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Bronchiolitis and RSV

Bronchiolitis is an infection that causes the small airways in your child’s lungs to become swollen. This can make it more difficult for your child to breathe.

  • Bronchiolitis affects children under the age of 2. It is caused by a virus, often the Respiratory Syncytial Virus (RSV)

  • The number of children with RSV is usually highest in winter but bronchiolitis can happen at any time of year

  • Bronchiolitis usually causes cold like symptoms and mild breathing difficulty. Breathing may be faster than normal as well as noisy and your child may not be able to take their usual amount of milk by breast or bottle

  • Your child may get a little worse each day until the 3rd or 4th day of their illness after which they are likely to start improving

  • Most children get better on their own. There are no medical treatments that speed up recovery from bronchiolitis. Many children will continue to cough for a few weeks afterwards

Some children, especially those under 6 weeks of age or young children with heart or lung problems, can develop worse breathing difficulty and may need to go to hospital for help supporting their breathing and feeding.

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When should you worry?

If your child has any of the following:

  • Breathing very fast or breathing that stops or pauses

  • Makes a grunting noise every time they breathe out

  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)

  • Becomes pale, blue, mottled and/or unusually cold to touch

  • Difficult to wake up, very sleepy or confused

  • Weak, high-pitched, continuous cry or can’t be settled

  • Has a fit (seizure)

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Has a rash that does not go away with pressure (the ‘Glass Test’)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Working hard to breathe, drawing in of the muscles below the ribs 

  • A harsh noise as they breathe in (stridor) only when upset

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Is 3-6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Temperature of 38°C or above for more than 5 days or shivering with fever(rigors)

  • Temperature less than 36°C in those over 3 months

  • Getting worse or you are worried about them

You need to contact a doctor or nurse today.

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

If your child has none of the above:

  • Watch them closely for any change and look out for any red or amber symptoms

  • Additional advice is also available for families for help cope with crying in otherwise well babies

  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

What should you do?

  • Most babies and children can be safely cared for at home

  • Bronchiolitis can get worse before it starts to get better. Babies and children are often most poorly on day 5 of the illness then start to get better

  • Keep a close eye on your baby's breathing and feeding. If you have any new concerns, please look at our red/amber/green table again

  • If your child is not feeding as normal, offer smaller feeds more often

  • Children with bronchiolitis may have some distress and discomfort. You may wish to give either paracetamol or ibuprofen to make them feel better (paracetamol can be given from 2 months of age). Please read and follow the instructions on the medicine container

  • Bronchiolitis is caused by a virus so antibiotics generally don’t help

  • Although you should continue to place your baby on their back to sleep, you can tilt the head of their cot upwards to help their breathing. You can do this by raising the cot legs on blocks or putting a pillow under the mattress. Remember never put a pillow or cushion under your baby's head as this is unsafe

  • Avoid co-sleeping with your baby if they are unwell with bronchiolitis or a respiratory tract infection. For more information, see our safe sleeping page

  • Avoid exposure to tobacco smoke which makes their breathing worse. Remember that smoke stays on your clothes even if you smoke outside

  • If you would like help to give up smoking you can get information and advice from your local GP surgery or click here for local support to help you quit smoking.  You can also call the National Stop Smoking Helpline Tel: 0300 123 1044 from 7am to 11pm every day

  • From September 2024, RSV vaccination is available to at risk groups including pregnant women and older people, for more information please click here.

How long will your child’s symptoms last?

Babies are usually unwell for 5 to 10 days. Most will get better within two weeks. Babies may still have a cough for up to 4 weeks afterwards and this is completely normal.

Your child can go back to nursery as soon as you feel they are well enough. Bronchiolitis does not normally cause long term problems for your child.

The chart below shows how long bronchiolitis lasts in children. The faces represent 10 children who have bronchiolitis. Green faces are those children who have recovered within that time period:

A chart showing how long bronchiolitis lasts in children. There are 10 faces representing 10 children who have bronchiolitis. There are 5 green faces to represent 5 children out of 10 who had recovered by day 14. There are 9 green faces to represent 9 children out of 10 who had recovered by day 21.

The diagram above is taken from www.whenshouldiworry.com

Where should you seek help?

For wear and tear, minor trips and everything in between

Self-care

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

  • Visit a pharmacy if your child is ill, but does not need to see a GP
  • Remember that if your child's condition gets worse, you should seek further medical advice immediately
  • Help your child to understand - watch this video with them about going to the pharmacy

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  • Doctors or GPs can treat many illnesses that do not warrant a visit to A&E
  • Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, you can call 111 or use 111 online.

Please note that 111 online is for people aged 5 and over. Call 111 if you need help for a child under 5.

An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  • Many visits to A&E and calls to 999 could be resolved by any other NHS services
  • If your child's condition is not critical, choose another service to get them the best possible treatment
  • Help your child to understand – watch this video with them about going to A&E or riding in an ambulance
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