How does the disease progress?
First, the virus affects the upper respiratory tract: runny nose, sneezing, and low fever. Then the inflammation goes down, and on the 2-3rd day the condition changes: breathing quickens, becomes noisy and whistling, the child begins to cough in fits. Peak severity usually occurs on days 3–5 of illness, after which gradual improvement occurs, although coughing and wheezing may persist for another 2–3 weeks. That is why in the first days it is important to monitor your breathing, and not focus only on temperature.
- Days 1–2: runny nose, sneezing, mild fever
- Days 2–3: wheezing, rapid breathing, cough
- Days 3–5: peak severity, greatest risk of worsening
- Then gradual improvement
- Residual cough up to 2–3 weeks
Who is sicker?
Most children experience bronchiolitis at home, but some groups require special attention and often require hospitalization. These are children in the first months of life, whose airways are especially narrow and pauses in breathing are possible, premature babies, children with congenital heart defects, chronic lung diseases and immune disorders. A significant risk factor is passive smoking: smoke in the apartment significantly worsens the course. The autumn-winter season and older children visiting children's groups increase the likelihood of infection.
- Age up to 3–6 months
- Prematurity
- Congenital heart defects
- Chronic lung diseases
- Immunodeficiency
- Smoking in the house
- Lack of breastfeeding
Diagnostics
The diagnosis is clinical: the doctor evaluates the respiratory rate, retraction of the compliant areas of the chest, listens to the lungs, measures blood oxygen saturation and watches how the child eats and drinks. Routine tests and x-rays are not needed for an otherwise healthy child with a typical picture: they do not change tactics and create unnecessary stress. An X-ray is taken if pneumonia is suspected, is unusually severe, or is worsening. Determination of a specific virus usually does not affect treatment and is carried out according to epidemiological indications in a hospital.
- Assessment of respiratory rate and respirations
- Auscultation of the lungs
- Pulse oximetry
- Assessing feeding and voiding volumes
- X-ray only if a complication is suspected
- Blood tests according to indications
Treatment
The basis is supportive care. It is necessary to regularly clear the nose with saline solution and an aspirator, especially before feeding: babies breathe through their nose, and congestion dramatically worsens their condition. Feeding should be done more often and in smaller amounts so that the child does not get tired. The room maintains cool, moist air and completely eliminates tobacco smoke. Antibiotics are not prescribed because the cause is viral. Inhalations with bronchodilators do not provide a lasting effect in most children and are used only as directed by a doctor. Hormonal drugs and antitussives are not indicated for bronchiolitis.
- Rinse the nose with saline and suction the mucus
- Small frequent feedings, sufficient drinking
- Cool, humid air, no tobacco smoke
- Antipyretic according to age when feeling unwell
- Oxygen and hospitalization according to indications
- Antibiotics are not prescribed without a bacterial complication
- Do not give cough suppressants to young children
Prevention and what's next
Viruses are transmitted through hands and objects, so the most effective measure remains hygiene: frequent hand washing, separate dishes, limiting the contact of a newborn with sick relatives and older children during the season. Breastfeeding reduces the risk of severe disease. Smoking in the apartment should be completely eliminated, including smoking on the balcony and returning to the room. After bronchiolitis, some children experience wheezing episodes with subsequent colds; with repeated episodes, pediatrician supervision and assessment of the risk of bronchial asthma are necessary.
- Washing hands before contact with a child
- Limiting visits when there is a cold in the family
- Breastfeeding
- Complete smoking cessation in the home
- Ventilation and wet cleaning
- Observation by a pediatrician for repeated episodes of wheezing