Bronchiolitis Management and Prevention

Introduction to Bronchiolitis

The American Academy of Pediatrics notes that bronchiolitis is a common viral infection of the small airways in infants and young children, typically starting with cold symptoms and progressing to cough, fast breathing, and wheezing, with most children recovering at home with supportive care over 8-15 days 1, 2
Bronchiolitis is caused by viruses that infect the small breathing tubes in a child's lungs, causing inflammation, swelling, and increased mucus production, with the most common virus being respiratory syncytial virus (RSV) 1, 3
Nearly 90% of children get RSV in their first 2 years of life, and up to 40% will develop lower respiratory tract infection during their first infection 1, 3

Children with bronchiolitis may exhibit faster breathing (tachypnea) 1
Wheezing or whistling sounds when breathing are common in bronchiolitis 4
Crackling sounds in the chest (rales) can be heard in children with bronchiolitis 4
A cough that may worsen before improving is a typical symptom of bronchiolitis 5

The American Academy of Pediatrics recommends offering frequent small feedings to children with bronchiolitis, as they may tire easily or have difficulty feeding due to nasal congestion and fast breathing 6
Gentle external nasal suctioning (bulb suction) should be used when visible nasal congestion affects breathing or feeding 2
Suctioning should be done as needed, rather than on a strict schedule, but not more than 4 hours should pass without suctioning if the child has significant congestion 2
Avoid deep suctioning, as it has been associated with longer illness duration 2
Keeping the child's head slightly elevated during sleep can help with breathing 2
Holding the child upright during and after feedings can help if they are having difficulty 2

Severe breathing problems, such as a breathing rate of 70 breaths per minute or higher, require immediate medical attention 5
Signs of severe illness, such as extreme difficulty feeding or complete refusal to eat or drink, necessitate emergency care 6
High-risk situations, including age less than 12 weeks, premature birth, chronic lung disease, heart disease, or weakened immune system, require more prompt medical evaluation 6, 5

Reducing exposure to viruses is key to preventing bronchiolitis, and this can be achieved by keeping the baby away from people who are sick with colds or respiratory infections 1
Avoiding crowded places during RSV season and not allowing smoking around the child can also help prevent bronchiolitis 1, 5
For high-risk infants, monthly injections of palivizumab during RSV season may be recommended to help prevent severe infection 1

Reinfection with RSV and other respiratory viruses is common throughout life, as immunity is not permanent 1, 3
Some children who have severe bronchiolitis may be at increased risk for wheezing episodes later in childhood 4