Treatment for Bronchiolitis
In most cases, bronchiolitis can be treated at home. Parents and caregivers should make sure the child gets plenty of fluids. Feed the child smaller amounts more often, breastfeed more frequently, or give 12 extra bottles each day. Sometimes it can be difficult to encourage babies with bronchiolitis to accept fluids, but it is important for their recovery that they do.
Use a cool-mist vaporizer or humidifier in the child's room or run hot water in the bathtub or shower and sit nearby with the child. Extra moisture helps loosen the mucus and clear out the airway so that baby can breathe more easily. Be sure to clean the vaporizer or humidifier daily and keep the child away from hot water to avoid burns.
Use a bulb syringe and saline nose drops to clear the child's nose of mucus, especially before feeding and sleeping. Hold the child in an upright position more often to help with breathing and do not allow anyone to smoke near the child.
Ask a qualified health care provider about giving the child acetaminophen (e.g., Children's or Infant's Tylenol) to reduce fever. Do not give the child aspirin because it can increase the risk for a serious condition called Reye syndrome.
Other over-the-counter medicines, such as decongestants, expectorants, cough medicines, and antihistamines are not used to treat bronchiolitis and are not recommended for use in children under the age of 2.
Antibiotics also are not used to treat bronchiolitis because it is a viral infection, not a bacterial infection. Herbal remedies may have adverse side effects and their effectiveness for bronchiolitis has not been well-documented.
Some medicines (e.g., Ventolin, Bricanyl) may be given to relieve symptoms and open airways. These medications are not always effective in children younger than 12 months of age.
Most children who have bronchiolitis get well in within 7–14 days. Parents should contact their child's physician immediately or call 911 if any of the following occur:
- The child turns bluish, especially the lips and fingertips.
- The child has a history of congenital heart disease or was born prematurely (more than 3 weeks early).
- There are fewer wet diapers than usual or no urine for 68 hours (may indicate dehydration).
- The child vomits, can't keep food down, or refuses to eat.
- Breathing rate accelerates to more than 40 breaths per minute.
- The baby's skin pulls in between the ribs with each breath.
- The child can only breathe while sitting up or breathing becomes increasingly difficult.
- Coughing, wheezing, or fever worsens.
- The child is exhausted, lethargic, or is not sleeping.
- The child has ear pain (infants may pull or tug at their ears).
In severe cases, babies who have bronchiolitis must be hospitalized for a few days. In the hospital, they often are given extra oxygen and IV fluids. Some babies are placed on respirators to help with breathing.
Severe bronchiolitis in babies who have serious medical conditions (e.g., prematurity, HIV/AIDS, cancer, cystic fibrosis, cardiopulmonary disease) may be treated with medications, such as antivirals (e.g., Ribavirin®). Before giving these medications, physicians must be certain that the bronchiolitis is caused by RSV, and not another type of virus.
Bronchodilators (e.g., albuterol, epinephrine), which often are prescribed for asthma, may be administered to children with bronchiolitis. These medicines can help open breathing passages, but they do not shorten the illness. Steroids (e.g., prednisone) occasionally are given to help relieve swelling in the lower air passages.