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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Medical Information & Treatment Guide
Acute Bronchiolitis (ICD-10: J21.9) is a viral respiratory infection characterized by inflammation of the small airways in the lungs, primarily affecting infants and children under two years of age.
Prevalence
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Common Drug Classes
Clinical information guide
Acute bronchiolitis is a common clinical syndrome of the lower respiratory tract that occurs in children younger than two years of age. It is characterized by inflammation, edema (swelling), and necrosis (cell death) of the epithelial cells lining the small airways, known as bronchioles. This inflammation leads to increased mucus production and airway obstruction. Pathophysiologically, the condition begins when a viral pathogen—most commonly the Respiratory Syncytial Virus (RSV)—invades the upper respiratory tract. As the virus spreads to the lower respiratory tract, it causes an inflammatory response that results in the clogging of the small airways with mucus and cellular debris. Because infants have smaller, more narrow airways and less collateral ventilation than adults, this obstruction leads to the characteristic wheezing and respiratory distress seen in this population.
Acute bronchiolitis is the leading cause of hospitalization among infants in the United States. According to data from the Centers for Disease Control and Prevention (CDC, 2024), approximately 58,000 to 80,000 hospitalizations occur annually among children younger than five years old due to RSV-related bronchiolitis. Research published in the journal Pediatrics (2023) indicates that nearly one-third of all children will develop clinical bronchiolitis before their second birthday. The condition is highly seasonal, with peak incidence typically occurring during the late fall, winter, and early spring months in temperate climates.
While bronchiolitis is often discussed as a single entity, it is classified based on the causative viral agent and clinical severity:
Acute bronchiolitis significantly impacts the quality of life for both the child and the caregiver. For the infant, the difficulty in breathing often interferes with the ability to breastfeed or take a bottle, leading to a risk of dehydration. Sleep is frequently disrupted by persistent coughing and congestion. For caregivers, the condition necessitates time away from work and can cause significant emotional distress. In severe cases requiring hospitalization, the family dynamic is further strained by the need for 24-hour monitoring and potential medical interventions.
Detailed information about Acute Bronchiolitis
The initial phase of acute bronchiolitis often mimics a common cold. Caregivers may first notice a clear runny nose (rhinorrhea), a mild decrease in appetite, and a low-grade fever (usually below 101°F or 38.3°C). These early signs typically last for one to three days before the infection progresses to the lower respiratory tract.
As the inflammation in the bronchioles increases, more specific symptoms emerge:
Answers based on medical literature
Acute bronchiolitis is a viral infection, so there is no 'cure' in the form of a pill or antibiotic that kills the virus. Instead, the body's immune system naturally fights the virus over the course of one to two weeks. Treatment focuses entirely on supportive care, such as keeping the child hydrated and ensuring they can breathe comfortably while the infection clears. Most children recover fully without any long-term complications. In severe cases, hospital support provides the necessary time for the child's lungs to heal.
The most effective home treatment is a combination of nasal suctioning and maintaining hydration. Using saline drops to loosen mucus followed by a bulb syringe helps clear the small nasal passages of infants, who are primarily nose-breathers. Caregivers should offer frequent, small feedings of breast milk, formula, or water to prevent dehydration. A cool-mist humidifier can also help keep the air moist and secretions thin. It is essential to avoid over-the-counter cough and cold medicines, as they are not effective for infants and can be dangerous.
This page is for informational purposes only and does not replace medical advice. For treatment of Acute Bronchiolitis, consult with a qualified healthcare professional.
In some cases, children may experience irritability, vomiting after coughing (post-tussive emesis), or a significant decrease in the number of wet diapers, which indicates dehydration due to the increased work of breathing and poor fluid intake.
During the peak of the illness (usually days 3 to 5), symptoms are at their most intense. In mild cases, the child remains playful despite the cough. In severe cases, the child may appear lethargic or exhausted from the effort of breathing.
> Important: Seek immediate medical attention if your child exhibits any of the following red flags:
In very young infants (under six weeks old), the classic symptoms of wheezing and coughing may be absent. Instead, the primary symptom of bronchiolitis may be apnea (periodic cessation of breathing) or extreme irritability. Older toddlers may present with symptoms more closely resembling a severe asthma attack.
Acute bronchiolitis is almost exclusively caused by viral infections. The primary pathogen is the Respiratory Syncytial Virus (RSV), which accounts for the vast majority of cases. According to research published in The Lancet Infectious Diseases (2022), the virus is highly contagious and spreads through respiratory droplets when an infected person coughs or sneezes. Once the virus enters the body through the eyes, nose, or mouth, it travels to the lower respiratory tract. The viral replication causes an intense inflammatory response, leading to the sloughing of epithelial cells and the formation of mucus plugs that block the small airways.
