Bronchiolitis in babies: symptoms, progression, and risk factors you should know

We all probably know someone who's had to take their child to the hospital with bronchiolitis. What do we really know about this respiratory illness, so common in the first years of life? It's important to know. What is bronchiolitis?how it is transmitted, what its characteristics are symptom, what risk factor's They can make the evolution slower or more severe and, above all, what we can do at home and when it is necessary to go to the emergency room.

Understanding these aspects helps families to act quicklyto better monitor the baby and avoid unnecessary complications, especially in children with greater vulnerability, such as premature babies or those with a pre-existing condition.

What is bronchiolitis?

Acute bronchiolitis is a respiratory infection that affects the lower part of the respiratory system, that is, it affects to the lungs and the smaller airwaysThe bronchioles. These small structures are like the terminal "branches" of the bronchi, through which air passes to the alveoli. When they become inflamed and filled with mucus, the air He enters and exits with difficulty.producing the characteristic whistles or wheezes.

One of the typical characteristics of this process is that it occurs in children under two years, most often in infants under 12 months and especially between 3 and 6 months of age. At this stage, the bronchioles are very narrow, so any inflammation or increase in mucus easily obstructs the passage of air.

The causes of the infection are different types of virusThe one that most commonly causes the infection is the Respiratory Syncytial Virus (RSV)It is responsible for most cases, especially during epidemics. But it is not the only one: the flu virus, parainfluenza viruses, adenovirus, rhinovirus, human metapneumovirus, coronavirus, and others can also cause bronchiolitis or wheezing episodes in infants.

When these viruses infect the lower respiratory tract, they cause inflammation of the bronchiolar wallsIncreased mucus production and, sometimes, small plugs of secretions. All of this causes partial or almost complete obstruction of these small airways, which explains the difficulty breathing and the noises when breathing.

How is bronchiolitis spread?

Bronchiolitis is highly contagious. The virus is mainly transmitted through respiratory droplets that we expel when we cough, sneeze, or talk, but also through the contact with secretions (mucus, saliva) and contaminated surfaces, such as toys, tables or railings.

The virus enters the body through the mucous membranes of the nose, mouth, or eyesSimply touching a contaminated surface with your hands and then touching your face is enough for the virus to be transmitted. That's why it spreads especially easily in environments with many children together, such as daycare centers.

Some key points about contagion:

• Babies and toddlers who attend creche or that have older siblings of school age They are more likely to come into contact with the virus.
• The virus can survive several hours on surfacesTherefore, shared toys are a frequent vehicle for contagion.
• Adults can be contagious with few or no symptoms, only showing a mild case of mild cold while for the baby it represents a serious case of bronchiolitis.

How does bronchiolitis progress?

Most children are sick between 7 and 12 days y They recover without problems afterwardsalthough the cough may last for another week. In the first few days, the symptoms usually begin as a upper respiratory infectionAnd then, in 2 or 3 days, signs of lower airway involvement appear.

In some more serious cases, the baby You will need to be admitted to the hospitalThis occurs especially when there is significant respiratory distress, inability to feed, low oxygen saturation, or the presence of risk factors (prematurity, heart disease, chronic lung disease, immunodeficiency, etc.).

In these more serious cases, where babies need to be hospitalized, it is common that in the following months and even years, when the child catches a cold, The symptoms that appear are similar to those of bronchiolitis (episodes of wheezing or whistling sounds, rapid breathing, persistent cough). These are called recurrent wheezingwhich are sometimes confused with infant asthma.

Some research studies have also shown that children who have suffered from bronchiolitis during the first months of life have, during childhood and adolescence, increased risk of developing asthma Children who have never suffered from bronchiolitis are at higher risk, especially when other associated factors exist, such as a family history of asthma or allergies.

Healing of bronchiolitis it's quite slowIt's common for families to feel like their baby "isn't getting better" because the cough and chest wheezing can last for several weeks. It's important to know that this prolonged recovery is normal. expected in many casesprovided that the child maintains good general health, eats acceptably and shows no signs of alarm.

