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Bronchiolitis

Bronchiolitis is a common, lower respiratory tract infection that occurs from late autumn through to early spring. It affects babies and young children and is particularly common in the first two years of life. More than 80 per cent of cases occur in the first year of life, commonly between two to 10 months of age. It is more common in winter.

The bronchiolitis virus causes the small breathing tubes (bronchioles) in the lung to become inflamed. It is spread by contact with other children and family members who may have had a cold-like illness. Although caused by different viruses, the most common is the Respiratory Syncytial Virus (RSV). This infection begins as a cold with symptoms like runny nose, cough and sneezing. Often a wheeze (a high pitched sound made on breathing) and fever may be present along with the cough worsening.

Sometimes the illness is complicated by rapid and laboured breathing, poor feeding and occasionally apnoea (periods when breathing stops). Hospitalisation is often required if these complications occur.

The virus lasts between six and 12 days, however, a cough may continue for up to four weeks after other symptoms have settled.

Treatment

Medications (antibiotics) do not work against bronchiolitis, as the infection is viral and easily spreads from person to person. The virus causing the bronchiolitis can be identified by collection of a sputum sample from the back of the nose called a ‘naso-pharyngeal aspirate or NPA’.

If your child is hospitalised, they will be nursed using infection control guidelines. Gown, gloves and mask will be donned prior to entering the room and discarded prior to leaving the room to reduce the spread of the virus. Visitors other than parent/carer(s) will be restricted during hospitalisation.

Nursing children in isolation helps to protect them from others who may be unwell. It also helps to prevent the spread of bronchiolitis. It is very important that you understand and follow these precautions to assist in your child’s recovery. Careful handwashing is very important to prevent the spread of infection.

Recovery from bronchiolitis takes time. The main treatments are oxygen, fluids and rest. It is important that you understand that your child’s condition may worsen before it gets better, but with oxygen, fluids, rest and time, the illness will follow its course.

The usual course of bronchiolitis is: 

1-Initial symptoms
2-Deterioration phase (2-4 days after the onset of symptoms)
3-Plateau phase (2-4 days)
4-Improvement phase (2-4 days)

Initial symptoms

Initial symptoms of bronchiolitis include:

  • runny nose
  • mild cough and stuffiness for one to two days
  • increase in breathing difficulties
  • very fast breathing
  • poor feeding
  • noisy breathing
  • drawing in of the chest with each breath
  • fever
  • apnoea (this may be the first symptom if your child is very young or has other medical problems).

Deterioration phase 

Typically initial symptoms last for three days, or longer if any other viruses are present. If your child has reached the deterioration phase and their condition dramatically worsens, they will be admitted to hospital.

On admission to Mater Children’s Private Brisbane, a nurse will show you to your child’s room and talk with you about the ward facilities available to you. The nurse will apply an identification armband on your child, which will remain in place throughout their stay. Mater Children’s Private Brisbane will provide a bed for one parent/carer if you wish to stay overnight.

Your admitting nurse will ask about your child’s medical/surgical history and any particular needs your child may have while they are an inpatient. It is important for you to provide the staff with detailed and accurate information about their clinical history, so that staff can properly plan your child’s treatment.

If your child is admitted to Mater Children’s Private Brisbane, nursing staff in conjunction with the medical officer, will be regularly observing and monitoring your child’s breathing, oxygen levels and ensuring that they are able to feed adequately.

Deterioration phase to plateau 

While in hospital, your child’s condition may worsen before it gets better as a result of the nature of the virus.  The usual time it takes to pass through each phase of the illness will vary from child to child, depending on in what stage of the illness they were admitted.

In general, the deterioration phase may last for three days, or longer if other viruses are present as well. The plateau phase may last longer if your child has complex health needs.

Your child’s treatment in Mater Children’s Private Brisbane may include oxygen via nasal prongs and frequent suctioning of nasal secretions. Smaller more frequent feeds will be offered to maintain fluid levels, and to prevent breathlessness and tiredness. If your child is unable to feed, they may require a nasogastric tube (a small tube inserted through the nostril and down into the stomach). Or they may have and IV inserted for fluids to be maintained.

Your child will be monitored and observed closely and cares will be grouped together and done all at one time to minimise handling, and reduce the interruptions to their rest time. Young children, babies in particular, require minimal handling during treatment to allow them to rest and help them get better. Observations and vital signs (including pulse, respiratory rate and heartrate) and oxygen therapy will be monitored every hour. 

Recovery 

With oxygen, fluids, rest and time, your child’s illness will gradually progress from the plateau phase to the improvement phase. This phase may last about seven days, depending on in what stage of the illness your child was admitted to Mater Children’s Private Brisbane.

Your child will continue to be nursed using infection control guidelines during this phase. nursing staff and the medical officer will continue to regularly monitor your child’s vital signs and feed/fluid intake.

Your child may still need supplemental oxygen therapy and will be monitored to ensure adequate oxygen is being received. The aim is for your child to breathe comfortably on room air and maintain their oxygen levels. This will be indicated by the results of the regular respiratory assessments by nursing staff and the medical officer. As your child improves, they will be able to tolerate enough oral feeds to maintain hydration.

Transition home 

Discharge from Mater Children’s Private Brisbane is appropriate when:

  • Your child has little or no respiratory difficulty, and is not requiring oxygen (unless oxygen dependent before admission).
  • Your child is taking enough oral feeds (without being short of breath) to wet the ‘normal’ amount of nappies (that is, the same number as before they became ill).
  • When you feel capable to manage your child at home.

Care at home

On discharge from Mater Children’s Private Brisbane, your child’s airways will be extra sensitive. The following tips may assist with their care:

  • Keep your home warm, especially in the late afternoon and evening.
  • Ensure a smoke free environment (please feel free to ask us for advice and support on how to QUIT smoking is you are ready to do so).
  • Encourage rest.
  • Ensure your child is getting enough fluids. Give smaller but more frequent feeds (breast or bottle). This way your child does not get too tired when feeding.
  • Ensure your baby’s nose is clear (as small babies breathe only through their nose). This can make breathing and feeding easier.
  • Avoid contact with other babies for 10 days as bronchiolitis is an infectious disease.

How to seek medical advice

For emergency medical treatment:

  • Call Queensland Ambulance Service on 000
  • Present to Mater Private Emergency Care Centre at 301 Vulture Street South Brisbane. Telephone: 07 3163 1000
  • Go to your closest hospital that treats children

If you have any concerns or questions please contact your doctor.

Return to your doctor or hospital if:

  • Your child has poor fluid intake and is refusing feeds-particularly if they have fewer wet nappies than usual.
  • Your child is breathing more rapidly or having difficulty breathing or their cough or wheeze is worsening.
  • Your child is increasingly irritable or lethargic.
  • You are at all concerned that something might be wrong with your child.

Seek urgent medical advice if:

  • Your child has any difficulty breathing, including apnoeas.
  • Your child is breathing fast.
  • Your child is unable to feed normally because of coughing or wheezing.
  • Your child becomes pale or sweaty or their skin looks blue.
  • You are at all concerned that something may be wrong.
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 14/6/2017.
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