Baby with cold

Chest infections are common among babies under 12 months, but bronchiolitis, which causes breathing difficulty, can be particularly distressing for your baby and for you, too. While most cases can be treated at home and clear up within a couple of weeks, some children do require hospital treatment. Here's a guide to the causes, symptoms and treatments…

Bronchitis or bronchiolitis?
What causes bronchiolitis?
What are the symptoms of bronchiolitis?
Is bronchiolitis contagious?
How is bronchiolitis treated?
Are there complications of bronchiolitis?
What Mumsnetters say about bronchiolitis

When we talk about 'chest infections' we really mean infections of the lungs or airways. The most common types are bronchitis and pneumonia, but bronchiolitis is one of the most common viral infection in babies.

What's the difference between bronchitis and bronchiolitis?

Briefly, bronchitis is an infection of the 'bronchi' (the main passageways into the lungs) and bronchiolitis is an infection of the 'bronchioles' (the very smallest airways in the lungs, close to the lung tissue). The bronchi become smaller the closer they get to the lung tissue, when they eventually become 'bronchioles', so the two infections are very similar. Both affect the airways around the lungs and cause inflammation (which creates soreness in the chest and a hacking cough), but bronchitis is more common among older children and adults, while bronchiolitis affects almost exclusively babies of up to two years.

Bronchiolitis affects one in three babies under 12 months and is most common between November and March. Symptoms (see below) tend to be at their worst at around four days before easing off. The majority of cases clear up within two to three weeks, without treatment from a doctor, but around 2% of cases become severe enough to require hospital treatment. Around 40,000 children in the UK are admitted to hospital with bronchiolitis each year. One in 10 of those cases requires treatment in intensive care for help with breathing or feeding.

What causes bronchiolitis?

It’s nearly always caused by a virus and the most common one is the airborne respiratory syncytial virus (RSV). In babies, RSV can lead to croup and even pneumonia, although in most cases it will result in bronchiolitis.

The virus enters the respiratory system through the windpipe and travels down the bronchioles (those tiny airways in the lungs). They then become inflamed and produce mucus, which blocks the airways, making it harder for your baby to breathe. This is why difficulty feeding is one of the early signs of bronchiolitis – you might find your baby is pulling away from the breast or bottle because she can't breathe easily.

How can I prevent my child from catching bronchiolitis?

There’s no surefire way to prevent it but there's plenty you can do to reduce the risk. Good levels of hygiene, with regular hand-washing, will help, although that's not to say that the one in three babies who catch bronchiolitis have poor hygiene; it's a bit more arbitrary than that. If you know of another child who’s suffering from bronchiolitis, give them a wide berth if you can until symptoms have cleared, and bear in mind that children remain infectious for around three weeks.

Maintaining a smoke-free environment for your baby will also help. If you or your partner smokes then try to stop. Reducing your baby's risk of respiratory infection is just one of the benefits.

I would be really cautious about a baby with breathing difficulties. It's not an over-reaction to take a baby to A&E if they're showing signs of breathing problems.

What are the symptoms of bronchiolitis?

  • Fever
  • Cough
  • Sore throat
  • Blocked or runny nose
  • Problems feeding
  • Vomiting
  • Wheezing
  • Rapid heartbeat
Babies playing with bear

Is bronchiolitis contagious?

Highly. The virus is passed on by 'droplet infection' – when somebody who’s suffering from the illness coughs or sneezes and tiny droplets float in the air and are breathed in by others. The droplets also settle on surfaces and objects which means that, among children, the virus is easily passed on by sharing toys. A child can be infectious for three weeks, even after their symptoms have cleared up, so keep up the hand-washing and give them separate towels to use, and encourage everybody in your family to wash their hands regularly with antibacterial gel. It's pretty tricky to avoid siblings catching it but it's worth a go.

How is bronchiolitis treated?

As you’re dealing with a viral illness, antibiotics will not help, so for mild cases, you can treat your baby at home as you wait for her symptoms to ease.

  • Keep her upright. This will help her breathing and make feeding easier.
  • Keep her hydrated. Small, regular amounts of fluid will help soothe her throat and stop her from becoming dehydrated.
  • Try vapour rubs and saline drops. The latter are salt water drops that go into the nostrils (you might encounter some resistance!) and help clear the nose. Mumsnetters have various recommendations about which are the most effective products on the market.

