Bronchiolitis is an infection that causes the tiniest airways in your child’s lungs to become swollen. This can make it more difficult for your child to breathe:
Bronchiolitis is caused by virus infections
It is common in winter months and usually only causes mild cold like symptoms
Most children get better on their own
Some children, especially very young ones, can have difficulty with breathing or feeding and may need to go to hospital
Paediatric Pathway
Click here to view the bronchiolitis paediatric pathway.
Severe difficulty in breathing - too breathless to feed
Becomes pale, mottled and feels abnormally cold to touch
Seems dehydrated (sunken eyes, drowsy or not had a wee or wet nappy for 12 hours)
Becomes extremely agitated, confused or very lethargic (difficult to wake)
Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
Is between 3-6 months of age with a temperature over 39°C
You need urgent help
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has any of the following:
Has laboured/rapid breathing or they are working hard to breathe – drawing in of the muscles below their lower ribs, at their neck or between their ribs (recession)
Seems dehydrated (sunken eyes, drowsy or not had a wee or wet nappy for eight hours)
Is becoming drowsy (excessively sleepy)
Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
Continues to have a fever of 38.0°C or above for more than 5 days
Seems to be getting worse or if you are worried
You need to contact a doctor or nurse today
Please ring your GP surgery or call NHS 111 - dial 111
If none of the features in the red or amber boxes above are present
Self care
Using the advice below you can look after your child at home
This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.
If your child is not feeding as normal offer smaller feeds but more frequently
Children with bronchiolitis may have some signs of distress and discomfort. You may wish to give either Paracetamol or liquid Ibuprofen to give some relief of symptoms (Paracetamol can be given from 2 months of age). Please read and follow the instructions on the medicine container
If your child is already taking medicines or inhalers, you should carry on using these. If you find it difficult to get your child to take them, ask your Pharmacist, Health Visitor or GP. Bronchiolitis is caused by a virus so antibiotics will not help
Make sure your child is not exposed to tobacco smoke. Passive smoking can seriously damage your child’s health. It makes breathing problems like bronchiolitis worse
Remember smoke remains on your clothes even if you smoke outside
If you would like help to give up smoking you can get information / advice from your local GP surgery or by calling the National Stop Smoking Helpline Tel: 0800 169 0 169 from 7am to 11pm every day.
Your child may have a runny nose and sometimes a temperature and a cough
After a few days your child’s cough may become worse
Your child’s breathing may be faster than normal and it may become noisy
He or she may need to make more effort to breathe
As breathing becomes more difficult, your baby may not be able to take their usual amount of milk by breast or bottle
You may notice fewer wet nappies than usual
Your child may vomit after feeding and become miserable
Most children with bronchiolitis will seem to worsen during the first 1-3 days of the illness before beginning to improve over the next two weeks. The cough may go on for a few more weeks. Antibiotics are not required
Your child can go back to nursery or day care as soon as he or she is well enough (that is feeding normally and with no difficulty in breathing)
There is usually no need to see your doctor if your child is recovering well. But if you are worried about your child’s progress discuss this with your Health Visitor, Practice Nurse or GP or contact NHS 111
There are many sensory issues associated with sleep including:
Sensitivity to sound, touch, and visual stimuli which can be distracting and distressing and can affect the process of falling asleep.
Interoception difficulties, particularly recognising when hungry, full or thirsty or when the person is tired.
Some children are more sensitive to foods like sugar, caffeine and additives which keep people awake.
Look at the bedroom environment to see what may be affecting their ability to go to sleep and stay asleep. Do their pyjamas and bedclothes feel comfortable, are they too hot or cold? Is it too light or too dark, too noisy or too quiet? Perhaps it is too cluttered and stimulating. Think about your child’s diet. Are they eating too early or not having enough to eat? Are they eating food that can stimulate them close to bedtime. There can be added difficulties where children have restrictive diets but some simple adjustments of what is eaten and when can make a big difference.
Sticking to the same routine helps your child to know what to expect at bedtime and helps them feel secure. It also helps to support your child’s internal body clock and keep it on track. The age related sleep advice and information on this website can help with establishing routines. Some children will benefit from using picture timetables, timers or social stories to help them understand their bed-time routine. More information about visual supports can be found on these websites
Your child may be feeling overstimulated after a busy day and needs help to wind down, or their environment may be overstimulating with lots of toys, TVs and computers within reach. Avoiding TV and computers or hand-held devices an hour before bedtime can help your child to wind down. Activities that are good for the wind down period are jigsaws and colouring. Having a relaxing bath and milky drink can help some children, but for some children having a bath can over-excite them so they may need to have their bath earlier in the day.
Children who wake to use the toilet, wet the bed, or who wear nappies or pull-ups at night that need changing may have disturbed sleep. Eric, the children’s bowel and bladder charity are a good source of advice on this topic.
What might help
Keeping a sleep diary
A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help.
The Sleep Charity have templates you can download; one for teenagers and one for younger children.
Seeking advice and help from sleep services
There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page.
Understanding sleep cycles
The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.
As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production. Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy Melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.
Setting a waking time consistently even in holiday times, called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm.
Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity
Prescriptions of melatonin
Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known.
In Shropshire, Telford and Wrekin the Community Paediatric Service and the BeeU Service (CAMHS) can prescribe Melatonin for children and young people who meet ALL of the following criteria.
the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis not required)
sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.
GPs are unable to prescribe Melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist).
Further support
Click on the link below to visit a page with information about
national websites and sleep organisations
local community services in Shropshire, Telford and Wrekin.