According to the American Academy of Pediatrics (AAP, 2023), infants born prematurely or those with chronic lung disease of prematurity are at the highest risk for hospitalization. Statistics show that infants with hemodynamically significant congenital heart disease also face a much higher rate of intensive care admission when infected with RSV.
Prevention focuses on hygiene and immunization. Frequent handwashing by all family members is the most effective way to prevent the spread of respiratory viruses. For high-risk infants, healthcare providers may recommend a monoclonal antibody prophylaxis (preventative treatment) during RSV season. In 2023, the FDA approved new preventative measures, including a maternal vaccine and a long-acting monoclonal antibody for infants, which have shown significant efficacy in reducing RSV-related hospitalizations.
The diagnosis of acute bronchiolitis is primarily clinical, meaning healthcare providers base it on the patient's history and a physical examination. There is no single laboratory test required to confirm the diagnosis in typical cases.
A healthcare provider will observe the child's breathing patterns, looking for signs of distress such as retractions and nasal flaring. They will use a stethoscope to listen for wheezing, crackles (rales), or diminished breath sounds. The provider will also assess the child's hydration status by checking the moistness of the mucous membranes and the fontanelle (soft spot) on the head.
While usually not necessary for a standard diagnosis, certain tests may be used in severe cases or to rule out other conditions:
Per the AAP guidelines, a diagnosis is made in a child under 24 months of age who presents with a viral upper respiratory prodrome followed by increased respiratory effort and wheezing.
Healthcare providers must distinguish bronchiolitis from other conditions, including:
The primary goals of treatment for acute bronchiolitis are to maintain adequate oxygenation, ensure the child remains hydrated, and reduce the work of breathing. Because the condition is viral, the focus is on supportive care rather than curing the underlying infection, which must run its course.
According to the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE, 2023), the standard of care is supportive. This includes frequent suctioning of the nasal passages using saline drops and a bulb syringe or suction device to clear mucus, which significantly improves an infant's ability to breathe and feed.
While medications are frequently requested, clinical guidelines emphasize limited use for most children:
In severe cases, supplemental oxygen is provided via nasal cannula to maintain oxygen saturation levels. In the most critical cases, high-flow nasal cannula (HFNC) or continuous positive airway pressure (CPAP) may be used to provide respiratory support.
Hydration is critical. If a child cannot drink enough due to rapid breathing, healthcare providers may administer intravenous (IV) fluids or use a nasogastric (NG) tube to provide nutrition and hydration directly to the stomach.
The most acute phase of the illness typically lasts 3 to 7 days, though a lingering cough can persist for 2 to 3 weeks. Monitoring involves regular checks of the respiratory rate, heart rate, and oxygen levels.
> Important: Talk to your healthcare provider about which approach is right for you.
For infants with bronchiolitis, maintaining hydration is the priority. Caregivers should offer frequent, smaller feedings (breast milk or formula) rather than large feedings, as a full stomach can press against the diaphragm and make breathing more difficult. For older children, clear liquids and electrolyte solutions may be recommended. A 2022 study in the Journal of Pediatrics highlighted that maintaining caloric intake is essential for the energy required for increased respiratory work.
Children with acute bronchiolitis should be encouraged to rest. Strenuous activity increases oxygen demand, which can worsen respiratory distress. As the child recovers, they can gradually return to normal play as tolerated.
Keeping the child’s head slightly elevated may help with drainage, though this should only be done under medical advice for infants due to SIDS risks (always follow 'Back to Sleep' guidelines unless otherwise directed). Using a cool-mist humidifier in the child's room can help keep secretions thin and easier to clear.
Caregivers should remain calm, as infants can sense parental anxiety, which may increase their own distress and respiratory rate. Utilizing skin-to-skin contact can help regulate an infant's heart rate and breathing.
There is limited evidence for herbal supplements or essential oils in treating bronchiolitis. In fact, some strong scents from essential oils can irritate sensitive airways and trigger coughing. Saline nasal drops remain the most evidence-based 'natural' intervention for congestion.
The prognosis for most children with acute bronchiolitis is excellent. The majority of children recover fully with supportive care at home. According to the National Institutes of Health (NIH, 2023), the mortality rate for children hospitalized with bronchiolitis is very low, estimated at less than 0.1% in developed nations. However, the recovery period can be slow, with symptoms often peaking on day 4 or 5 and a cough lasting up to 21 days.
