Bronchiolitis and RSV in babies: symptoms, home care and warning signs

Bronchiolitis is an infection of the smallest airways of the lungs, the bronchioles. The NHS stresses it is different from bronchitis, which causes a cough with lots of mucus and can affect people of any age. It is caused by a virus, usually RSV, which spreads in coughs and sneezes. NHS inform adds that RSV can live on surfaces or objects for several hours and that peak season is late autumn and winter, though it can happen all year round.

Because nearly every child meets RSV in their first two years, most cases are mild and look like a cold. A minority of babies develop the breathing and feeding difficulties that make bronchiolitis frightening for families.

The NHS says early symptoms resemble a cold: sneezing, a runny or blocked nose and a slightly high temperature. A child may then develop a cough, faster breathing, difficulty feeding or eating, noisy breathing with wheezing or crackling, and irritability. Babies with RSV may feed less than usual.

Symptoms are usually worst between days 3 and 5, and the cough usually improves within 3 weeks. NHS inform notes a person with RSV is normally contagious for 1 to 2 days before symptoms and for most people 3 to 8 days afterwards, while some infants may stay contagious for up to 4 weeks.

The NHS says to call 999 if:

• your child is having difficulty breathing, such as grunting noises, the tummy sucking under the ribs, or breathing quickly

• there are pauses when your child breathes

• the skin, tongue or lips are blue or grey (on brown or black skin check palms, soles, lips, gums and inside the eyelids)

• your child is floppy and will not wake up or stay awake

The NHS says to ask for an urgent GP appointment or call 111 if the cold is getting worse, the child is feeding or eating much less than normal, there has been a dry nappy for 12 hours or more or other signs of dehydration, a baby under 3 months has a temperature of 38C or an older child 39C or higher, the baby feels hotter than usual on the back or chest or is sweaty, the temperature is very high or low or the child is shivering, the child is very tired or irritable, or you are simply worried. The same page reminds parents that they may know if their child seems seriously unwell and should trust their own judgement.

There is no specific treatment for bronchiolitis, and many children get better on their own at home. The NHS suggests:

• children's paracetamol for babies over 2 months, or ibuprofen for babies over 3 months, if they are distressed or uncomfortable, but not both at the same time

• keeping the child upright as much as possible while awake, which helps breathing

• checking on the child regularly, including during the night

• encouraging fluids, with smaller feeds more often for babies and extra water or diluted fruit juice for older children

The NHS says not to smoke around your child, because children who breathe in cigarette smoke have a higher risk of severe bronchiolitis. It also says not to try to cool a child by sponging with cool water or removing all their clothes, and not to give aspirin to a child under 16. Saline nose drops from a pharmacy are mentioned on the NHS RSV page for blocked noses.

The NHS lists babies under 6 months, babies and children born very prematurely, and those with a heart or lung condition or a weakened immune system as more likely to become seriously ill. Some of these children may be offered an injection of infection-fighting antibodies each winter, usually given in a hospital children's clinic.

The NHS says the RSV vaccine is free from 28 weeks of pregnancy, helping to protect the baby for the first months of life, and that it is also offered to adults aged 75 or over and some adults aged 65 to 74 with weakened immunity or a long-term lung condition. Hand hygiene, disposable tissues and keeping newborns away from people with colds or flu are the other measures listed.

Where a baby needs hospital, the NHS RSV page says treatment may include fluids to avoid dehydration or oxygen to help breathing. For nurseries and schools, UKHSA guidance says children with RSV should stay at home if they have more than mild symptoms, for example a high temperature, and that settings only need to contact the health protection team if absences are unusually high or there is a serious case.