Bronchiolitis

Advice for parents and caregivers

What is bronchiolitis?

Bronchiolitis is when the smallest air passages in a child's lungs become swollen. This can make it more difficult for your child to breathe.

Usually, bronchiolitis is caused by a virus called respiratory syncytial virus (known as RSV). Almost all children will have had an infection caused by RSV by the time they are two years old. It is most common in the winter months and usually only causes mild "cold-like" symptoms. 

Most children get better on their own.

Some children, especially very young ones, can have difficulty with breathing or feeding and may need to go into hospital.

Most children with bronchiolitis get better within about two weeks but the cough may go on longer. 

When should you worry?

If your child has any of the following:

  • Has blue lips  

  • Is pale, mottled and feels abnormally cold to touch  

  • Has pauses in their breathing lasting more than a few seconds, has an irregular breathing pattern  or is making a grunting noise every time they breathe out  

  • Is too breathless to feed  

  • Is extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)  

  • Is stiff or rigid or makes repeated, jerky movements of arms or legs that doesn't stop when you hold them (a fit or seizure)  

  • Develops a rash that does not disappear with pressure (the ‘Glass Test’)  

  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features)   

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Shows signs of working hard to breathe. These include constantly breathing fast, flaring of the nostrils, drawing in of the muscles below the ribs  

  • Not interested in feeding and/or seems dehydrated (no tears, sunken soft spot on the head, drowsy or no wet nappies in the last 8 hours)  

  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them) – especially if they remain drowsy or irritable despite their fever coming down  

  • Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations) or continues to have a fever of 38.0°C or above for more than 5 days 

  • Is getting worse or if you are worried  

You need to contact a doctor or nurse today.

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

If your child has none of the above:

Watch them closely for any change and look out for any red or amber symptoms 

 Additional advice is also available for families to help cope with crying in otherwise well babies – click here 

 

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

 

  • Rapid breathing
  • Needing more effort to breathe
  • Nostrils moving
  • Pulling in of chest muscles between their ribs
  • Pulling of their neck muscles

  • If your baby was premature
  • If your baby is less than 6 weeks old

Or if your child has:

  • A lung problem
  • A heart problem
  • A problem with their immune system
  • Or any other pre-existing medical condition that may affect their ability to cope with this illness

If your child meets any of the criteria above please contact your GP or 111 to discuss their symptoms

  • Your child may have a runny nose and sometimes have a temperature and a cough
  • After a few days your child's cough may become worse
  • Your child's breathing may be faster than normal and it may become noisy. They may need to make more effort to breathe
  • Sometimes, in very young children, bronchiolitis may cause them to have brief pauses in their breathing
  • Sometimes their breathing can become more difficult, and your child may not be able to take their full amount of milk by breast or bottle or may want to take a smaller amount more often
  • You may notice fewer wet nappies than usual
  • Your child may vomit after feeding

If your child is not feeding as normal, offer them feeds little and often.

  • If your child has a fever, you can give them paracetamol in the recommended doses. If your child is older than 6 months old, you may also give them ibuprofen
  • At home, we do not recommend giving both paracetamol and ibuprofen at the same time together. If your child has not improved after 2-3 hours you may want to give them the other medicine. Never exceed the dose on the bottle
  • If your child is already taking medicines or inhalers, you should carry on using these. If you find it difficult to get your child to take them, ask your Health Visitor or GP for advice. 
  • Bronchiolitis is caused by a virus so antibiotics won't help

Make sure your child is not exposed to tobacco smoke. Remember smoke remains on your clothes even if you smoke outside. 

Passive smoking makes breathing problems like bronchiolitis worse. If you would like help to give up smoking you can get information and advice from your GP surgery, or click here for local support to help you quit smoking. 

  • Bronchiolitis usually lasts 2 weeks, but the cough may go on for a month or more
  • As a parent or carer, you may find this useful to know as it lasts longer than the normal coughs and colds that children get
  • Your child can go back to nursery or day care as soon as they are well enough (feeding normally and with no difficulty in breathing)
  • There is usually no need to see your doctor if your child is recovering well. If you are worried about your child's progress, please discuss this with your Health Visitor, Practice Nurse or GP. 
Bronchiolitis Primary Care Pathway for Professionals