Bronchiolitis

Bronchiolitis is a common viral infection of the small airways in the lungs, most often affecting infants and children under two years old. It usually causes a mild illness but can cause significant breathing difficulty in some infants.

• Starts with cold-like symptoms — runny nose and mild cough
• Progresses over a couple of days to wheezing and faster breathing
• Difficulty feeding, due to breathlessness interfering with sucking and swallowing
• Chest indrawing and grunting in more significant cases
• Fever, which is usually mild
• Danger signs requiring urgent care include severe chest indrawing, inability to feed, lethargy, or blue-tinged lips

• Most commonly caused by respiratory syncytial virus (RSV), and sometimes other respiratory viruses.
• Spread through respiratory droplets and contact with contaminated surfaces.
• Risk of more severe illness is increased in infants under six months, those born prematurely, and those with underlying heart or lung conditions.

• Diagnosed clinically based on the characteristic pattern of cold-like symptoms progressing to wheeze and fast breathing in an infant or young child.
• Assessment focuses on identifying danger signs — severe chest indrawing, inability to feed, lethargy, or low oxygen levels — which determine whether hospital admission is needed.
• Chest X-ray and other testing are not usually needed for typical cases and are reserved for more severe or uncertain presentations.

Most cases are mild and managed at home with supportive care — small, frequent feeds, clearing the nose of mucus before feeding, and monitoring for worsening symptoms.

Antibiotics are not effective, since bronchiolitis is caused by a virus, and are not given unless there is a specific reason to suspect a bacterial complication.

Infants with danger signs — significant breathing difficulty, inability to feed, lethargy, or low oxygen levels — require hospital admission for oxygen therapy and supportive feeding support.

Most infants recover fully within one to two weeks, though the cough can sometimes persist longer.

• Practise good hand hygiene, particularly around infants, during the RSV season.
• Avoid exposing infants to tobacco smoke, which increases the severity of respiratory infections.
• Support exclusive breastfeeding for the first six months, which provides immune protection.
• Keep infants away from people with cold symptoms where possible, particularly very young or premature infants.
• Seek prompt medical care for an infant with breathing difficulty, poor feeding, or lethargy.