RSV and bronchiolitis in babies: what parents need to know
Bronchiolitis is one of the most common reasons parents of young babies end up calling NHS 111 or heading to A&E in the winter months. Most cases are mild and pass at home, but knowing which signs mean your baby needs urgent help can make a real difference. This article pulls together the key facts from NHS guidance so you know what to expect and when to act.
What is bronchiolitis?
Bronchiolitis is a chest infection that affects the tiny airways deep inside the lungs. It is very common in babies and children under two years old. The vast majority of cases are mild, and most babies recover at home without any special treatment.
The infection is almost always caused by a virus called respiratory syncytial virus, usually shortened to RSV. RSV spreads easily from person to person through coughs and sneezes, and it is so widespread that almost all children catch it at least once before their second birthday.
Symptoms to look out for
Bronchiolitis often starts out looking like a normal cold. Over the first day or two you might notice:
- A runny or blocked nose
- Sneezing
- A mild cough
As the infection moves deeper into the chest, symptoms can progress to:
- Faster breathing than normal
- A noisy, wheezy or crackling sound when your baby breathes
- Difficulty feeding, because breathing and sucking at the same time becomes hard work
- Irritability and unsettledness
Symptoms are usually at their worst between days 3 and 5. After that point most babies start to turn a corner, and the cough typically clears up within three weeks.
When to call 999
Some babies, particularly very young or premature ones, can become seriously unwell with bronchiolitis. Call 999 immediately if your baby:
- Is working very hard to breathe or appears to be struggling with each breath
- Has pauses in their breathing
- Has skin, lips or a tongue that looks blue
- Seems unusually drowsy or is difficult to wake
These are emergency signs and need an ambulance straight away, not a wait for a GP appointment.
When to contact your GP or call 111
Even if your baby is not in an emergency situation, contact your GP or NHS 111 if you notice any of the following:
- Symptoms that are getting noticeably worse rather than staying the same
- Your baby is feeding or eating much less than usual
- Signs of dehydration, such as fewer wet nappies than normal
- A high temperature: 38°C or above in a baby under 3 months, or 39°C or above in an older baby
- Your baby seems very tired or is not responding the way they usually would
- You are simply worried, even if you cannot pinpoint exactly why
Trust your instincts. Parents notice changes in their baby that are easy to miss in a short consultation.
Babies who need closer watching
Not all babies face the same level of risk. Those who need particular care and earlier medical attention include:
- Babies under 6 months old, who are more vulnerable to serious illness from RSV
- Babies born very prematurely, whose lungs may not be fully developed
- Babies with an underlying heart or lung condition
- Babies with a weakened immune system
If your baby falls into any of these groups, contact a healthcare professional at the first sign of bronchiolitis rather than waiting to see how things develop.
Caring for your baby at home
There is no specific antiviral treatment for bronchiolitis. The goal of home care is to keep your baby as comfortable as possible while their immune system does its job. NHS guidance suggests:
- Offer smaller feeds more often. If your baby is struggling to breathe and feed at the same time, shorter, more frequent feeds are easier to manage than longer ones.
- Encourage plenty of fluids. For older babies, extra water or diluted fruit juice alongside their normal feeds can help with hydration.
- Keep your baby upright when possible, as this can make breathing a little easier.
- Use infant paracetamol or ibuprofen if your baby seems uncomfortable or has a raised temperature, following the dosing instructions for their age and weight.
- Check on your baby regularly, especially overnight, so you can spot any changes in breathing or colour quickly.
If your baby needs hospital care
A small number of babies with bronchiolitis are poorly enough to need treatment in hospital. The NHS notes that bronchiolitis can be serious in some children, and hospital care is there for those cases. If your baby is admitted, the clinical team will take it from there. Your job as a parent is simply to seek help early if you are worried.
Preventing RSV: the vaccine in pregnancy
Hand hygiene is the single most effective everyday step. RSV spreads on hands and surfaces, so washing hands regularly, cleaning toys and other shared items, and avoiding sharing feeding equipment all help reduce the chance of spreading the virus.
From 2024 the NHS has also offered a RSV vaccine during pregnancy. It is available from 28 weeks of pregnancy and works by building antibodies that pass to your baby before birth. This can help protect your baby and reduce the risk of severe RSV illness for the first six months of their life. If you are pregnant and have not yet been offered or taken up the RSV vaccine, speak to your midwife or GP.
Frequently asked questions
How long does bronchiolitis last in babies?
Symptoms tend to be at their worst between days 3 and 5. After that most babies gradually improve, and the cough usually clears up within three weeks.
When should I call 999 for my baby with bronchiolitis?
Call 999 immediately if your baby is visibly struggling to breathe, has pauses in their breathing, or if their skin, lips or tongue take on a bluish colour. These signs need emergency help right away.
Is there a treatment for bronchiolitis?
There is no specific cure. Home care focuses on keeping your baby comfortable, offering smaller feeds more often, giving extra fluids, and using infant paracetamol or ibuprofen for discomfort. Most babies recover fully without any special medical treatment.
Can the RSV vaccine in pregnancy help protect my baby?
Yes. The NHS offers an RSV vaccine from 28 weeks of pregnancy. The antibodies it produces cross the placenta to your baby and can help reduce the risk of severe RSV illness for the first six months after birth. Ask your midwife if you have not yet been offered it.
Which babies are most at risk from bronchiolitis?
Babies under 6 months, babies born very prematurely, and those with a heart or lung condition or a weakened immune system are at higher risk of becoming seriously unwell. If your baby fits any of these descriptions, seek medical advice early rather than waiting.
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