Introduction

Bronchiolitis is a common lower respiratory infection among infants and young children, and it can be a source of concern for parents and caregivers. Understanding how to manage bronchiolitis effectively at home is crucial to keeping your child as happy and well as possible during their illness. This article offers practical guidance on home management strategies for bronchiolitis to equip you with the skills to manage your child’s illness as confidently as possible. 

Understanding bronchiolitis

Bronchiolitis is a viral infection that primarily affects small airways, called bronchioles, in the lungs. Bronchiolitis is most frequently caused by respiratory syncytial virus (RSV), but it can also be triggered by other viruses such as rhinovirus, adenovirus, and influenza. The main symptoms of bronchiolitis include:

• Coughing 
• Wheezing 
• Difficulty breathing
• Congestion 

These symptoms can range from mild to severe, and may worsen over several days.¹ 

The early diagnosis of bronchiolitis is essential for prompt intervention and management. Doctors typically diagnose bronchiolitis based on a physical examination and the presence of characteristic symptoms. In severe cases, further diagnostic tests, such as chest X-rays or blood tests, may be necessary to assess the extent of lung involvement and rule out other potential complications.² 

Understanding bronchiolitis and its potential impact on a child's respiratory system is vital for caregivers to manage the condition effectively at home. By recognising the signs and symptoms of bronchiolitis and its causes, caregivers can take proactive measures to alleviate discomfort and promote recovery in their child.

Who is most at risk of bronchiolitis?

Bronchiolitis most commonly occurs during the winter and spring months.³ Infants and young children, particularly those under two, are most susceptible to bronchiolitis due to their smaller airways and developing immune systems. Other factors that put children more at risk of bronchiolitis and of more severe symptoms include:⁴

• Low birth weight 
• Prematurity 
• Underlying health conditions 
• Being exposed to secondhand smoke

How do I know if my child has bronchiolitis? 

Bronchiolitis generally presents with cold and flu-like symptoms such as a runny and blocked nose and coughing, sometimes with a slight fever.⁴

These symptoms can progress to your child finding it more difficult to breathe, and you may hear a slight wheeze when your child breathes; this can last for a week or more. Children will frequently develop an inner ear infection (otitis media). Bronchiolitis is usually a mild illness that can be treated at home. 

How is bronchiolitis diagnosed?

Doctors usually diagnose bronchiolitis based on the symptoms that your child is presenting with and what they find when examining your child. Sometimes, because the symptoms of bronchiolitis can overlap with other conditions (e.g. pneumonia, viral-induced wheeze or asthma), further investigations are carried out, such as an x-ray or a blood test. Sometimes, a healthcare professional may need to take a swab of your child’s nose to identify the virus causing the infection.² 

When to see a doctor

Often, your doctor will advise that bronchiolitis can be managed at home. However, some symptoms warrant further assessment by a doctor and sometimes even a trip to your local emergency department.⁵ It’s imperative to stay vigilant if your child was born prematurely, has a heart or lung condition, or a condition that weakens their immune system.

Signs that it may be worth taking your child to see their GP include:

• Feeding less than normal
• Less wet nappies than usual
• Your child isn’t their usual self
• Vomiting
• Temperature above 39 degrees Celsius (if over three months of age) or 38 degrees Celsius (if under three months of age), mainly if this does not come down with paracetamol-containing medications

Signs that indicate that the infection is becoming serious, and may require a trip to the emergency department include:

• Blue or grey skin (including lips and fingernails) - this can be a sign of low oxygen levels
• Struggling to breathe - sometimes, this will present as your child not being able to speak or cry
• Being unable to, or refusing to, drink enough water
• Very fast, shallow breathing
• Wheezing or grunting
• Unresponsiveness, weakness or extreme tiredness

Managing bronchiolitis at home

There are a number of medical and non-medical treatments for managing bronchiolitis at home.^6,7 

Managing fever

If your child has a fever, you can give them either paracetamol (for all ages) or ibuprofen (if they are over three months old) in the recommended doses.

Trying to cool your child by sponging them with cold water or taking off all of their clothes is not recommended. 

Eating and drinking

If your baby is feeding less than usual, consider trying to offer feeds little and often.

For older children, try to encourage them to drink extra water or diluted fruit juice throughout the day. If they’ve lost their appetite, again, consider offering them small amounts of food more often throughout the day. 

Other medicines and inhalers

If your child is already taking medicines or using inhalers, you should continue using them as prescribed. If you find getting them to take their medication difficult, you should ask your doctor for advice. 

Smoking

Your child must not be exposed to tobacco smoke. Passive smoking can seriously damage your child’s health and can worsen breathing problems, such as bronchiolitis. Remember, even if you smoke outside or away from your child, smoke will remain on your clothes - so it is best to avoid smoking altogether, especially when your child is unwell. 

Should I give my child antibiotics? 

No, you should never give your child antibiotics unless a doctor prescribes them. Bronchiolitis is caused by a virus, and as such, antibiotics will not help your child get over the infection faster. 

What else can I do to make my child more comfortable? 

If your child is struggling with a stuffy or blocked nose, try giving them salt water (saline) nose drops. Other options include steam therapy and vaporisers, which can help your child clear their upper airways of mucus without the use of medications. 

Keep your child as upright as possible when they’re awake—this makes it easier for them to breathe. Elevating the head of the bed at night can sometimes help them sleep when they have a stuffy nose. 

How can I stop my child from getting bronchiolitis in the first place? 

The viruses that cause bronchiolitis (usually RSV) are spread very easily via droplets, such as those produced by coughs and sneezes. Almost all children will have had bronchiolitis by the time they are two years old, but there are some ways we can make our children less likely to be infected by bugs such as RSV, such as:⁸ 

• Washing your and your child’s hands regularly
• Washing/cleaning your child’s toys and the surfaces within your house regularly - especially after play dates 
• Using disposable tissues and throwing them away as soon as they’ve been used
• Keeping newborn babies away from anyone with cold-like symptoms, especially if your baby is still under two months old or was born prematurely
• Do not smoke around your child. As discussed previously, children who breathe in cigarette smoke have a higher risk of having bronchiolitis and have a higher risk of having a more severe infection

Summary

Bronchiolitis, a common respiratory infection among infants and young children, presents unique challenges for parents and caregivers. This article has provided valuable insights into understanding bronchiolitis and offered practical guidance on managing it effectively at home. By recognising the symptoms and causes of bronchiolitis, caregivers can take proactive steps to alleviate discomfort and support their child's recovery.

It's important to remain vigilant for signs of worsening symptoms and seek medical attention when necessary. While bronchiolitis can often be managed at home with supportive care, certain symptoms, such as persistent fever, difficulty breathing, or dehydration, may require prompt medical intervention.

Additionally, preventive measures such as regular handwashing, maintaining a smoke-free environment, and minimising exposure to individuals with cold-like symptoms can help reduce the risk of bronchiolitis.