Do Children Get Bronchiolitis or Bronchitis?
Children, particularly those under 2 years of age, get bronchiolitis—not bronchitis—which is a distinct viral lower respiratory tract infection characterized by inflammation of the small airways. 1, 2
Age-Specific Disease Definition
- Bronchiolitis is specifically a disease of infants and young children aged 1 month through 23 months, as defined by the American Academy of Pediatrics clinical practice guidelines 1, 2
- The condition is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, with increased mucus production following an upper respiratory illness 1
- Approximately 90% of children are infected with Respiratory Syncytial Virus (RSV), the most common cause of bronchiolitis, within the first 2 years of life 1, 2
Why Bronchiolitis, Not Bronchitis
- Bronchiolitis affects the small airways (bronchioles), presenting with tachypnea, wheezing, and/or crackles in children under 2 years 1
- The clinical presentation includes rhinitis and cough that may progress to tachypnea, wheezing, rales, use of accessory muscles, and nasal flaring 1, 2
- Children with recurrent episodes of "bronchiolitis" after the first year of life likely do not have viral bronchiolitis, but rather recurrent wheezing or asthma 3
Epidemiology and Impact
- Bronchiolitis is the most common lower respiratory infection in young children and the most common cause of hospitalization in those aged less than 1 year 2, 4
- The condition leads to more than 90,000 hospitalizations annually in the United States, with most occurring in infants less than 1 year old 2
- Up to 40% of children infected with RSV will experience lower respiratory tract infection during their initial infection 1, 2
Age-Related Clinical Presentations
Infants 1-12 Months
- More likely to present with increased work of breathing, including tachypnea, nasal flaring, and intercostal retractions 2
- Higher risk of apnea, particularly in those younger than 1 month and in premature infants 2
- Infants younger than 12 weeks are at highest risk for severe disease 2, 5
Children 12-24 Months
- Typically present with rhinitis and cough that may progress to wheezing and rales 2
- Generally able to compensate for increased respiratory effort better than younger infants 2
Clinical Course and Resolution
- Bronchiolitis is typically self-limiting, with most children recovering within 2-3 weeks 2, 5
- The mean time to cough resolution is 8-15 days, with 90% of children cough-free by day 21 1, 2
- Children with persistent symptoms beyond 4 weeks may represent a different clinical problem, sometimes termed "post-bronchiolitis syndrome" 1, 2
Common Clinical Pitfall
- The American Academy of Pediatrics emphasizes that diagnosis should be based on history and physical examination alone—the pathognomonic features include low-grade fever, dry cough, bilateral wheezing, tachypnea in a child under 2 years following an upper respiratory prodrome 2, 5
- Routine viral testing, chest radiographs, or laboratory studies are not necessary as they do not change management 2, 5