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Bronchiolitis

By Adamos Chatzipanagis, paediatrician
www.paidiatros.com

What causes bronchiolitis? 

Bronchiolitis very often affects babies 1-18 months old. It frequently appears in epidemics during the winter and spring. It is usually due to a virus, called respiratory syncytial virus, or to other viruses, like influenza, parainfluenza and adenoviruses. The above viruses affect the lungs, and more specifically the bronchioles, (small tubes that transfer air to the lungs). This infection causes edema (swelling) and overproduction of mucus, resulting in the bronchioles becoming blocked, preventing the easy circulation of air.
How is bronchiolitis manifested?
The main symptom is difficulty in breathing. The first symptoms resemble those of a common cold. The child has “a runny nose”, as well as a cough. The coughing gradually deteriorates, and the child starts to have difficulty breathing, and there is wheezing. The breathing rate increases, as well as the heart rate. The muscles between the ribs move in and out during each breath. The child may have a fever, but this is not a necessary symptom. Children suffering from bronchiolitis often remain active, despite their difficulty breathing.
What is the incubation period?
A few days to a week may pass from the moment the virus enters the child’s body, until the manifestation of the first symptoms.
How is bronchiolitis diagnosed?
Your doctor will take a history of your child’s illness, and will then examine the child. Listening to the chest with a stethoscope will help the paediatrician diagnose bronchiolitis. He may also measure the oxygen in the blood. A chest x-ray, or testing of the nasal mucus, may be done at the hospital.
How long does bronchiolitis last?
The disease lasts for about 7-10 days. However, there are cases that last longer. They are seldom very serious and needing hospitalisation. Rarely, there may be complications like pneumonia and otitis.
How is bronchiolitis transmitted?
Viruses that cause bronchiolitis are usually found in the secretions of the nose, and are transmitted from human to human through coughing and sneezing. Children who go to nursery schools are at greater risk.

What is the treatment for bronchiolitis?
Most cases of bronchiolitis are dealt with at home, following the paediatrician’s instructions.
Children with bronchiolitis may respond to medications used for asthma. These medications are administered by inhalation. If the child has a fever, an antipyretic is necessary. There is no need for antibiotics, unless your paediatrician thinks otherwise.
A dry atmosphere makes the cough worse. On the other hand, inhalation of hot steam may help. Sleeping in an upright position and raising the head may help.
Smoking undoubtedly makes the cough worse. Don’t let anyone smoke in the house, or near your child.
Children with bronchiolitis get very tired when they are eating. Offer small and frequent meals, according to the child’s age. Try to offer lots of liquids, and easily digestible foods appropriate to the child’s age.
Hospitalisation may be considered necessary in 3 out of 100 children, for the following reasons:
1. Administration of oxygen.
2. Administration of intravenous fluids.
3. Very rarely, the child’s breathing may need to be supported with special breathing apparatus.
How can you protect the child?
Unfortunately, there are no appropriate vaccines to protect children from bronchiolitis. Breastfeeding protects from bronchiolitis and other infections. Babies under 3 months old should avoid contact with people who have colds. However, this is not always possible. Children born prematurely, and children who suffer from chronic heart or lung disease, are more likely to suffer from bronchiolitis. These children should receive monthly injections of antibodies during the winter, as a precaution.
Inform your paediatrician if:
1. Breathing becomes more difficult as time passes.
2. The child turns blue or has apnea.
3. The child has a high fever.
4. The child cannot drink 50% of the liquids he normally drinks, or is vomiting.
5. If you are failing to cope with the situation.

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