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  • Your child has been diagnosed with bronchiolitis
  • It's an infection of the smallest airways in the lungs
  • Caused by a virus called RSV (respiratory syncytial virus)
  • Wheezing during the first 2 years of life is often caused by bronchiolitis
  • You wonder if your child needs to be seen again

Symptoms of Bronchiolitis

  • Wheezing is the main symptom that helps with diagnosis. Wheezing is a high-pitched purring or whistling sound.
  • You can hear it best when your child is breathing out.
  • Rapid breathing at a rate of over 40 breaths per minute.
  • Tight breathing (having to work hard to push air out).
  • Coughing (may cough up very sticky mucus).
  • Fever and a runny nose often start before the breathing problems.
  • The average age for getting bronchiolitis is 6 months (range: birth to 2 years).
  • Symptoms are like asthma.
  • About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times.

Cause of Bronchiolitis

  • A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus.
  • The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter.
  • People do not develop life-long immunity to the RSV virus. This means they can be infected many times.

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

  • Struggling for each breath or short of breath.
  • Tight breathing so that your child can barely speak or cry.
  • Ribs are pulling in with each breath (called retractions).
  • Breathing has become noisy (such as wheezes).
  • Breathing is much faster than normal.
  • Lips or face turn a blue color.

Diagnosis of Bronchiolitis

  • A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope.

Prevention of Spread to Others

  • Cover the nose and mouth with a tissue when coughing or sneezing.
  • Wash hands often. After coughing or sneezing are important times.

When To Call

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out or stopped breathing
  • Lips or face are bluish when not coughing
  • You think your child has a life-threatening emergency

Go to ER Now

  • Your child looks like they did when hospitalized before with bronchiolitis
  • Ribs are pulling in with each breath (called retractions)
  • Not alert when awake ("out of it")

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe
  • Lips or face have turned bluish during coughing
  • New harsh sound with breathing in (called stridor)
  • Wheezing (purring or whistling sound) is worse than when seen
  • Breathing is much faster than when seen
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, and no tears.
  • Milk taken is less than half of normal amount
  • High-risk child (such as chronic lung disease) and getting worse
  • Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
  • Age less than 6 months old and worse in any way
  • Fever higher than 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Nonstop coughing spells
  • Trouble feeding worse than when seen
  • Earache or ear drainage
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Coughing causes vomiting 3 or more times
  • Mild wheezing sounds last more than 7 days
  • Cough lasts more than 3 weeks
  • You have other questions or concerns

Self Care at Home

  • Bronchiolitis same or better than when last seen

Care Advice

What You Should Know About Bronchiolitis:

  • Bronchiolitis is common during the first 2 years of life.
  • Most children just have coughing and fast breathing.
  • Some develop wheezing. This means the lower airway is getting tight.
  • If you were given a follow-up appointment, be sure to keep it.
  • Here is some care advice that should help.

Asthma Medicines:

  • Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines.
  • If one has been prescribed for your child, give it as instructed.
  • Keep giving the medicine until your child's wheezing is gone for 24 hours.

Coughing Fits or Spells:

  • Breathe warm mist (such as with shower running in a closed bathroom).
  • Give warm clear fluids to drink. Examples are apple juice and lemonade.
  • Age less than 6 months, only give breast milk or formula.
  • Amount. If 6 - 12 months of age, give 1-2 teaspoons (5-10 mL) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
  • Reason: both relax the airway and loosen up any phlegm.

Homemade Cough Medicine:

  • Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using these tips:
  • Age 6 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-2 teaspoons (5-10 mL). Give 4 times per day when coughing. Caution: do not use honey until 1 year old.
  • Age 1 year and older: use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough. If you don't have any honey, you can use corn syrup.

Nasal Saline to Open a Blocked Nose:

  • Your baby can't nurse or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus.
  • Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. If under 1 year old, use bottled water or boiled tap water.
  • Step 1: put 3 drops in each nostril. (If age under 1 year old, use 1 drop).
  • Step 2: suction each nostril out while closing off the other nostril. Then, do the other side.
  • Step 3: repeat nose drops and suctioning until the discharge is clear.
  • How often: do nasal saline when your child can't breathe through the nose. Limit: no more than 4 times per day.
  • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
  • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction.


  • If the air in your home is dry, use a humidifier. Reason: dry air makes coughs worse.

Smaller Feedings:

  • Use small, frequent feedings whenever your child has the energy to drink.
  • Reason: children with wheezing don't have enough energy for long feedings.
  • Offer enough fluids to prevent dehydration.

Avoid Tobacco Smoke:

  • Tobacco smoke makes coughs and wheezing much worse.
  • Don't let anyone smoke around your child.

What to Expect:

  • Wheezing and rapid breathing most often improve over 2 or 3 days.
  • Mild wheezing sounds can last up to 1 week.
  • Coughing may last 3 weeks.
  • Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein.

Return to Child Care:

  • Your child is contagious for 7 days after the cough first started.
  • Your child can return to child care after this time.

Call Your Doctor If:

  • Trouble breathing occurs
  • Wheezing gets worse (becomes tight)
  • Trouble feeding occurs
  • Fever lasts more than 3 days
  • You think your child needs to be seen
  • Your child becomes worse


Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
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