Why your wheezing baby may need TLC, not medication

Claire McCarthy, MD
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications

Follow me at @drClaire

When a baby is sick with fever, cough, and a wheeze, it’s natural to think that what they need is medication — like an antibiotic, or one of the medications used to treat wheezing in children with asthma (such as albuterol). But it turns out that if a condition called bronchiolitis is the culprit, the best treatment is no treatment.

Bronchiolitis is a bad cold (caused by various viruses) that settles into the lungs. When it does, it leads to fever, lots of congestion, cough, and noisy or wheezy breathing. It’s incredibly common. In fact, one in five babies under 12 months ends up at the doctor’s office for bronchiolitis — and 2% to 3% end up hospitalized. It can be quite serious, especially when it’s caused by a particular virus called respiratory syncytial virus (RSV). While here in the US it’s rarely fatal, in other countries with fewer medical resources, thousands of babies die of bronchiolitis every year.

If it can be so serious, why do the latest guidelines say that doctors shouldn’t use antibiotics, albuterol, or other treatments? Because they don’t help — and they can have side effects that aren’t good for babies.

It’s not that we can’t do anything at all to help babies with bronchiolitis. We just need to help them in different ways.

Certain babies have a higher risk of getting really sick with bronchiolitis. Those include babies who are born prematurely, babies with lung disease or heart disease, and those who have a problem with their immune systems. For those babies, we recommend that they get a monthly shot, called Synagis, during the winter (roughly September to March) to help prevent RSV. If your baby falls into one of those categories and is less than a year old, you should absolutely talk to your doctor about this treatment.

For other babies, what we recommend is that families and caregivers use non-medical ways to help them feel more comfortable and breathe easier. They include:

  • lots of fluids — dehydration can make all that congestion worse
  • a humidifier, to loosen the congestion
  • a bulb syringe to clear out the baby’s nose (nasal saline drops, available at any pharmacy, can help you get more out of the nose)
  • acetaminophen or ibuprofen for fever.

You should always check in with your doctor if you think your baby has bronchiolitis, and your doctor may want to see the baby to be sure that it’s not something else that does need treatment. You should also call your doctor if, after being diagnosed with bronchiolitis, your baby develops

  • a high fever (more than 102 degrees Fahrenheit), or a new fever after being sick for a few days
  • trouble breathing that doesn’t get better with the humidifier or the bulb syringe (signs of trouble breathing include rapid breathing or sucking in around the ribs)
  • a pale or blue color to the skin
  • sleepiness or irritability that is much worse than normal
  • refusal to take fluids, or not wetting diapers every 6 hours.

It’s most likely that these won’t happen, and that your baby will be just fine. As with so much in medicine and parenthood, what babies with bronchiolitis mostly need is lots of TLC — and some patience.