Welcome to The Art of Patients, I’m Dr Golly. In the colder months we see lots of babies with coughs and colds, but today we’re going to talk about a more serious chest infection that affects children under the age of 2, but mostly those under 6 months. It’s called – bronchiolitis.
Bronchiolitis means inflammation of the bronchioles, which comes from the ancient Greek ‘bronkhos’ – meaning windpipe. Let’s jump to the whiteboard and learn about the structure and function of the lungs, and what goes wrong when a child has bronchiolitis.
OK, let’s think of our breathing tubes as an upside-down tree. The large trunk is the main breathing tube – the trachea – coming down from the mouth. From there it branches into 2 bronchi and they continue branching into tiny air tubes until they eventually finish with the smallest twigs, which are called bronchioles – these are covered by air sacs that looks like bunches of grapes – called alveoli. Here is where we get gas exchange via blood cells, allowing oxygen IN and carbon-dioxide OUT.
Nasty viruses that cause the common cold can cause swelling and inflammation of those bronchioles, which is why we call it bronchiolitis. If alveoli can’t do their job properly, it can cause a child to work harder to breathe and give them a raspy cough and/or wheeze.
Bronchiolitis starts off like any cold, with fevers, runny nose and cough. We find that the symptoms worsen on day 2 -3 of the illness and it usually lasts for a week to 10 days, though that ‘characteristic, raspy cough’ can linger for up to 3 weeks after the child’s other symptoms resolve.
For mild bronchiolitis, no investigations are necessary and most cases can be managed perfectly safely at home, with regular reviews by your GP. The two most common reasons for a child being hospitalized for bronchiolitis are: dehydration and breathing difficulties.
To see how hard your child is working to breathe, look to see if their skin is being sucked in under – or between – the ribs and at the base of the neck. In very young babies, their head might be bobbing. They can also be breathing fast or using stomach, neck and shoulder muscles to assist in breathing. If in doubt – have them seen by a doctor.
When it comes to their drinking, if your child is taking less than half their normal feed volume, or making half their usual number of wet nappies, they’re becoming dehydrated and should be seen by a doctor.
So – how do we treat bronchiolitis? Babies need to rest and may benefit from pain relief. The trick to prevent dehydration is to give smaller, more frequent feeds. It’s important to understand that in viral bronchiolitis, antibiotics are not given because they don’t work on viruses. Also remember that babies will be infectious for the first few days of their illness, so keep them away from other children and remember to wash your hands well.
Remember that smoking in the family home increases the risk of bronchiolitis and makes each episode worse. Also, despite the presence of a wheeze, asthma medicines usually don’t work for young children with bronchiolitis.
Although many cases can be managed at home, you should definitely see your doctor if your child is less than 6 weeks old, was born premature, or has a heart or neurological condition. Otherwise, have them seen if they are becoming dehydrated, working hard to breathe or if you are worried for any other reason.