Take your baby to hospital if…

  • She‘s having serious breathing difficulties. Some Mumsnetters, who’ve seen their children suffer from bronchiolitis, describe the baby’s chest sucking in, as they struggle to breathe. If you notice that, it's worth taking her in.
  • Her breathing is rapid. Fifty to 60 breaths per minute is the rate which should cause alarm. You can try counting her breaths if you like but you’re probably better trusting your instincts: if you think her breathing is too rapid then take her to the doctor. Better safe than sorry and medical staff will only ever be happy to see a baby that turns out to be fine – you're not wasting anyone's time.
  • Her skin turns pale or blue. A sure sign that your baby needs to see a doctor. Once they get her breathing properly, she'll turn a nice healthy colour again.
  • She has consistent lack of appetite. If she’s eating less than half of what she usually eats then she needs to see a doctor.
  • She’s dehydrated. She needs to be drinking more than half her usual fluid intake; if it starts to slip dramatically, she can become dehydrated and may need medical treatment.
  • Her nappies are dry. This is a sign that she’s dehydrated and if it's happening consistently, she needs to see a doctor.
  • She’s constantly tired and irritable. You know better than anyone when your baby just isn't herself. If she's really out of sorts with a chest infection it's worth asking a doctor to check her over.
  • She has a high temperature. Anything over 38C that doesn't reduce with Calpol (if she's old enough to take it) is cause for concern and needs to be looked by a doctor.
My daughter had a cough and cold-like symptoms. Then she was sucking in under her ribs and taking more breaths than usual. We called an ambulance and spent the night in hospital, so she could be observed. We were told she had bronchiolitis.

How do doctors treat bronchiolitis?

At the hospital, medics might use nasal cannula oxygen to treat your baby. These short plastic tubes sit at the entrance to the nostrils to help her get enough oxygen. They might also need to feed your baby via a tube if she hasn’t been eating, in which case you can express milk, or provide formula, to be fed to her.

Admissions to intensive care are extremely rare. When they do happen it’s usually because the baby is still struggling to breathe, in spite of treatment, or because the baby is suffering from apnoea (repeatedly stopping breathing for a few seconds).

If your baby is admitted to hospital, try not to worry. Remember that plenty of children go through this experience and come through it without complications, as these Mumsnetters will tell you.

Parent holds baby's finger

Are there complications of bronchiolitis?

In the vast majority of cases, the answer is “no”. In the medium term, however, the breathing difficulties caused by bronchiolitis can damage the airways and leave your baby with mild coughing and wheezing for about three months.

It’s fairly common for bronchiolitis to recur, sometimes even in the same winter. However, subsequent bouts are usually milder than the first.

Longer term, there’s speculation that babies who suffer repeated bouts of bronchiolitis might go on to develop asthma. However, there’s no definitive evidence of a link yet.

In rare cases, bronchiolitis can be accompanied by pneumonia which requires separate treatment.

What Mumsnetters say about bronchiolitis

“My son was admitted to hospital with bronchiolitis at 11 weeks. We struggled with him at home for about four days but his breathing was really getting quite laboured. His chest was kind of 'sucking in' as he tried to breathe and he was particularly bad at night. They didn't actually do much in hospital that I hadn't been doing at home. But it was reassuring to have medical staff on hand as he was so young.”

“The thing you need to look for is blueness around the lips and the sucking in of the chest, as that means they are really struggling to breathe and may need some oxygen.”

“Count her breaths per minute. If they’re higher than 50, with sucking under her ribs, or at the base of the throat, then she needs to see a doctor asap.”

“I took my daughter to the doctor after she’d been sick for two days. Bronchiolitis was not diagnosed (it starts out like a cold, so is not easy to spot). After four more days, she still wasn’t better, and when I took her back to the GP she was admitted immediately. She needed oxygen and a nasal feeding tube, but she made a good recovery.”

“When my baby was in hospital with bronchiolitis, I felt helpless. But just knowing you're close by will comfort them. Ask the doctor if you can put something that smells of you or home in the cot with him, as it might give him some comfort.”

“My eldest child was in hospital twice in her first year with bronchiolitis and has never suffered from any chest-related infection since. My youngest, on the other hand, did not have bronchiolitis but now, at four years old, has asthma, so there’s no automatic link between bronchiolitis and asthma in my experience!”