Bronchiolitis – Diagnosis and Treatment
Diagnosis
Healthcare providers usually start diagnosing bronchiolitis by observing the child’s signs and listening to the lungs using a stethoscope.
Common symptoms include coughing, wheezing, congestion, trouble breathing, mild fever, and signs such as rapid breathing (tachypnea), retractions, and crackling sounds (crackles) heard during auscultation.
Some children may also show signs like apnea or a bluish tint to the skin (cyanosis).
Providers can often diagnose bronchiolitis by reviewing symptoms and performing a physical exam. Extra tests are sometimes used if symptoms worsen or if the provider suspects another illness.
Possible Additional Tests:
| Test | What It Checks | When It’s Used |
|---|---|---|
| Chest Radiograph | Lungs (pneumonia/atelectasis) | If there are unusual sounds or severe symptoms. |
| Viral Testing | RSV or other viruses | To find if respiratory syncytial virus is present. |
| Blood Tests | White cell count, oxygen levels | For severe cases or to check for low oxygen. |
| Pulse Oximetry | Blood oxygen levels | To monitor oxygen saturation during illness. |
Providers also check for signs of dehydration, such as dry mouth, tiredness, and little urine output. These steps help distinguish bronchiolitis from other lower respiratory tract infections and guide the right care plan.
Treatment
Medical Support in the Hospital
Infants and young children with bronchiolitis may need hospital care if their breathing becomes harder or if they are not getting enough oxygen.
Severe respiratory distress, very low oxygen levels (hypoxemia), or trouble drinking liquids may require a hospital stay. Hospital staff check breathing, heart rate, and oxygen often.
Hospital treatments may include:
- Oxygen Therapy: Staff give oxygen with a mask, nasal prongs, or a high-flow nasal cannula to help children who have trouble getting enough oxygen on their own.
- Fluids by Vein: If a child cannot drink due to sickness, staff provide fluids through an IV to prevent dehydration.
- Suctioning: Staff use gentle suctioning with a bulb syringe or device to remove mucus from the nose, making it easier to breathe.
- Monitoring: Care teams closely watch for signs of respiratory failure or the need for extra breathing support like mechanical ventilation in very severe cases.
Providers usually do not give medications like bronchodilators or corticosteroids for bronchiolitis unless a trial shows clear benefit. They only use antibiotics if a bacterial infection, such as pneumonia, is also present.
For very high-risk infants, providers may administer a monoclonal antibody therapy to help prevent complications from respiratory syncytial virus (RSV).
Lifestyle tips and home-based care
Parents can take steps at home to help children feel better while they recover. Keeping the air moist helps. Using a cool-mist humidifier or vaporizer in the child’s room loosens mucus and makes breathing easier.
Clean the humidifier every day to prevent mold or bacteria from growing, which can be harmful. Hydration is a top priority. Children need enough fluids to avoid dehydration. Infants under 1 year should keep having breast milk or formula.
Older kids can have water, juice, or milk. Sometimes, drinking is difficult because of a stuffy nose. Offering small sips often helps a child get enough liquid.
| Age Group | Recommended Drinks | Tips |
|---|---|---|
| Infants | Breast milk, formula | Offer more often |
| Older kids | Water, juice, milk | Use small, frequent sips |
Saline nose drops can help relieve congestion. These drops are gentle and safe for children. After placing a few drops into one nostril, gently use a bulb syringe to clear the mucus.
Repeat on the other side. Take care not to push the bulb too far into the nose. Fever or pain can make children uncomfortable. Parents may use over-the-counter medicines like acetaminophen or ibuprofen for relief.
Do not give aspirin to children, since it can cause serious health problems such as Reye’s syndrome. Always check with a healthcare provider before using any medication.
Parents should keep children away from tobacco and other sources of smoke. Secondhand smoke can make breathing problems worse and slow healing. Anyone who smokes should do so outside the home and the car.
Practicing good hygiene reduces the spread of infection. Remind children and adults to wash their hands well and avoid sharing cups or utensils. This helps keep germs from spreading to others in the home.
If symptoms get worse or do not improve, contact a healthcare provider.
Getting Ready for Your Child’s Visit
Steps You Can Take Before the Appointment
Parents and caregivers can make notes before visiting the healthcare provider. Write down all symptoms the child is showing, when the symptoms started, and if they have changed.
Note anything out of the ordinary, not just symptoms that seem like a cold or flu. List any important personal details related to the child’s health.
For example, mention if the child was born with a low birth weight, was born early, or has ongoing health problems like heart or lung conditions.
Children at higher risk, such as those with a weak immune system or babies younger than three months, may need special attention.
These risk factors are especially important during winter and in crowded situations, as bronchiolitis spreads easily and has its peak incidence during cold months, especially in the northern hemisphere.
Questions for the health provider may be helpful, such as:
- What might be the reason for these symptoms?
- Are tests needed, and if so, which ones?
- What is the expected length of these symptoms?
- Is this contagious, and if so, how can we prevent spreading it?
- What kind of treatment or care does the American Academy of Pediatrics recommend?
- Are there options for less expensive or generic medicines?
- What home care measures can make the child feel better?
Bringing a written list can make the visit easier and more organized.
What Your Healthcare Provider Might Ask
During the appointment, the healthcare provider will likely ask several questions about the child’s health. They may want to know:
- When and how the symptoms started
- Whether the symptoms are constant or come and go
- How serious the symptoms seem
- What makes the symptoms worse or better
Being ready to answer these questions helps make the visit more effective.
If you provide details about the child’s health and risk factors, the provider can decide if more tests or special treatments are necessary to lower the risk of complications and limit transmission to others.
