The cough can be particularly bothersome during nighttime, disrupting the child’s sleep and causing distress for both the child and parents.
Key characteristics:
- Begins as a dry, irritating cough
- Becomes more frequent over time
- May sound harsh or raspy
- Often worse at night
- Can persist for several weeks even after other symptoms improve
2. Wheezing
Wheezing is a high-pitched whistling sound that occurs when a child breathes, particularly during exhalation. This symptom is a hallmark sign of bronchiolitis and indicates that the small airways are narrowed and inflamed.
The wheezing in bronchiolitis occurs because mucus and inflammation cause the bronchioles to become swollen and partially blocked. As air is forced through these narrowed passages, it creates the characteristic whistling sound. The wheezing may be audible without a stethoscope in moderate to severe cases, though in milder cases, a healthcare provider may need to use a stethoscope to detect it.
Parents should note that wheezing can vary in intensity throughout the day and may worsen during physical activity, crying, or feeding. This symptom typically appears a few days after the initial cold-like symptoms begin.
3. Rapid or Labored Breathing
Children with bronchiolitis often experience rapid breathing (tachypnea) or show signs of working harder to breathe. This is one of the most important symptoms to monitor, as it indicates the severity of the condition.
Signs of labored breathing include:
- Breathing rate faster than normal (more than 60 breaths per minute in infants)
- Flaring of the nostrils with each breath
- Retractions – visible pulling in of the skin between or below the ribs
- Head bobbing with breathing efforts
- Grunting sounds during breathing
- Using abdominal muscles excessively to breathe
Rapid or labored breathing occurs because the inflamed airways make it harder for oxygen to reach the lungs efficiently. The body compensates by increasing the breathing rate and using accessory muscles to help with respiration. If you notice your child showing signs of severe breathing difficulty, seek immediate medical attention.
4. Nasal Congestion and Runny Nose
Bronchiolitis typically begins with symptoms similar to a common cold, including nasal congestion and a runny nose. These are often the first symptoms parents notice, appearing before the more serious respiratory symptoms develop.
The nasal discharge usually starts as clear and watery but may become thicker and sometimes yellow or greenish as the illness progresses. Significant nasal congestion can be particularly problematic for young infants who are obligate nose breathers, meaning they primarily breathe through their noses rather than their mouths.
This congestion can interfere with feeding, as infants need to breathe through their noses while nursing or bottle-feeding. Parents may notice that their baby takes frequent breaks during feeding or shows frustration when eating due to difficulty breathing through a congested nose.
5. Fever
Many children with bronchiolitis develop a fever, although it is not always present. When fever does occur, it is typically low-grade to moderate, ranging from 100.4°F to 102°F (38°C to 39°C).
The fever associated with bronchiolitis usually appears early in the illness, often accompanying or shortly following the initial cold-like symptoms. It may last for a few days before resolving, even though other respiratory symptoms continue. Some children may not develop a fever at all, so the absence of fever does not rule out bronchiolitis.
Important considerations about fever:
- Fever alone is not a reliable indicator of severity
- Very high fever may suggest a secondary bacterial infection
- Infants under 3 months with any fever should be evaluated by a healthcare provider promptly
- The pattern of fever resolution does not always correlate with improvement in breathing symptoms
6. Difficulty Feeding and Decreased Appetite
Feeding difficulties are a significant symptom of bronchiolitis, particularly in infants. Children with this condition often show reduced interest in feeding or have trouble completing their usual feeding volumes.
The breathing difficulties associated with bronchiolitis make it challenging for infants to coordinate sucking, swallowing, and breathing simultaneously. As a result, they may:
- Take smaller amounts at each feeding
- Pull away from the breast or bottle frequently
- Appear frustrated or agitated during feeding attempts
- Take much longer to complete a feeding
- Refuse feeds altogether in severe cases
Decreased fluid intake can lead to dehydration, which is one of the main complications requiring hospitalization in bronchiolitis cases. Parents should monitor for signs of dehydration including fewer wet diapers than usual, dry mouth, absence of tears when crying, and lethargy.
7. Irritability and Fatigue
Children suffering from bronchiolitis often display changes in their behavior and energy levels. They may appear more irritable, fussy, or difficult to console than usual. This behavioral change results from the discomfort caused by breathing difficulties, congestion, and overall illness.
Fatigue is also common, as the increased work of breathing and disrupted sleep patterns exhaust the child. Parents may notice that their child:
- Sleeps more than usual or seems excessively drowsy
- Shows less interest in playing or normal activities
- Appears listless or less responsive
- Has difficulty staying awake during feedings
- Cries more frequently but with less energy
While some degree of irritability and fatigue is expected with any illness, extreme lethargy or unresponsiveness is a warning sign that requires immediate medical evaluation. Similarly, if a child becomes increasingly difficult to wake or seems confused, this warrants urgent medical attention.
Main Causes of Bronchiolitis
Bronchiolitis is caused by viral infections that inflame the small airways in the lungs. Understanding these causes can help parents take appropriate preventive measures.
Respiratory Syncytial Virus (RSV)
RSV is responsible for approximately 70-80% of bronchiolitis cases. This highly contagious virus spreads through respiratory droplets and can survive on surfaces for several hours. Most children are infected with RSV by age two, though the severity varies greatly.
