Bronchiolitis in infants and young children

How it presents and evolves

The illness may begin like a cold, with a blocked nose and a mild fever. Cough, rapid breathing, noises during breathing and tiredness during feeding may follow. Symptoms often worsen around days 3–5 and then improve; the cough may last longer.

This course should not be used as a reason to wait if the child is getting worse. Very young infants, those born prematurely and children with significant heart or lung problems may be at higher risk of severe illness.

When prompt assessment is needed

Seek prompt assessment when the baby drinks noticeably less, has far fewer wet diapers, looks tired or the condition is worsening. In an infant under 3 months, a temperature of 38 °C or higher requires urgent assessment. Do not use the absence of fever as proof that breathing is safe.

What the pediatrician assesses

The diagnosis rests mainly on symptoms and examination. The work of breathing, feeding, hydration and, when needed, oxygenation are assessed. The decision about hospital care also takes into account age, accompanying illnesses and the family’s ability to monitor.

In typical bronchiolitis, blood tests and chest X-ray are not done automatically. Changes on a chest X-ray can be misinterpreted as pneumonia and lead to an antibiotic without benefit. Examinations are added when the course is atypical or another diagnosis is suspected.

Why treatment is mainly supportive

Care aims at breathing and adequate fluid intake until the infection settles. Antibiotics do not treat the virus. Salbutamol, corticosteroids and chest physiotherapy are not routinely recommended for typical bronchiolitis. Wheezing does not automatically mean asthma, nor a need for the same treatment.

In hospital, the child may need oxygen or support with hydration and feeding. These measures are decided according to the condition and monitoring, not only the strength of the cough.

Frequently asked questions from parents

Is bronchiolitis contagious? Yes. The virus spreads through droplets from coughing, hands and contaminated surfaces. Frequent handwashing, cleaning surfaces, keeping away from sick people and no smoking at home reduce the risk for infants.

Will my child develop asthma? Not necessarily. Wheezing during bronchiolitis does not automatically mean asthma. Some children have repeated episodes of wheezing in the first years, but most improve. The doctor assesses whether there are other factors, such as eczema or family history.

Why does the baby eat less during the illness? A blocked nose and fast breathing make sucking and swallowing harder. More frequent feeding in smaller amounts and gentle nasal cleaning before feeds help. If intake falls markedly or diapers become very few, seek prompt assessment.

Why are antibiotics or syrups not given? Bronchiolitis is caused by a virus and antibiotics do not treat it. Syrups and other medicines usually give no benefit and may cause side effects. Treatment supports breathing and hydration until the infection passes.

How long does the cough last after bronchiolitis? The cough may continue for several weeks after other symptoms have improved. If it is getting worse, comes with a new fever or difficulty breathing, or lasts very long, the baby should be reassessed.

Which babies are at higher risk? Those born prematurely, under 3 months, with heart or lung disease, with reduced immunity or exposed to tobacco smoke. These babies need closer follow-up and a lower threshold for seeking assessment.

Care and follow-up at home

When the doctor judges home care suitable, offer feeds more often and in smaller amounts. Observe breathing and wet diapers and check the child during the night as well. Careful cleaning of the nose may help feeding; avoid deep or aggressive suction.

Wash hands, clean surfaces and keep the newborn away from sick people. The environment must be free of tobacco smoke. Before leaving the visit, clarify which changes require a recheck and where to go outside the clinic’s opening hours.

Care at Tirana Polyclinic: We offer pediatric consultation for assessment and follow-up when the condition allows outpatient care. Infants who need oxygen, continuous monitoring or feeding support are referred to hospital.