While most recover, some children may experience:
There is a documented association between severe bronchiolitis in infancy and the development of recurrent wheezing or asthma later in childhood. Research in The Journal of Allergy and Clinical Immunology suggests that children who had bronchiolitis caused by rhinovirus may have a higher risk of developing asthma than those infected with RSV.
Once the acute phase has passed, children can return to their normal routines. Parents should be aware that subsequent viral colds may cause a return of mild wheezing for several months following the initial infection.
Contact your pediatrician if the cough is not improving after 10 days, if the child develops a new fever after initially improving, or if you notice signs of ear pain.
The typical duration of acute bronchiolitis is approximately 7 to 14 days, though some symptoms may persist longer. The first few days usually involve cold-like symptoms, with the most severe respiratory symptoms occurring between days 3 and 5. After this peak, most children begin to show gradual improvement in their breathing and energy levels. However, a lingering 'post-viral' cough can continue for three weeks or more in some children. If symptoms worsen after the first week, a follow-up with a healthcare provider is recommended.
Antibiotics are not effective against bronchiolitis because the condition is caused by viruses, not bacteria. Using antibiotics unnecessarily does not help the child get better faster and can lead to side effects like diarrhea or the development of antibiotic-resistant bacteria. A healthcare provider will only prescribe antibiotics if they suspect a secondary bacterial infection, such as an ear infection or bacterial pneumonia. For the vast majority of bronchiolitis cases, supportive care is the only recommended approach. Always follow the guidance of your pediatrician regarding medication use.
Bronchiolitis and asthma share similar symptoms, such as wheezing and coughing, but they are different conditions. Bronchiolitis is an acute infection of the small airways caused by a virus, typically occurring in infants. Asthma is a chronic inflammatory condition of the airways that is often triggered by allergies, exercise, or irritants. While a severe case of bronchiolitis can increase the risk of developing asthma later in life, the two are distinct medical diagnoses. Bronchiolitis usually occurs as a one-time or infrequent event, whereas asthma involves recurrent episodes.
You should seek emergency medical care if your child shows signs of significant respiratory distress. This includes 'caving in' of the chest or neck muscles (retractions), breathing that is consistently faster than 60 breaths per minute, or a bluish tint to the lips or skin. Other emergency signs include long pauses in breathing (apnea), extreme lethargy, or a total refusal to drink fluids. If your child appears exhausted by the effort of breathing, they may need hospital-based support like supplemental oxygen. When in doubt, always contact your local emergency services or pediatrician immediately.
Yes, it is possible for a child to have bronchiolitis more than once, as several different viruses can cause the infection. While the Respiratory Syncytial Virus (RSV) is the most common cause, other viruses like rhinovirus or parainfluenza can also lead to the condition. Additionally, infection with one strain of RSV does not provide complete immunity against other strains or future infections. However, the first infection is typically the most severe, and subsequent infections often result in milder symptoms as the child's airways grow and their immune system matures. Proper hygiene remains the best defense against repeat infections.
The most effective 'natural' remedies are saline nasal rinses and maintaining a humid environment. Saline drops are a safe, drug-free way to thin mucus and make it easier to suction out of an infant's nose. Using a cool-mist humidifier can also soothe irritated airways, though it must be cleaned daily to prevent mold growth. Honey should never be given to infants under one year of age due to the risk of botulism, and essential oils should be used with caution as they can sometimes trigger airway irritation. Rest and skin-to-skin contact are also excellent natural ways to support a child's recovery.
Bronchiolitis often significantly disrupts sleep for both infants and their parents. Nasal congestion and a persistent cough tend to worsen when the child is lying flat, leading to frequent awakenings. Infants may also be more irritable or 'clingy' due to the discomfort of the infection. While it is tempting to use pillows to prop up an infant, this is not safe due to the risk of SIDS; instead, focus on thorough nasal suctioning before bedtime. As the inflammation subsides, sleep patterns typically return to normal within a week or two.
The viruses that cause bronchiolitis, such as RSV, are highly contagious to people of all ages. However, because adults have much larger and more developed airways, the virus usually only causes symptoms of a common cold, such as a sore throat, runny nose, or mild cough. Adults rarely develop the lower respiratory tract inflammation (bronchiolitis) seen in infants. Nevertheless, an adult with a 'cold' can easily pass the virus to a vulnerable infant, where it can develop into severe bronchiolitis. This is why handwashing and avoiding contact with infants when you are sick are so important.