A baby starts with a cold, develops a cough and a whistling breath, seems to improve, and then wheezes again. Parents often fear that the illness has returned. This article explains the usual course after bronchiolitis, home care, and the signs that call for medical help.
Why It Happens
Bronchiolitis is usually a viral infection in which the smallest airways in the lungs become inflamed and clogged with mucus, narrowing the path for air. The American Academy of Pediatrics (AAP) 2014 clinical practice guideline covers children from 1 through 23 months of age, and RSV is a leading cause. Infant airways are very narrow and can stay sensitive after the infection settles, so even a mild cold may bring back some wheezing for a while.
How It Differs by Age and Stage
The CDC describes RSV as often starting with a runny nose and mild cough, with a cough developing about 1-3 days after early symptoms and wheezing or labored breathing possible soon after. In babies under 6 months the picture may be only irritability, lower activity and poor feeding, and pauses in breathing longer than 10 seconds (apnea) can occur. Wheezing generally tends to be worst in the first 2-3 days and then eases, while a cough often lingers around two weeks. Some children cough for 3-4 weeks, and some wheeze again with each new cold.
What to Do at Home
The AAP guideline describes treatment as supportive, centered on hydration and oxygen when needed. At home, offer breast milk or formula in smaller, more frequent feeds, and use saline drops with gentle suction when a blocked nose interferes with feeding. Keep the room from becoming too dry, avoid any exposure to tobacco smoke, and hold the baby with the upper body slightly raised. The AAP guideline strongly recommends against routinely giving bronchodilators such as albuterol or epinephrine to infants diagnosed with bronchiolitis, and against routine chest X-rays or lab tests when the diagnosis is made from history and exam. If a clinician has prescribed an inhaler for your child, follow those directions.
Common Misunderstandings
Antibiotics are often expected for returning wheezing, but because a virus is the usual cause they typically do not help. Over-the-counter cough and cold medicines are not shown to speed recovery in young children and carry risks, so check with a clinician first. Another worry is that one bout of bronchiolitis means asthma for life. Some children do go on to have repeated wheezing, but many improve as they grow. A family history of asthma or allergy, or wheezing that keeps coming back, is a reason to ask the pediatrician for an evaluation.
When to Seek Care
The CDC advises getting medical help when a child has trouble breathing, is not drinking enough, or is getting worse. A cough or wheeze that lasts more than 3 weeks, or episodes that repeat several times a month, deserve an office visit. Go to the emergency room right away if the skin sucks in below the ribs or neck with each breath, the nostrils flare, breathing is very fast or pauses, the lips or face turn blue or gray, the baby can barely feed, or there is no wet diaper for 6-8 hours. This information is based on U.S. and international sources; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.