Symptoms of bronchiolitis

Symptoms at first are those of a common coldThe baby has a stuffy nose, a cough for two or three days, and a slight fever or a fever that does not exceed 39°C. He may be somewhat more irritable or have less appetite, but maintains a relatively good general condition.

Afterwards it is possible that the disease appears stagnantIt's quite distressing because it gives the impression that the baby will never get better and we don't know what to do anymore. Or it can get worsewhich is most common from the second or third day after the start of the cold.

Typical worsening is characterized by:

• Increased Breathing frequency (breathes faster than normal for his age).
• Breathing difficult, with sinking of the ribs (retraction), exaggerated movement of the abdomen and widening of the nostrils.
• Increased cough, sometimes in successive blows that can cause vomiting.
• Appearance of breathing noisesespecially when exhaling, which are described as "whistles" or "whistles".

Coughing increases, baby breathes faster and with difficultyWe see how their ribs become more prominent, their abdomen rises and falls dramatically, and their nostrils flare with each breath. Their breathing may become very noisy. a kind of whistling sound appears when breathingAll of this indicates that the bronchi and bronchioles are being clogged by inflammation and due to the increased mucus caused by the illness.

In very young infants, especially premature ones, an important sign can be a (stopping breathing for a few seconds), sometimes without the breathing difficulty being very noticeable. These episodes require immediate medical evaluation.

It's time to consult your pediatrician again or go to the emergency departmentYou may need to be admitted to the hospital to monitor your breathing, ensure proper hydration, and, if necessary, administer oxygen.

You will probably have to go to check-ups at your pediatrician or at the emergency room, as instructed, to assess your progress. In addition to being patient, it's important to be clear about which signs to watch for at home and what self-care measures will best support your recovery.

Reasons for alarm

Any type of An increase or worsening of symptoms is cause for alarm.In addition, there are specific signs that indicate the baby may be deteriorating and that require urgent consultation:

• Repeated vomiting. The baby cannot keep liquids down and when you change the diaper it is dry or only slightly wet. This may indicate that the baby is is dehydrating.
• If baby He is very sleepyHe is difficult to wake up or appears unusually lethargic and unresponsive.
• If the baby's skin begins to have a purplish colorespecially around the lips or fingertips. This may indicate that the baby It is not able to properly oxygenate the blood.
• If you notice that the baby He turns pale and sweaty., with a generally poor appearance.
• If you get very fatigued with the feedings and hardly eats, or repeatedly refuses the breast or bottle.
• If the baby breathes worse and worse: faster, ribs become very prominent, abdomen moves a lot, chest sinks, or stops breathing for seconds.
• If the baby was premature or has heart disease or pulmonary, you should consult a specialist or go to the emergency room if the first symptoms of respiratory infection, even if they seem mild.

In the healthcare field, the following is used: pulse oximetry Oxygen saturation is measured to assess whether the child needs supplemental oxygen or hospitalization. As a general guideline, a saturation below 92% usually indicates hospital referral, although all factors are always considered together. other clinical signs and the baby's risk factors.

Risk factors for bronchiolitis and severe forms

There are certain risk factors that can affect the baby develop bronchiolitis and also so that the painting is more serious and requires hospitalizationAccording to several studies, the most important ones are:

• That the baby has school-aged siblingsespecially if they share a room or spend many hours together.
• Daycare assistance or preschools, where contact with other children and respiratory viruses is very common.
• That it is exposed to smoky environmentsEspecially if their parents smoke or if there is tobacco use in the home or car. Smoke irritates the respiratory tract and increases susceptibility to infections and serious illnesses.
• Babies born prematurelyespecially if the pregnancy was less than 35 weeks or if there is bronchopulmonary dysplasia or another chronic lung disease of the premature infant.
• Having low birth weight or growth problems in the first few months, since the baby's reserves are lower.
• Congenital heart disease with hemodynamic repercussions or other heart diseases that make the body less tolerant of a lack of oxygen.
• immunodeficiencies or treatments that lower defenses, which facilitate more intense and prolonged infections.
• neuromuscular diseases that hinder the child's ability to cough and clear their secretions.
• Chronic exposure to pollution and highly polluted environments, which damage and irritate the respiratory tract.
• Do not breastfeedThere are several studies that give a protective value to breastfeeding regarding the risk of developing bronchiolitis and of it becoming severe. Even the duration of breastfeeding, both exclusive and mixed, has been linked to a better evolution of the infection and less need for income.

