Bronchiolitis in Babies: Symptoms and Home Care

Your baby started with a runny nose and a little cough. A few days later the cough is worse, they are breathing faster, and maybe you hear a whistle or crackle in the chest. This is a common pattern for bronchiolitis, an infection that is one of the most frequent reasons babies get sick in the cooler months. Most babies get through it at home with good care. Knowing what is normal, and what is not, helps you decide when to call.

What bronchiolitis is

Bronchiolitis is an infection of the smallest airways in the lungs, called bronchioles. A virus makes the lining of these tiny tubes swell and fill with mucus. Because a baby's airways are already so small, even a little swelling makes breathing harder.

It mostly affects children under 2, and it is hardest on babies in the first months of life. Several viruses can cause it. RSV is the most common, but cold viruses, flu and others can cause it too. That is why a baby can have bronchiolitis more than once.

Bronchiolitis is not the same as bronchitis, which affects larger airways and is more common in older children and adults.

Symptoms and the usual course

Bronchiolitis often follows a pattern:

• Days 1 to 2: It looks like a cold. Runny or stuffy nose, mild cough, maybe a low fever.
• Days 3 to 5: The cough gets worse and breathing may become faster or noisier. You may hear wheezing. Babies may eat less because it is hard to suck and breathe at the same time. This is usually the hardest stretch.
• After that: Most babies slowly improve over the next week or so. The cough can hang on for 2 to 4 weeks even after your baby feels better.

Very young babies, especially those under 2 months or born early, may not cough much. Instead they may be fussy, tired, eat poorly, or have pauses in their breathing.

Home care that helps

There is no medicine that cures bronchiolitis. The virus has to run its course, and your job is to keep your baby comfortable and well hydrated.

Clear the nose

Babies breathe mostly through the nose, so a stuffy nose makes feeding and sleeping harder. Before feeds and sleep:

• Put a few saline (salt water) drops in each nostril to loosen mucus
• Wait a moment, then gently suction with a bulb syringe or a nasal aspirator
• Do not suction too often or too deep, which can irritate the nose and cause more swelling

Keep up fluids

• Offer breast milk or formula more often, in smaller amounts, if your baby tires quickly
• Count wet diapers. Fewer wet diapers is a sign your baby needs more fluid
• Do not give plain water to young babies unless your pediatrician tells you to

Other comfort steps

• A cool-mist humidifier may help loosen mucus. Clean it often.
• Keep your baby away from cigarette, vape and wood smoke.
• Let your baby rest. Always place them on their back to sleep, on a flat surface with nothing else in the crib, even when congested. Do not prop the mattress or use sleep positioners.
• For fever or fussiness, ask your pediatrician whether acetaminophen is right for your baby's age and what dose to give by weight. Never give aspirin to children.

See the AAP's guide to bronchiolitis in babies for more on home care.

Medicines usually don't help

It is natural to want a treatment. But for typical bronchiolitis, the American Academy of Pediatrics does not recommend routine use of:

• Antibiotics, because bronchiolitis is caused by a virus
• Inhaled breathing treatments like albuterol, or steroids, which studies show do not help most babies with bronchiolitis
• Over-the-counter cough and cold medicines, which are not safe for babies and young children
• Medicated nose drops or vapor rubs unless your pediatrician approves

Your pediatrician may treat your baby differently if they have asthma, a heart or lung condition, or signs of another infection such as an ear infection.

Who is at higher risk

Call early, and expect closer follow-up, if your baby:

• Is younger than 3 months
• Was born premature
• Has heart or lung disease, a weak immune system, or a condition that affects muscle tone or swallowing

Warning signs

Watch your baby's breathing, feeding and diapers. Undress them to the diaper and look at the chest and belly. Call right away if you see:

• Working hard to breathe: skin pulling in between or under the ribs or at the neck, nostrils flaring, grunting, or the belly moving in and out strongly
• Breathing very fast, or so fast that your baby cannot feed
• Poor feeding: taking much less than usual, or refusing feeds
• Fewer wet diapers: for example, no wet diaper in 6 to 8 hours, a dry mouth, or no tears when crying
• Pauses in breathing of more than a few seconds
• Very sleepy, hard to wake, or unusually fussy and unable to settle

MedlinePlus also lists signs that need care for bronchiolitis.

When to call us

Call your A thru Z Pediatrics office if your baby is breathing faster than usual, wheezing, eating less, has fewer wet diapers, or has a fever lasting more than 2 to 3 days. A baby under 3 months with a temperature of 100.4°F or higher in the bottom needs a call right away, day or night.

Call 911 or go to the ER if your baby is struggling to breathe, has lips or skin that look blue or gray, stops breathing or has long pauses, or is limp or will not wake up.

Worried about your baby's cough? You can request a visit.