Bronchiolitis in babies: symptoms, treatment and when to get help

The NHS says the early symptoms of bronchiolitis are similar to a cold, such as sneezing, a runny or blocked nose and a slightly high temperature. A child may then get a cough, breathe more quickly, find it difficult to feed or eat, have noisy breathing (wheezing or crackling sounds) and become irritable.

The NHS says symptoms are usually worst between days 3 and 5, and the cough usually gets better in 3 weeks. It adds that bronchiolitis is different from bronchitis, which causes a cough with lots of mucus and can affect people of all ages.

The NHS says there is no specific treatment for bronchiolitis. It usually gets better on its own and you can look after your child at home, but it can be serious in some children, who may need hospital treatment.

For care at home the NHS gives a short list of dos and don'ts. NICE guidance for clinicians says that antibiotics are not used to treat bronchiolitis in babies and children, and that a chest X-ray should not be done routinely.

• Give children's paracetamol to babies over 2 months or ibuprofen to babies over 3 months if they are distressed or uncomfortable. Do not give these medicines at the same time.

• Keep your child upright as much as possible when they are awake, as this helps them breathe more easily.

• Check on your child regularly, including during the night.

• Encourage them to drink lots of fluids: smaller feeds more often in babies, and extra water or diluted fruit juice for older children.

• Do not smoke around your child.

• Do not try to lower their temperature by sponging with cool water or taking off all their clothes.

• Do not give aspirin to a child under 16.

Yes, the viruses that cause it spread easily. The NHS says RSV is very common and spreads easily in coughs and sneezes, and almost all children get it at least once before they are 2 years old.

The NHS lists ways to lower the chance of getting or spreading it. Keep newborn babies away from anyone with a cold or the flu, especially if they were born prematurely or have serious health conditions.

• Wash your hands and your child's hands often.

• Wash or wipe down toys and clean surfaces regularly.

• Avoid sharing things like cutlery and cups.

• Use disposable tissues and throw them away as soon as you have used them.

• Do not smoke around your child. The NHS says children who breathe in cigarette smoke have a higher risk of getting severe bronchiolitis.

Bronchiolitis is an infection of the small airways in the lungs. The NHS describes it as a common chest infection that affects babies and children under 2.

NICE guidance for clinicians says symptoms usually peak between 3 and 5 days, and that it is important to think about alternative diagnoses such as viral-induced wheeze or early-onset asthma in older infants and young children who have persistent wheeze without crackles, recurrent episodic wheeze or a personal or family history of atopy.

The NHS says bronchiolitis is caused by a viral infection, usually respiratory syncytial virus (RSV). It is not usually serious, but some babies and children have a higher risk of getting seriously ill.

The NHS says symptoms are usually worst between days 3 and 5, and the cough usually gets better in 3 weeks. NICE guidance says that the cough resolves in 90% of infants within 3 weeks. Feeding and breathing difficulties are usually most troublesome in the first days, then ease as the cough clears.

If a cold gets worse, or your child is feeding much less or has become more tired and breathless, get advice rather than waiting.

The NHS says you may know if your child seems seriously unwell and should trust your own judgement.

NICE guidance says babies and children should be referred immediately for emergency hospital care (usually by 999 ambulance) if they have apnoea, look seriously unwell to a healthcare professional, have severe respiratory distress (such as grunting, marked chest recession or a breathing rate over 70 breaths a minute) or central cyanosis.

It says referral to hospital should be considered for a breathing rate over 60 breaths a minute, difficulty with breastfeeding or inadequate fluid intake (50% to 75% of usual volume), clinical dehydration, or persistently low oxygen saturation. Hospital treatment can include oxygen and help with feeding. The NHS says some children may be given an injection of infection-fighting antibodies each winter to reduce the risk of severe RSV: this includes children born very prematurely, or with a heart or lung condition or a weakened immune system.

The NHS says the RSV vaccine helps reduce the risk of RSV causing problems such as bronchiolitis. It is available on the NHS from 28 weeks of pregnancy, which helps protect the baby and reduces the risk of severe RSV for the first 6 months after birth. It is also offered to adults aged 75 or over, and to adults aged 65 to 74 who have a weakened immune system or a long-term lung condition.

On the NHS most children with bronchiolitis are looked after at home, with advice from a GP or NHS 111 if symptoms worsen. Hospital admission is through urgent care or the emergency department when breathing or feeding is a problem.

Some families choose to see a private paediatrician for reassurance. In general terms the same principles apply: assess breathing, feeding and hydration, avoid unnecessary antibiotics and X-rays, and know the signs that mean a child needs emergency care.