Baby with difficulty in breathing (bronchiolitis)

My 4-month-old niece has just been admitted to hospital with bronchiolitis. She looks very distressed and is struggling to breathe. What is bronchiolitis and can my baby catch it – we visited when my niece had a cold 4 days ago?

Bronchiolitis in babies is a viral infection of the smallest airways in the chest (called bronchioles). It causes at least 1% of children under 2 years of age to be admitted to hospital and is one of the major reasons for the children’s wards of hospitals to be very busy over late autumn and winter. It is most commonly due to an infection by the Respiratory Syncitial Virus (RSV). This virus is highly infectious and can survive outside the human body for eight hours. So, if you touch a surface that has been sneezed or coughed upon you will pick up the virus on your hands. If you then rub your eye or nose you will infect yourself. Except in babies or asthmatics this will only mean an adult or older child will develop a cold or “chest cold” but the carrier of the RSV is a walking time bomb for any baby you handle. This is why hand washing is an obsession for nurses, doctors and other staff who handle children. It also means that it is likely that your baby probably has become infected with RSV but remember every child under 2-years becomes infected with RSV. Only 1-2% have to be admitted with bronchiolitis the other 98-99% just develop a bad cold.

The infection of the bronchioles causes swelling of the lining of these small tubes. This makes it difficult to move air in and out and the baby has to breathe harder and their oxygen levels may fall. As drinking from the breast or bottle is the hardest work a young baby has to do, they may become too tired to take in their daily requirement and many hospitalised bronchiolitics become dehydrated. Fortunately the body’s defence mechanisms against infection mean that on about the 4^th or 5^th day of hospitalisation most babies will start to become better but they may need intense medical/nursing care before this happens.

The hospital management of bronchiolitis is to give oxygen if the oxygen levels in the blood are low and extra fluid by a tube through the nose into the stomach or by a drip into a vein if dehydration is likely or has occurred. One patiently waits for the baby’s defence systems to fight off the infection. Death from bronchiolitis is extremely rare unless a pre-existing heart or lung condition compromises the baby.

Please remember to wash your hands before handling a baby so that you are not responsible for transmitting RSV infection.