What Is Bronchiolitis?
Bronchiolitis is an infection of the small airways (bronchioles) in the lungs, almost always caused by a virus. It is the most common lower respiratory tract infection in infants under 12 months of age and is particularly prevalent during the winter months. While it can be alarming for parents, the vast majority of cases resolve with supportive care at home.
Recognising the Symptoms
Bronchiolitis typically begins with symptoms that look like a common cold: a runny nose, mild cough, and possibly a low grade fever. Over the following two to three days, the infection moves into the lower airways, and you may notice your baby developing a more persistent cough, faster or noisier breathing, difficulty feeding (particularly breastfeeding or taking a bottle), intermittent fever that comes and goes, irritability and difficulty settling to sleep, and reduced wet nappies.
In some cases, the illness follows on from a recent ear infection or upper respiratory infection that was treated with antibiotics. It is important to understand that bronchiolitis is viral, meaning antibiotics will not help and are not indicated.
When to See a Doctor
Most babies with bronchiolitis can be managed safely at home. However, you should seek medical attention if your baby is under three months old and develops a fever, is feeding less than half their normal amount, has fewer than three wet nappies in 24 hours, is breathing very fast or you can see their ribs with each breath, appears drowsy, floppy, or unusually quiet, or develops a blue tinge around the lips or fingertips.
These signs may indicate that your baby needs closer monitoring or hospital assessment.
How a Private GP Can Help
At Clinique Alpa, we offer thorough same day assessments for unwell infants. A typical consultation for a baby with suspected bronchiolitis includes measuring temperature, oxygen saturations, and heart rate; examining the ears with an otoscope to check for concurrent ear infections; examining the throat and chest for signs of secondary bacterial infection; and listening to the chest to assess the degree of airway congestion.
If the examination confirms bronchiolitis without complications, we provide a clear management plan tailored to your baby’s age and symptoms.
Treatment at Home
There is no specific antiviral treatment for bronchiolitis. Management is supportive and focuses on keeping your baby comfortable while the immune system clears the infection:
Salbutamol inhaler via spacer: In selected cases, particularly when there is significant wheeze or airway congestion, a short course of salbutamol inhaler (two puffs four times daily via an aerochamber) may be prescribed for up to one week. This is sometimes called burst therapy and can help open the small airways.
Saline nasal drops: Saline drops in each nostril before feeds and sleep help loosen nasal congestion. An electronic nasal aspirator can be used afterwards to clear the mucus.
Fluids and feeding: Continue breastfeeding as frequently as your baby will take. Breast milk provides antibodies that support recovery. If you are breastfeeding, increasing your own fluid and protein intake can help maintain supply during this period.
Air quality: An air purifier in your baby’s sleeping room can reduce irritants. Keep the room well ventilated and avoid exposure to cigarette smoke, strong perfumes, or aerosol sprays.
Fever management: Paracetamol suspension (given by mouth or as suppositories if your baby refuses oral medication) can be used for fever. Ibuprofen is an alternative for babies over three months.
Managing Eczema Alongside Bronchiolitis
It is common for babies with bronchiolitis to develop or worsen a skin rash. Raised, bumpy patches on the cheeks and around the eyes are often infantile eczema, which can flare during viral illness. Treatment includes a gentle emollient cream applied liberally several times daily and, if needed, a mild steroid cream for the face, used for a maximum of one to two weeks under medical guidance.
Frequently Asked Questions
How long does bronchiolitis last?
The worst symptoms typically last five to seven days, but a residual cough can persist for two to three weeks. This is normal and does not usually indicate a complication.
Can bronchiolitis come back?
Yes. Babies can have more than one episode, particularly if they are in nursery or have older siblings. Each episode is usually less severe than the first.
Should I take my baby to A&E?
If your baby has any of the red flag signs listed above, particularly reduced feeding, fewer wet nappies, or laboured breathing, you should seek urgent medical assessment. For milder symptoms, a private GP assessment can provide the same thorough examination without the A&E wait.
Book a Paediatric Assessment
If your baby has a persistent cough, fever, or you are concerned about their breathing, book a same day appointment at Clinique Alpa. We see infants and children at our clinic in Palmers Green, North London.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP at Clinique Alpa.