Bronchitis In Toddlers

Overview

Bronchitis or as it is otherwise called, a chest cold is a lung infection affecting all age groups. In this context, we would be focused on bronchitis in toddlers. A toddler is a child aged 1 - 3 years or 12 - 36 months.

What is bronchitis?

Bronchitis is an infectious lung disease, where the air passage from the trachea to the lung tissue is affected. This air passage is called the bronchial tubes or bronchi. In bronchitis, the cells that line the bronchial tubes are infected, and thus there is inflammation which causes the bronchial tubes to swell causing cough, and sometimes there is the formation of excess mucus which leads to the sputum seen in productive cough.

The swelling caused by inflammation further narrows the bronchial tubes, leading to decreased airflow, and thus wheezing, which is demonstrated as noisy breathing in toddlers.

For more information on bronchitis, check out the NHS website.¹

Types of bronchitis

Bronchitis is classified based on the course and duration of the disease. They are divided into:

1. Acute bronchitis; Acute bronchitis occurs suddenly and is more common.⁶ The symptoms usually resolve before 4 weeks.
2. Chronic bronchitis; Chronic bronchitis is somewhat rare, and the symptoms last longer than 4 weeks. The symptoms may resolve and then return again.

Causes of bronchitis in toddlers

Acute bronchitis is an infectious disease and is caused by a number of microorganisms.³ These microorganisms thus distinguish acute bronchitis into 2 sub-types namely;

1. Viral bronchitis; This is the commonest form of acute bronchitis in toddlers. Here, bronchitis is caused by viruses which include; adenovirus, rhinovirus, influenza (flu) etc. This form of bronchitis is usually self-limiting i.e. it revolves on its own, while in some other cases, may transform to develop bacterial bronchitis.
2. Bacterial bronchitis; This is a less common form of bronchitis, and is caused by bacteria which include; Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae etc.

Other causes of bronchitis include

• Dust and allergens
• Inhaled chemicals and fumes
• Inhalation of cigarette smoke (second-hand smoke)

For more information on acute bronchitis, check out the NCBI website.⁶

Risk factors

There are certain risk factors that could predispose a toddler to bronchitis. These risk factors include:

1. Presence of previous allergies
2. Infants with underlying heart or lung conditions
3. Depressed/ deficient immune system
4. Contact with infected individuals e.g people with common cold, bronchitis etc
5. Exposure to cigarette smoke 
6. Asthma
7. Chronic sinusitis
8. Presence of enlarged tonsils and/or adenoids

Symptoms 

The following are symptoms of bronchitis:

1. Mild cough; which may be dry or productive (i.e. mucus-filled)
2. Yellow, green, clear, or blood tinged sputum
3. Stuffy or runny nose
4. Noisy breathing also known as wheezing
5. Generalized body weakness
6. Low-grade fever
7. Trouble breathing (dyspnoea) and respiratory distress
8. Headaches
9. Muscle pains
10. Nausea and vomiting (rare)

Diagnosis

Diagnosis of this infection is purely clinical, this means it does not necessarily require a whole bunch of tests to confirm. The doctor would ask a bunch of questions on the symptoms your toddler is experiencing, and conduct a physical exam which in most cases will tell the doctor what exactly is wrong with your infant.

Some basic tests that could be done to clarify doubt includes:

Complete blood count

 Complete blood count is done to determine presence of an active infection, and also rule out anemia.

Chest X-rays

Chest x-rays are important to have a clearer view of the lungs, and to rule out other similar diseases like pneumonia. Although parents may fear for the risk that radiation poses to infants, there are lead blankets that protect the child from unnecessary radiation to other parts of the body. The process id painless, and also quick.

Pulse oximetry

Pulse oximetry is a test which measures the amount of oxygen circulating in the blood i.e. oxygen saturation. It is done using the pulse oximeter which is placed on the thumb. It is painless and rapid.

Sputum and nasal discharge samples

Culture of sputum and nasal discharge samples is important to determine the microorganism responsible for the investigations. Also the antibiotics sensitive to the microorganism is also determined.  

Treatment 

In most cases, acute bronchitis in toddlers is self-limiting, which means they tend to resolve on their own, and as such require no medication. In some severe cases, some medications may be given to relieve some worrisome symptoms, and in more severe cases, medications are required to resolve it.

Medications

Medications used in bronchitis varies based on the causative organism, and the symptoms present.

Viral bronchitis 

Viral bronchitis most times is not cured by medications as antibiotics are ineffective.³ Viral bronchitis tends to resolve on its own. However, the symptoms may be relieved by the following

• Nasal decongestants for stuffy nose
• Cough depressants to alleviate cough
• Pain relief drugs e.g acetaminophen to relieve pain 
• Expectorants, which are effective for coughs and chest congestion
• Bronchodilators to relieve trouble breathing and respiratory distress
• Oxygen therapy in cases of trouble breathing and respiratory distress

Bacterial bronchitis

Bacterial bronchitis, unlike viral respond to antibiotic therapy, although it is not the first line of treatment, and is only reserved for more severe cases, as the milder cases tend to resolve spontaneously. The medications which can be used here tus include:

• Antibiotics, in severe cases
• Nasal decongestants for stuffy nose
• Cough depressants to alleviate cough
• Pain relief drugs e.g acetaminophen to relieve pain 
• Expectorants, which are effective for coughs and chest congestion
• Bronchodilators to relieve trouble breathing and respiratory distress
• Oxygen therapy in cases of trouble breathing and respiratory distress 

Home remedies

There are home remedies which have been seen to help with the symptoms of bronchitis in toddlers. Some of these home remedies include:

• Get enough rest
• Stay hydrated
• Give honey to soothe cough
• Humidifiers helps to loosen mucus and improve breathing

Complications

Bronchitis in toddlers if not properly treated can deteriorate, and cause some complications which include:

• Respiratory distress
• Blue coloration of your toddlers skin and lips, due to lack of oxygen
• Chronic cough
• Spread of infection to the smaller branches of the bronchus called the bronchioles. This condition is known as bronchiolitis
• Severe bronchiolitis,⁴ if further gone untreated.
• Spread to siblings, and other family members
• Death of the toddler

Prevention

Like the saying goes, prevention is better than cure. Modalities employed to prevent this disease is mainly infection control, as it is an infectious disease.¹⁰

Infection control methods involve:

• Regular hand washing; it is imperative to wash your hand before and after handling your baby, and also wash your baby's hand regularly.
• Clean surfaces, and toys used by your infant regularly.
• Make use of disposable napkins to avoid infecting your toddler.
• Keep infants away from other children with the flu, or common cold, as these infections tend to spread. Find out how the flu spreads at the NHS website.¹¹

When to see a doctor

Speak to your doctor if:

• Your toddler has a fever greater than 38°c
• Chronic cough, last more than 3 weeks
• Your toddler is having trouble breathing.
• If your toddler is having noisy breathing or wheezing
• If you notice bluish coloration on your babies skin and lips
• If your toddler has a bloody sputum
• If the bronchitis keeps coming back after treatment.

Summary

Bronchitis generally is a very stressful and uncomfortable infection that can affect the quality of life once it hits. Bronchitis in toddlers is much more scary, and should be treated with urgency.

Don't hesitate to reach out to your doctor once you realize the symptoms are present in your child.

This disease is however very treatable, and should not be a cause for alarm in parents. However, if your toddler presents with symptoms like trouble breathing, fever etc, do report to the doctor as soon as possible.

A good personal hygiene is more than enough to prevent this, and save your toddler the stress of going through this disease.