Should I Take My Baby To the Doctor For a Cold?
Colds In Babies Can Cause Serious Symptoms
You have probably arrived at this page because your baby has a bad cold, and you are not sure whether you should call a doctor. So I will start by saying that in my experience it is better to overreact than to wait too long. If after you have read this article you are still worried, make that call.
I am not a medical professional, but I am parent whose daughter had bronchiolitis twice as a baby, and I know how rapidly it can take effect. My aim with writing this is not to alarm parents, but to encourage you to trust your parental instinct and get the help your baby needs. By sharing our daughter’s story, I hope you will see that even a seriously ill baby can recover.
The first time my daughter had bronchiolitis she did not have the classic symptoms, but was very ill. This article will explain both the classic symptoms and other signs to watch out for.
What is bronchiolitis?
Bronchiolitis is a condition or complication that can occur during a viral illness. The bronchioles are small airways of the lungs that connect the main tubes (the bronchi) to the air sacs (alveoli.) In bronchiolitis, the bronchioles become inflamed and this restricts the flow of air in and out of the lungs.
Does having bronchiolitis mean my baby has asthma?
No, the two conditions are different. Some children who have had bronchiolitis do go on to develop asthma, but not all do. Our daughter often had asthma symptoms with a cold but at no other times. This is known as virally-triggered asthma.
If your baby has a cold and is having breathing difficulties, do not try to treat with her with asthma medication as this could make her worse.
What causes bronchiolitis?
It is most frequently caused by the respiratory syncytial virus (usually called RSV) but in around 25% of cases, another virus is the cause. The human rhinovirus is the next most common cause.
These illnesses are variations of the common cold so at first your baby will appear to have a bad cold. Most often bronchiolitis starts after a baby has had the cold for a few days.
Is it serious?
In the vast majority of cases it is not, but for some babies it can be very serious and may mean a lengthy stay in hospital. In extreme cases, it can be fatal.
At what time of year are babies most at risk?
In the Northern Hemisphere, most cases of bronchiolitis occur between October and March. (For the Southern Hemisphere those times would be April to September.) It was November both times my daughter contracted it, but her cousin caught bronchiolitis in June. So just because it is not the time of year for bronchiolitis, don’t assume your baby can’t have it. If she appears to you to be very ill she probably is.
Who gets bronchiolitis, and who is most at risk with it?
Bronchiolitis most commonly affects babies under one year old, particularly babies of 3 – 6 months. However, babies over one year can be affected. My daughter had bronchiolitis twice, and the second time she was over a year old.
Babies whose mothers smoked during pregnancy are more at risk of contracting severe bronchiolitis, as are babies who live in a smoky environment. Babies who have congenital heart disease or who were born prematurely are also more at risk. (My daughter was premature.)
Can anything prevent bronchiolitis?
Since smoking near a baby increases the risk, make sure your baby is not in a smoky environment.
Because the viruses that cause bronchiolitis are contagious, it is important to wash hands, avoid coughing near your baby if possible, and try to avoid taking your baby into crowded places.
There is no vaccine against the illnesses that cause bronchiolitis, but if your baby is considered at risk he may be offered an injection containing anti-bodies to the RSV virus, which is the most common cause of bronchiolitis. This injection is given at monthly intervals during the RSV season. Because our daughter tested negative for RSV she was given this shot throughout the winter months.
When to call the doctor for your baby’s cold
Some symptoms of bronchiolitis that professionals advise parents to look out for:
- A dry cough.
- Having difficulty feeding or not feeding at all.
- Nostrils flare as the baby tries to breathe more deeply.
- Rapid breathing (in babies under one year old this is over 6o breaths a minute.)
- The baby’s diaphragm (just below the ribs) sinks in as she tries to breathe.
- Blue tinged lips or skin.
- Your baby stops breathing for up to 10 seconds a time – the name for this is apnoea.
If your baby has the first 2 symptoms only, they probably just have a cold. If they have several of the first 6 symptoms, you should call a doctor. If your baby has a cold and has either of the last 2 symptoms, even if they don’t have the others, get to hospital as quickly as possible or call an ambulance.
The video below is the best out of several I watched that explain the symptoms of bronchiolitis and when to see a doctor.