Other Viral Causes
Several other viruses can cause bronchiolitis, including:
- Human rhinovirus: The common cold virus can also cause bronchiolitis in susceptible infants
- Human metapneumovirus: A virus similar to RSV that peaks during late winter and spring
- Influenza virus: Can cause bronchiolitis, particularly during flu season
- Parainfluenza virus: Another common respiratory virus affecting young children
- Adenovirus: Can cause more severe cases of bronchiolitis
Risk Factors
Certain factors increase the likelihood of developing bronchiolitis or experiencing more severe symptoms:
- Age under 6 months
- Premature birth
- Exposure to tobacco smoke
- Crowded living conditions
- Lack of breastfeeding
- Attending daycare
- Having siblings in school
- Congenital heart or lung disease
- Weakened immune system
Prevention Strategies
While it is not always possible to prevent bronchiolitis, several measures can reduce the risk of infection and transmission:
Hand Hygiene
Frequent handwashing is one of the most effective ways to prevent the spread of viruses that cause bronchiolitis. Wash hands thoroughly with soap and water for at least 20 seconds, especially before handling infants, after changing diapers, and after coughing or sneezing.
Avoid Exposure to Sick Individuals
Keep infants and young children away from people who have colds or respiratory infections. If household members are ill, they should wear masks when caring for infants and avoid kissing or close face-to-face contact.
Limit Exposure During Peak Season
During RSV season (typically fall through spring), consider limiting visits to crowded places with young infants, particularly those at high risk. This includes shopping centers, public gatherings, and unnecessary medical visits.
Keep Surfaces Clean
Regularly disinfect frequently touched surfaces such as doorknobs, toys, countertops, and mobile devices. Viruses that cause bronchiolitis can survive on surfaces for several hours.
Avoid Tobacco Smoke Exposure
Never smoke around children, and avoid taking them to places where they will be exposed to secondhand smoke. Tobacco smoke damages the respiratory system and increases the risk and severity of bronchiolitis.
Promote Breastfeeding
Breastfeeding provides antibodies and immune factors that help protect infants from infections, including those that cause bronchiolitis. Exclusive breastfeeding for at least six months is recommended when possible.
Consider Preventive Medication for High-Risk Infants
For certain high-risk infants, healthcare providers may recommend preventive treatments during RSV season. Parents should consult with their pediatrician to determine if their child qualifies for such interventions.
Maintain Updated Vaccinations
While there is no vaccine specifically for RSV, keeping children up to date with recommended vaccinations, including the flu vaccine, can prevent some cases of bronchiolitis and reduce overall illness burden.
Frequently Asked Questions
How long do bronchiolitis symptoms last?
Most symptoms of bronchiolitis last 7-10 days, with improvement typically beginning around day 3-5. However, the cough and wheezing may persist for 2-4 weeks. Some children may have reactive airways for several months following the infection.
When should I take my child to the doctor for bronchiolitis?
Contact your healthcare provider if your child is under 3 months old, has difficulty breathing, shows signs of dehydration (fewer than one wet diaper every 8 hours), refuses to feed, has a persistent fever over 100.4°F, or if symptoms worsen after initial improvement. Seek emergency care if your child has severe breathing difficulty, blue-tinged lips or skin, or appears extremely lethargic.
Can adults get bronchiolitis?
While bronchiolitis is primarily a disease of infants and young children, adults can contract the viruses that cause it. In adults and older children, these same viruses typically cause common cold symptoms rather than bronchiolitis. However, adults with compromised immune systems or chronic lung disease may develop more significant respiratory symptoms.
Is bronchiolitis contagious?
Yes, the viruses that cause bronchiolitis are highly contagious. They spread through respiratory droplets when an infected person coughs or sneezes, and through contact with contaminated surfaces. Children are most contagious during the first few days of symptoms but can continue to shed virus for several weeks.
What is the difference between bronchiolitis and bronchitis?
Bronchiolitis affects the smallest airways (bronchioles) and primarily occurs in infants and young children. Bronchitis involves inflammation of the larger airways (bronchi) and is more common in older children and adults. Both conditions cause cough and respiratory symptoms, but bronchiolitis typically causes more breathing difficulty in young children due to their smaller airway size.
Can bronchiolitis be treated at home?
Mild cases of bronchiolitis can often be managed at home with supportive care including ensuring adequate hydration, using a cool-mist humidifier, keeping the child’s head elevated, and using saline drops for nasal congestion. However, any infant with bronchiolitis should be evaluated by a healthcare provider to assess severity, and parents should monitor closely for signs of worsening.
Does bronchiolitis lead to asthma?
Children who have had bronchiolitis, especially severe cases requiring hospitalization, have a higher risk of developing recurrent wheezing and asthma later in childhood. However, not all children with bronchiolitis will develop asthma. The relationship between bronchiolitis and later asthma is complex and not fully understood.
Can my child get bronchiolitis more than once?
Yes, children can get bronchiolitis multiple times, as there are many different viruses that can cause it, and immunity to one virus does not protect against others. Additionally, immunity to RSV is incomplete, so children can be infected multiple times, though subsequent infections are typically milder.
References:
- Mayo Clinic – Bronchiolitis
- Centers for Disease Control and Prevention – RSV
- NHS – Bronchiolitis
- World Health Organization – Bronchiolitis
- MedlinePlus – Bronchiolitis
The information on this page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions related to your health.
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