What patient education is necessary for managing bronchiolitis, including symptoms, red flags, and treatment options?

Patient Education for Bronchiolitis

Bronchiolitis is a common viral infection of the small airways in infants and young children that typically starts with cold symptoms and may progress to cough, fast breathing, and wheezing, but most children recover at home with supportive care over 8-15 days. 1, 2

What Is Bronchiolitis?

Bronchiolitis is caused by viruses that infect the small breathing tubes in your child's lungs, causing inflammation, swelling, and increased mucus production. 1 The most common virus is respiratory syncytial virus (RSV), which peaks between December and March in North America, though other viruses like rhinovirus, influenza, and parainfluenza can also cause it. 1 Nearly 90% of children get RSV in their first 2 years of life, and up to 40% will develop lower respiratory tract infection during their first infection. 1

What to Expect

Your child's illness will typically begin with runny nose and cough (like a cold), which may then progress over several days to include: 1

• Faster breathing (tachypnea)
• Wheezing or whistling sounds when breathing
• Crackling sounds in the chest (rales)
• Working harder to breathe, shown by flaring nostrils, grunting sounds, or pulling in of the chest muscles between or below the ribs
• Cough that may worsen before improving

The illness is self-limiting and typically lasts 8-15 days, with symptoms often worsening in the first few days before gradually improving. 2

Home Care Instructions

The main treatment for bronchiolitis is supportive care at home, as there are no medications that cure the viral infection. 3, 4, 5

Hydration and Feeding

• Offer frequent small feedings, as your child may tire easily or have difficulty feeding due to nasal congestion and fast breathing. 1
• Ensure adequate fluid intake to prevent dehydration. 3, 5
• Watch for signs of dehydration: decreased wet diapers, dry mouth, no tears when crying, or sunken soft spot on the head.

Nasal Congestion Management

• Use gentle external nasal suctioning (bulb suction) when you see visible nasal congestion affecting breathing or feeding. 2
• Suction as needed rather than on a strict schedule, but avoid letting more than 4 hours pass without suctioning if your child has significant congestion. 2
• Avoid deep suctioning, as this has been associated with longer illness duration. 2

Positioning

• Keep your child's head slightly elevated during sleep to help with breathing. 2
• Hold your child upright during and after feedings if they are having difficulty.

What NOT to Do

• Do not use over-the-counter cough and cold medications, as they are not effective and may be harmful. 3, 4
• Do not expect antibiotics to help, as bronchiolitis is caused by viruses, not bacteria. 3, 4, 5
• Do not smoke or allow smoking around your child, as smoke exposure worsens respiratory symptoms. 1

RED FLAGS: When to Seek Immediate Medical Care

Call 911 or go to the emergency department immediately if your child has any of these warning signs: 1, 6

Severe Breathing Problems

• Breathing rate of 70 breaths per minute or higher (count for a full 60 seconds). 6
• Severe retractions (chest pulling in deeply with each breath).
• Grunting with every breath.
• Pauses in breathing (apnea) or irregular breathing patterns. 1
• Lips or skin turning blue or gray.

Signs of Severe Illness

• Extreme difficulty feeding or complete refusal to eat or drink. 1
• Signs of dehydration: no wet diapers for 8-12 hours, very dry mouth, no tears, sunken soft spot.
• Lethargy, extreme sleepiness, or difficulty waking your child. 1
• Unresponsiveness or decreased alertness. 1

High-Risk Situations

Seek medical attention more readily if your child has any of these risk factors for severe disease: 1, 6

• Age less than 12 weeks (3 months old). 1, 6
• Born prematurely (before 37 weeks gestation). 1, 6
• Chronic lung disease or history of breathing problems at birth. 1, 6
• Heart disease. 1, 6
• Weakened immune system. 1, 6
• Neuromuscular disease affecting breathing or swallowing. 1

When to Contact Your Doctor (Non-Emergency)

Contact your child's doctor during office hours if: 1

• Symptoms are not improving after 5-7 days or are getting worse.
• Your child is having increasing difficulty feeding.
• You are concerned about your child's breathing, even if not severe.
• Fever persists beyond 3-4 days.
• You are unable to care for your child at home or need additional support.

Prevention

The best way to prevent bronchiolitis is to reduce exposure to viruses: 3, 4

• Wash hands frequently with soap and water, especially before touching your baby.
• Keep your baby away from people who are sick with colds or respiratory infections.
• Avoid crowded places during RSV season (typically winter months).
• Do not allow smoking around your child.
• Clean and disinfect surfaces and toys regularly.
• If possible, delay daycare enrollment during the first few months of life, especially during RSV season.

For high-risk infants (those born very prematurely, with chronic lung disease, or significant heart disease), your doctor may recommend monthly injections of palivizumab during RSV season to help prevent severe infection. 3, 4

Important Reminders

• Reinfection with RSV and other respiratory viruses is common throughout life, as immunity is not permanent. 1
• Most children with bronchiolitis recover completely at home without complications. 7, 3
• Your child may have a lingering cough for several weeks after the acute illness resolves, which is normal. 2
• Some children who have severe bronchiolitis may be at increased risk for wheezing episodes later in childhood. 1, 4