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The early symptoms of bronchiolitis are similar to those of a common cold. The first symptom is usually a blocked or runny nose and your child may also have a slight cough or fever (high temperature). A normal temperature is 36C-36.8C (96.8F-98.2F).
Symptoms usually get worse during the first three days, then gradually improve. During this time, your child may experience:
- a rasping and persistent dry cough
- rapid or noisy breathing
- brief pauses in their breathing
- feeding less and having fewer wet nappies
- vomiting after feeding
- being irritable
Although most children recover from bronchiolitis within a few days, it's important to look out for signs of more serious symptoms, such as breathing difficulties. Even though most cases of bronchiolitis are not serious, these symptoms can be very worrying for parents.
When to seek medical advice
Contact your GP or midwife if your child has any of the symptoms of bronchiolitis described in the list above. This is particularly important if your baby is under 12 weeks old or they have an underlying health problem, such as a congenital heart or lung condition. Congenital means that the condition has been present from birth.
In all cases, be aware of any changes to your child's symptoms. Contact your GP again if you are worried or if your child develops any of the following symptoms:
- Increased difficulty breathing or wheezing as they breathe
- Poor feeding (if your child has taken less than half the amount that they usually do during the last two or three feeds)
- No wet nappy for 12 hours or more
- A rapid breathing rate of more than 40 breaths a minute
- A high temperature (fever) of 38C (100.4F) or above
- Being very tired or irritable
When to call 999
While it is unusual for children to need hospital treatment for bronchiolitis, the symptoms can get worse very quickly.
Call 999 for an ambulance in any of the following circumstances.
- Your child has severe breathing difficulties or exhaustion from trying to breathe. You may see the muscles under your child's ribs sucking in with each breath, your child may be grunting with the effort of trying to breathe or they may be pale and sweaty.
- Your child has a rapid breathing rate of more than 60 breaths a minute.
- You are unable to rouse (wake) your child or, if roused, they do not stay awake.
- Your child's breathing stops for more than 10 seconds at a time (this is known as recurrent apnoea).
- Your child's skin begins to turn very pale or blue, particularly around the lips or fingernails (known as cyanosis).
Although it is very difficult to prevent bronchiolitis, you can take steps to reduce your child's risk of catching it and help prevent the virus spreading. This includes:
- Washing both your child's hands and your hands frequently
- Washing or wiping toys and surfaces regularly
- Keeping infected children at home until their symptoms have improved
- Keeping newborn babies away from people with colds or flu
- Preventing your child being exposed to tobacco smoke
Some children who are at high risk of severe bronchiolitis may also require monthly antibody injections, which help limit the severity of the condition.
There are some benefits, particularly for children, in catching a few coughs and colds. Children tend to get a lot of colds because the body takes time to build up immunity. Your body learns to fight off a particular kind of virus every time you get an infection, which is why you get fewer colds as you get older.
While most bugs will run their course without doing any real harm, Dr Shah says there are certain cases when you or your child should see a GP. These include:
- If you or your child has a chronic condition such as asthma, diabetes or heart disease
- If you have a very high temperature and feel ill, for example if you also have an unusually severe headache or abdominal pain
- If your child is vomiting but does not have diarrhoea, or has a rash in addition to the fever
- If your child stops drinking and is unusually lethargic
- If your child's fever doesn't respond to paracetamol or ibuprofen
Babies, and older and frailer people should get help if they're unwell. All babies under three months with a temperature of more than 38°C (100.4°F) should be urgently assessed by a doctor, as should babies aged three to six months with a temperature higher than 39°C (102.2°F).
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