In addition to these factors, it should be taken into account that the infants under 3 months They have a special risk of complicated outcomes, even if they were born healthy and at term. In them, respiratory reserve is lower, and any increase in the work of breathing can lead to exhaustion more quickly.

Bronchiolitis treatment: what to do and what not to do

In bronchiolitis There are no medications that cure the disease or speed up recovery.The infection is viral in origin, and the body needs time to control the virus and repair the inflammation in the respiratory tract. Therefore, most medications They are not routinely recommended..

The most important thing is to focus on the supportive care:

• Keep a adequate hydrationoffering small, frequent feedings so the baby doesn't get tired.
• Perform nasal washes with physiological saline solution and gentle aspiration of secretions, especially before feedings and bedtime.
• Guarantee a proper oxygenation when needed, administering oxygen in the hospital if saturation is low.

Regarding specific medications, the recommendations from the main clinical guidelines are:

1. Bronchodilators
   They don't work in most cases because the blockage is mainly due to the inflammation and excess mucusnot a bronchospasm as in asthma. In some very specific situations, when there is suspicion of asthma or bronchial hyperreactivity In slightly older children, they can be tried and maintained only if there is a clear improvement after a trial dose.
2. Corticosteroids
   Although they are potent anti-inflammatories, have not demonstrated a benefit in typical bronchiolitis in healthy infants. They do not reduce hospital admissions or shorten the duration of the illness, so they should not be used routinely in acute bronchiolitis.
3. Antibiotics
   They're useless because bronchiolitis is a Viral infectionThey are only used if a added bacterial infection (otitis, bacterial pneumonia, etc.), something infrequent and which should be assessed by the pediatrician.
4. Nebulized adrenaline
   It may provide temporary relief in some severe cases in a hospital setting, but it does not change the course of the disease or prevent complications, therefore It is not routinely recommended in uncomplicated bronchiolitis.
5. Other medications not recommended
   Mucolytics, cough syrups, decongestants, antihistamines, or alternative therapies have not demonstrated effectiveness and can be harmful. Respiratory physiotherapy with vibrations or percussion is also not indicated in typical acute bronchiolitis, as it does not improve the course of the condition and can cause adverse effects.

Home care and prevention

In most cases, bronchiolitis is a self-limited disease that children spend at home with adequate supervision. Some simple measures can greatly improve the baby's comfort and reduce the risk of complications:

• Keep a correct hydrationOffering the breast or bottle more frequently, but in smaller amounts so that the baby gets less tired.
• Perform nasal washes with saline solution and gently aspirate secretions, especially before eating and sleeping.
• Place the baby in semi-upright position when awake and supervised, to facilitate breathing and drainage of secretions.
• Keep a smoke-free environment and prevent anyone from smoking at home or in the car.
• Ventilate the rooms well and maintain a pleasant temperature, without overdressing the baby.
• Avoid, as much as possible, close contact with people with cold symptoms, especially if the baby is very young or has risk factors.

As general measures for preventing bronchiolitis and other respiratory infections, it is essential frequent hand washing For adults and children, regular cleaning of toys and surfaces, and limiting attendance at daycare for high-risk babies during periods of increased circulation of respiratory viruses if advised by the pediatrician.

Currently available immunization with monoclonal antibodies against RSV This prophylaxis is for certain infants at higher risk of severe forms of RSV (premature infants, infants with significant heart disease, infants with chronic lung disease, and other groups defined by specialists). It is administered during periods of high RSV circulation and is prescribed on an individual basis by the pediatric or neonatology team.

With clear information, proper monitoring of symptoms, and good preventive habits, most cases of bronchiolitis in infants and young children can be safely managed, minimizing the risk of complications and unnecessary hospitalizations.