Bronchiolitis in Babies

We wrote this piece for pocket nannies but thought it might be useful to share here too!

It’s the time of year for coughs and colds and unfortunately, babies are vulnerable and catch the winter viruses that are doing the rounds. Last year, when my youngest was 9 months old, we ended up in A&E as he had breathing difficulties caused by bronchiolitis, and this typically happened the day before I was due to return to work! He was in good company, however as every year, 2% of all babies are admitted to hospital with bronchiolitis and this is the main reason Paediatricians are so busy in the winter months!

Bronchiolitis (not to be confused with bronchitis) is caused by a virus that might cause a cold in you or I – the commonest is called RSV. In babies under a year of age, it causes swelling and inflammation to their tiny airways and lots of mucous. As a result, they can find breathing and feeding really challenging. As a parent or nanny, you will probably hear a wet sounding cough (they often sound like they’ve been a life long smoker when they cough), and they may struggle to feed. They may have a raised temperature (fever) up to 38.5oC – bronchiolitis doesn’t tend to cause very high temperatures so if your baby is very hot, please get them checked out.

From experience, we know that bronchiolitis tends to get worse over the first 3-4 days of the illness, reaching their worst on day 3-4 and then slowly getting better over the next week. Whilst their breathing difficulties ease, they may continue to cough for up to 6 weeks after an episode of bronchiolitis. Despite trying multiple treatments over the years, we now know that there is nothing that will make bronchiolitis go away any faster – babies fight the infection on their own but in the meantime, we need to ensure they are coping well.

Top tips – things to watch out for:

1. Look at your baby’s breathing – signs that they are struggling to breathe include: breathing faster than usual; drawing in their chest under their ribs or between each rib; bobbing the head or nostrils flaring with each breath. If they are really struggling, you may also hear a ‘grunting’ sound at the end of every breath. If you see any of these things, please see a doctor, who will examine them and may measure their oxygen levels – some babies need oxygen in hospital while they recover from bronchiolitis.

2. Feeding – as you can imagine, feeding will be much trickier if your baby is working hard to breathe. As a rough rule of thumb, if your baby is taking at least half of their normal volumes of milk, they will be able to stay hydrated. This is obviously much easier to measure in a formula fed baby but harder in a breast fed baby, so also keep a check on…

3. …nappies! Your baby should still be wetting nappies every 6-8 hours at a minimum. If they are not managing this, there is a chance they may be becoming dehydrated. Some babies will need help with feeding while they have bronchiolitis and in hospital, we sometimes need to give milk through a tube directly into their stomachs. If you are concerned that your baby is not feeding at least half of their usual milk, or not having enough wet nappies, please get them seen by a doctor.

4. Temperature (fever) – as we said above, bronchiolitis can cause a raised temperature (up to 38.5oC). Very young babies – under 3 months of age, should be seen by a doctor if they have a temperature above 380C unless it is directly following their 8 week immunisations. Very young babies can become poorly quickly so for the really little ones, please get them seen by a doctor if they have a fever above 38oC.

5. If their nose seems to be blocked, you can try giving saline nasal drops, which you can buy in any pharmacy, before trying to feed them. This will often make feeding easier.

Bronchiolitis is so common in the first year of life, and most babies get better without the need for any extra support, but each year, we do see some who need extra help with their breathing or feeding while they recover. I was fortunate as nothing stops my youngest from feeding and his breathing settled after a few hours in hospital. His cough did last for weeks though so it wasn’t much fun for any of us in the nights that followed! Really hope you and your little ones stay well this winter!

Dr Rebecca

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