Bronchiolitis and RSV: how to spot the symptoms – and what to do next
RSV is a common virus that can cause bronchiolitis and breathing problems in young children. Here's our expert GP's guide to the key signs to look out for and what to do if you think your child has the illness
In a nutshell: Bronchiolitis is a common chest infection, caused by the respiratory syncytial virus (RSV), that can affect babies and children under 2 years old. It's most common in babies aged 3 to 6 months. Usually, the infection is mild and clears up without medical treatment but a small number of children with severe symptoms will need to be treated in hospital.
What are the symptoms of bronchiolitis?
The symptoms of bronchiolitis can be similar to a cold, such as a runny or blocked nose and a cough, but the most telltale signs are:
- Slight fever: a raised temperature
- Runny/blocked nose or sneezing
- Decreased appetite: less interest in food and eating than normal
- Irritability: your baby may be more irritable than is normal for them
- Fast or noisy breathing: if your child is having difficulty breathing or working hard to breathe. If you see any of the following, please seek urgent medical help:
- rapid breathing (for a child under 1 year: approx 30 to 40 breaths per minute; for a child between 1 and 2: 25 to 35 breaths per minute)
- grunting noises
- nostrils flaring with each breath
- the muscles between and underneath the ribs pulling in with each breath
- 'tracheal tug' (seeing the windpipe move down with each breath.
What do I do if I think my child has bronchiolitis?
There's no specific treatment or medication for bronchiolitis and, for most children, the infection will quickly clear up on its own. Symptoms tend to be worse on days 3 to 5, then start to ease – although the cough may take longer to clear up (about 3 weeks).
To help alleviate the symptoms, you could:
- Keep your baby upright as much as possible when they're awake, to make breathing easier.
- Raise the 'head' end of your baby's cot by putting the legs on blocks or putting a pillow under the mattress (never put a pillow directly under your baby's head, as that's not considered safe).
- Try to make your baby is getting enough fluid, to avoid dehydration.
- Ask your pharmacist about saline drops. If your pharmacist thinks they're appropriate for your baby, you can put a few inside your baby's nostril to help clear their nose.
- Treat any fever with age-appropriate doses of child paracetamol or ibuprofen.
When should I seek medical help for a child with bronchiolitis?
Most children will recover from bronchiolitis without any intervention but some children are at risk from developing more severe symptoms and becoming seriously unwell. Your child is more likely to be vulnerable to a severe bronchiolitis infection if:
- They were born prematurely
- They have a heart condition
- The have a weakened immune system
Whether your child falls into 1 of these more vulnerable categories or not, you should see a GP urgently or call the NHS on 111 if:
- Your child is under 3 months old and has temperature of 38°C or above
- Your child hasn't had a wet nappy for 12 hours or has other signs of dehydration
- Your child has been drinking far less than usual
- Your child seems very irritable or tired
- You're worried about your child
You should call 999 for an ambulance if:
- Your child is having great difficulty breathing: taking rapid, shallow, quick or wheezy breaths, with the muscles under and in between the ribs and the base of the throat pulling in with each breath, grunting, and nostrils flaring with each breath
- Your child's tongue and lips turn blue
- There are long pauses in your child's breathing
- You cannot wake your child or they seem floppy/unrousable
What will happen if I have to take my baby to hospital?
Although there are no specific medications to treat the infection which causes bronchiolitis, if your child is admitted to hospital they may well be given oxygen supplementation and nasogastric feeding while they recover.
'I've never seen a baby's tummy pumping so fast for breaths': one mum's story
Mum Beth Foster took to Facebook to warn other parents about bronchiolitis, after her 6-week-old daughter Myah (pictured) developed the infection.
"Please be aware of bronchiolitis this winter," Beth posted. "It's so easily missed and so bloody dangerous. It starts with just a simple cough and cold and can turn to so much more within hours.
"I've never seen a baby's tummy pumping so fast fighting for the breaths, and I've never been so scared.
"I took her to the doctor on Tuesday and he prescribed some eye drops for a gunky eye, and at that point she wasn't struggling. But on Saturday she had a coughing fit and her face turned purple for around 15 seconds. I phoned 111, got an out of hours doctor's appointment and then we got sent straight to the hospital.
"When I arrived they checked Myah's sats and 3 nurses ran off with her to immediately get her straight on oxygen. We had no clue how serious this all was until that point.
"There is nothing more heart-breaking. Even if your baby has a slight cough or cold, just get checked out."
Does bronchiolitis cause any long-term complications?
The vast majority of children who get bronchiolitis recover quickly and aren't left with any long-term health problems.
For some children, particularly if they've had bronchiolitis severely, they may have a lingering cough and wheeze for another 3 or 4 months.
If your child has repeated bouts of bronchiolitis, their risk of getting asthma in later life may be increased.
What can I do to prevent my child getting bronchiolitis?
RSV, the virus that cause bronchiolitis is incredibly common and very easily spread, so it's more or less impossible to make sure your child never comes into contact with it. However, you can reduce the likelihood of your child getting or spreading it by taking the following steps:
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- Keep your baby away from other children and people who are sick, especially in your baby's first 2 months of life, and avoid contact with anyone who has cold or flu-like symptoms
- Wash your hands and your child's hands often and thoroughly, especially before picking up or feeding your baby
- Ask anyone caring for or coming to see your baby to wash their hands first
- Use disposable tissues and throw them away immediately after use
- Wash or wipe down toys regularly
- Do not smoke around your child or let other smoke around them (children who passively inhale tobacco smoke are at increased risk of developing bronchiolitis).
What is bronchiolitis exactly – and what causes it?
Bronchiolitis is a viral infection that's caused inflammation of the bronchioles – small breathing tubes that branch of the main passageways in your child's lungs. The inflammation makes the tubes swell and produce more mucus than usual, which can clog the space in the tubes, reduce the amount of air entering the lungs and make it harder to breathe.
It's the most common lower-lung chest infection in infants. It's estimated that 1 in 3 babies in the UK will develop bronchiolitis before their 1st birthday.
Most bronchiolitis cases are caused by the respiratory syncytial virus (RSV), which is usually most prevalent between October and March. It is an airborne virus and is transmitted through the coughs and sneezes of people who have colds, or through sharing or touching hard-surface items, such as toys, cups, door handles and taps, that other people who are ill have recently touched.
Is there a vaccination for bronchiolitis?
There is currently a trial ongoing into a new RSV vaccination, called nirsevimab. Initial studies have shown that this is safe and it is now being tested in larger scale trials across Europe. This vaccination could be a gamechanger with regards to bronchiolitis.
About our expert Dr Philippa Kaye
Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy's, King's and St Thomas's medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.
Pics: Getty Images; Beth Foster/Facebook
Last updated: March 2023
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