Is Your Little One Coughing? It Could Be Bronchiolitis

Dr. Adam Bullock is a pediatric emergency medicine physician at Inova Children’s Hospital. He is board certified in pediatrics and pediatric emergency medicine.

Wintertime in our Northern Virginia brings lots of cases of irritating coughs in young children to the emergency room. One of the most common causes is a condition called bronchiolitis. In fact, bronchiolitis is the most common lung infection in the first two years of life. Its severity can range from an irritating cough that just keeps parents up at night to life-threatening respiratory failure in the child.

Bronchiolitis is an infection deep in the lungs caused by a virus. It most commonly occurs in children under two years of age. The small airways in the lungs, called bronchioles, become inflamed and filled with mucous (like the mucous in your nose when you have a cold). It will typically begin with an upper airway infection in the nose and throat, causing cough, fever and nasal congestion. Then after two to four days, it can progress to a lower airway infection.

What causes bronchiolitis?

Bronchiolitis is the result of a viral infection inside the lungs, like having a “cold” in the lungs. The most common virus that causes bronchiolitis is respiratory syncytial virus (RSV), which is most common in the late fall and early winter. Other viruses can cause bronchiolitis throughout the year. There are many other viruses that can cause bronchiolitis besides RSV, and the exact virus responsible for an individual’s illness is usually not identified. 

How do I know if my child has bronchiolitis?

Bronchiolitis occurs in children younger than two years and presents with coughing. Often, but not always, there is also fever and congestion. Sometimes, there is also respiratory distress in more severe cases. Most children have one to three days of upper respiratory symptoms (nasal discharge, congestion, cough) before the infection moves into the chest.

What is respiratory distress?

• Fast breathing
• Working harder to breathe
• Grunting with breathing
• Chest muscle retractions with breathing (pulling in the neck muscles or between the ribs)
• Belly breathing
• Low oxygen level (measured in the clinic or emergency room)

These symptoms will peak at days three to seven of infection and then gradually improve. But keep in mind, the cough itself can seem to take “forever” to go away – up to three weeks.

Diagnosis of bronchiolitis

The diagnosis of bronchiolitis is made by examination by a physician; there are no specific tests for this condition. Sometimes, but not always, a nasal swab will be taken to test for RSV or influenza. We don’t always test for these viruses, because knowing which virus is causing the infection does not really change what we do about it.

Furthermore, chest X-rays are not usually helpful in the diagnosis of bronchiolitis. However, they may be taken depending on the severity of the illness, just to make sure something else is not going on.

Treatment of bronchiolitis

There is no specific treatment for bronchiolitis. Therefore, it requires time and a lot of patience to wait for your child’s body to take care of the infection. 

In more severe cases of bronchiolitis, children may need medical support until the infection passes. These children will often be started on oxygen to support their breathing (typically delivered by nasal cannula) and admitted to the hospital. Sometimes, IV fluids will be started if feeding is poor.

Antibiotics and/or steroids are never helpful in treating bronchiolitis and are not recommended by the American Academy of Pediatrics. The use of breathing treatments (for example, albuterol) is generally not recommended either, because it rarely helps. Bronchiolitis is not asthma. However, in some children, such as those with eczema or those who have had wheezing before, albuterol may be tried to see if it helps.

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