Patient information · Paediatrics
Bronchiolitis
getting a small baby through a chesty virus
Bronchiolitis is a viral infection of the smallest airways in the lungs. It affects babies and children under two, is commonest in winter, and makes breathing and feeding hard work for a week or so. Almost all babies recover fully at home.
Call 999 now if your baby
- stops breathing, or has pauses in breathing;
- has lips, tongue or skin that look blue, grey or very pale;
- is working very hard to breathe — grunting, nostrils flaring, or the skin sucking in under the ribs, between the ribs or at the base of the neck;
- is breathing very fast, or has become floppy, exhausted or difficult to wake;
- is taking less than half their usual feeds over several feeds, or has had no wet nappy for 12 hours.
Babies under three months, babies born prematurely, and those with a heart or lung condition can deteriorate faster and should be reviewed sooner rather than later. Tower Bridge Hospital London is not an emergency service. The nearest emergency department is the Royal London Hospital, Whitechapel Road, London E1 1FR.
How the illness runs
Knowing that days three to five are usually the peak helps. A baby who is getting slowly better after that, even with a rattly cough, is doing what we expect. A baby who is getting worse after day five needs reviewing.
Why there is no medicine for it
Bronchiolitis is caused by a virus, most often RSV. Antibiotics do not work on viruses. Inhalers, steroids and cough medicines have all been tested in bronchiolitis and none of them shorten the illness or help the breathing — which is why your baby has not been given them. This is not because nothing is being done; it is because the treatments that exist do not work for this particular illness.
What helps is careful feeding, rest and close watching. Babies who need hospital care are admitted for help with feeding and oxygen while the illness runs its course, not for a drug that cures it.
Feeding and comfort at home
- Smaller feeds, more often. A blocked, breathless baby cannot manage a full feed. Half the usual amount twice as often is the aim.
- Do not stop feeding, even if your baby vomits after coughing. Vomiting a feed up after a coughing fit is common and does not mean feeds should be reduced — offer the next one as usual.
- Clear the nose before feeds. Saline nose drops from a pharmacy, a minute or two before a feed, make a real difference to a baby who cannot breathe and suck at the same time.
- Keep your baby fairly upright when awake and being fed. Follow normal safe sleep advice at night — on the back, in their own cot, on a flat firm mattress.
- Paracetamol may be given if your baby is distressed by a temperature, at the dose on the packet for their age. Ibuprofen is only suitable from three months of age and over 5kg.
- No smoking or vaping anywhere in the home. Smoke exposure makes bronchiolitis measurably worse.
- Rest. Expect your baby to sleep more and be less interested in play for a week or so.
Count wet nappies. They are the most reliable thing you can track at home. Fewer than usual, or a long stretch with a dry nappy, means your baby is not taking enough milk — and that is the commonest reason a baby with bronchiolitis needs to be admitted. Six or more wet nappies a day is normal for a young baby.
Preventing it
- Wash hands before handling your baby, and ask visitors to do the same.
- Keep newborns away from anyone with a cold, and away from crowded indoor spaces in winter where you can.
- An RSV vaccine is offered during pregnancy, usually from around 28 weeks, and passes protection to the baby for their first months. If you are pregnant, ask your midwife or GP.
- Some babies at particularly high risk are offered a protective antibody injection. We can advise if this might apply to your child.
Book an appointment with us if
- your baby is feeding less well but is not showing the emergency signs above;
- the illness is dragging on beyond three weeks, or the cough is worsening rather than settling;
- your baby has repeated episodes of wheezing after this illness;
- you would simply like your baby examined and their breathing and oxygen levels checked.
We see children seven days a week, usually the same day.
Seen today, not next week
Same-day appointments most days, seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.
Also able to advise
Your own GP · Your local pharmacist