Health Topics

Infant Wheezing

By DuPage Medical Group Pediatrics

What are the symptoms?

Initially, the symptoms of bronchiolitis are indistinguishable from those of a common cold.  Infants will present with congestion, runny nose and cough with or without fever.  Over the next 2-5 days, they will develop worsening cough and abnormal breathing sounds such as wheezing (high pitched whistling noise when exhaling).  Some may develop difficulty breathing (breathing fast and shallow, drawing in of muscles in neck or between ribs, nostrils flaring, belly heaving). Some infants will have difficulty taking feeds normally and may have increased spitting up or vomiting from all the mucus production and coughing.  The symptoms usually last 1-2 weeks, with severe symptoms not typically lasting longer than 3-5 days.  Some infants may have some lingering cough for several weeks.

How is it treated?

Most cases of bronchiolitis are relatively mild and can be managed at home. Treatment is largely supportive, much the same as for a cold.  Antibiotics will not be helpful, as the infection is viral, not bacterial.  Clearing the mucus is the most helpful thing you can do.  Use nasal saline drops to loosen/thin the mucus and then suction the nose with a bulb syringe.  Do this as often as needed to keep your child comfortable.  Run a cool-mist humidifier where the child sleeps and try to prop up the head of their crib mattress if possible.  Give acetaminophen (for infants over 2 months, unless directed by a physician) or ibuprofen (for infants over 6 months) as needed for any fever or discomfort.  Offer plenty of liquids; your infant may do better with smaller, more frequent feeds for a few days.  Children who have wheezing or trouble breathing may be given prescriptions for oral or inhaled medications to help calm inflammation and open the airways.  Severe cases of bronchiolitis may require hospitalization for oxygen therapy, breathing treatments, and IV fluids.  Infants at risk for severe illness include premature infants, those with underlying lung or heart problems, and those with weakened immune systems.

 Is it contagious?

The viruses that cause bronchiolitis are contagious.  They are spread by contact with droplets of fluid from an infected person’s nose or mouth – either through the air from coughs and sneezes or by touching shared objects.  The incubation period (time from exposure until the first symptoms develop) is approximately 2-7 days.  The best way to prevent spread of infection is with frequent handwashing.  Keeping infected children isolated until the symptoms have resolved is also recommended.  There is no vaccine to prevent bronchiolitis, but infants at high risk for severe disease may be given a medication monthly during peak season to help decrease the likelihood of contracting RSV and lessen the severity of the disease should they contract it.  This contains antibodies to the virus and is given by injection in a physician’s office.

 When should I be concerned?

Seek immediate help:

-       If your child has any evidence of labored breathing

-       If your child’s lips, tongue or fingernails are blue

-       If your child appears dehydrated (dry inside the mouth, no tears with crying, no urine for more than 8 hours)

-       If your child is lethargic

-       If your child is under 2 months old and has a fever 100.4 or greater

Call for an appointment:

-       If your child has cold symptoms that seem to be worsening instead of improving after a few days

-       If your child has a fever that lasts longer than 4-5 days or goes away and then recurs later in the illness

-       If your child has any abnormal breathing sounds such as wheezing

Topics and Subtopics: Children's Health & Respiratory Problems

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