Bronchiolitis, an inflammation of the bronchioles—the smallest airways in the lungs—primarily affects children under two years old, especially those between two and six months of age. The main culprits are viruses such as respiratory syncytial virus (RSV), rhinovirus, and adenovirus. These viruses trigger inflammation, mucosal swelling, and excessive fluid production, narrowing the airways and leading to symptoms like wheezing, rapid breathing, and coughing.

The illness typically peaks between the third and fifth day. Most children show significant improvement within 7 to 14 days, though a cough can persist for two to four weeks in some cases. It is common for the illness to last longer than 10 days, as with your child, but this does not necessarily indicate a secondary bacterial infection. This extended duration can still be a normal progression of a viral illness.

Since antibiotics do not kill viruses, administering them for bronchiolitis will not help your child recover and may even cause harm. Doctors only consider antibiotics if there is clear evidence or strong suspicion of a co-existing bacterial infection, such as pneumonia or acute otitis media.

Signs that suggest a bacterial infection include a high fever of 39 degrees Celsius or higher, lasting for more than three days, or a fever that reappears after having subsided for several days. Other indicators are thick yellow or green phlegm, noticeable fatigue, significantly reduced feeding, and difficulty breathing. Severe bacterial infection symptoms may also be revealed through blood tests and X-ray imaging.

The primary treatment for bronchiolitis is supportive care, not antibacterial medication. Parents should use physiological saline solution nasal drops four to six times a day and gently suction their child's nose to keep the airways clear. Ensure the child drinks enough fluids or breastfeeds more frequently to thin mucus and prevent dehydration. Elevate the child's head during sleep to facilitate easier breathing. Administer paracetamol to reduce fever if it exceeds 38.5 degrees Celsius. Keep the room well-ventilated and moderately humid, while avoiding cigarette smoke and dry, cold air.

Parents should not independently administer cough suppressants, corticosteroids, or bronchodilator nebulizers without a doctor's prescription. These medications can cause adverse side effects or worsen the child's condition.

A doctor examines a child with a respiratory illness. Illustration: Tam Anh General Hospital

For a one-year-old with prolonged bronchiolitis, it is advisable to take your child to a medical facility for a lung examination. Do not delay seeking medical attention if your child exhibits signs of faster-than-normal breathing accompanied by chest retractions, nasal flaring, or refusing to feed. The most important actions are providing proper supportive care, closely monitoring for severe symptoms, and promptly seeking follow-up care or immediate medical consultation if any abnormalities arise to ensure a safe recovery.

Master, Doctor Nguyen Thi Huong

Department of Pediatrics

Tam Anh General Hospital Hanoi