This doctor explains the symptoms of Bronchiolitis and Croup
Other Signs Your Baby May Have More Than Just A Cold:
The first time our daughter had bronchiolitis; to begin with her only symptom was sleeping a little longer than usual. Since she’d had a cold for several days and hadn’t slept well, so at first we thought she might just need more rest. She wasn’t fevered, her breathing wasn’t fast, she had no wheezing sound and had fed reasonably well.
However, to me, something seemed wrong. She wasn’t blue-tinged, but she looked slightly grey. Like many mothers, I thought perhaps I was over-reacting and since my husband wasn’t worried at that stage I didn’t call a doctor.
Since my daughter was born very prematurely, it was important for her not too go too long without a feed, so eventually I woke her. She fed well, so again I thought I had been overreacting. Then she stopped breathing, and her eyes rolled so that only the whites were visible. Before we had time to resuscitate her she began breathing again.
Trust Your Parental Instincts.
Even though our daughter began breathing again without assistance, we took her to hospital. At first the staff thought she seemed fine, this soon proved to be far from the case.
When to go to the doctor or hospital: Quick checklist of symptoms
Call the Doctor or Take Baby to Hospital
Having diffiulty feeding
Very listless and sleepy
Nostrils flare when breathing
Diagphram sinks in when breathing
Blue tinged lips or skin
Stops breathing for up to 10 seconds
What Will Happen If You Take Your Baby To A Doctor
Your doctor will check your baby’s lungs with a stethoscope for signs of infection such as wheezing or crackling and will assess his overall state of health. If your doctor thinks your baby can stay at home, your doctor will advise you on how to make your baby more comfortable until the bronchiolitis has passed. Your doctor might prescribe a bronchodilator inhaler. Bronchodilators relax muscles and open airways, but are not always effective for bronchiolitis. Some doctors might prescribe a nebulizer. (See below for more information.)
If your baby is experiencing a lot of difficulty breathing, your doctor is likely to refer him to hospital.
An Oxygen Probe on a Baby's Foot
What Will Happen If You Take Your Baby To Hospital?
- Almost certainly the first thing that will happen is a doctor will check your baby’s lungs with a stethoscope.
- The oxygen level in your baby’s blood will be checked. This is done non-invasively, and is not painful or harmful. A probe will be attached to your baby’s foot and will look similar to the one in the photograph on the right.
- If your baby’s oxygen levels are good, he may not need any treatment, but if he already has severe difficulty breathing, some treatment will be necessary.
- Your baby’s chest may be x-rayed.
Treatments Your Baby May Receive
You may be frightened by thoughts about the treatment your baby will receive. Below are descriptions of some treatments, ranging from those for least serious to most serious. The accompanying photographs are of my daughter when she was still very small and were not taken during bronchiolitis, although in the photograph with the ventilator she was ill.
Giving your baby medication through nebulizer is common treatment for bronchiolitis. A nebulizer is a machine that creates a fine mist containing droplets of the medicine. This helps to open the airways. You can see how a nebulizer works in the video below. The second time my daughter was in hospital for bronchiolitis she was given medication through a nebulizer.
If your baby does not need oxygen you may be given a nebulizer to use at home. This will depend on the policy of your hospital.
This video shows how to use a nebulizer
A baby on oxygen
Often, the first treatment a baby will be given is oxygen. There are several ways to administer oxygen: using a mask, by oxygen prongs or by placing an oxygen headbox over the baby’s head. In the first instance your baby’s oxygen will most likely be administered by mask.
You can see a baby with oxygen prongs in the photo on the right.
If your baby is very ill, and does not respond to oxygen alone, the next treatment likely to be used is a CPAP machine. CPAP stands for continuous positive airway pressure: it uses air pressure to stop airways collapsing. This means your baby does not have to work so hard to breathe.
The first photograph on the right below is of a baby on CPAP. As you can see it is still possible to hold your baby.
If your baby is still not able to breathe with a CPAP machine, then she will be placed on a ventilator. This does the breathing for the baby. If your baby needs a ventilator she will transferred to an intensive care unit, and may be sedated. It can be very frightening to see your baby on a ventilator, but even if this happens she is likely to recover well. That first time our daughter had bronchiolitis she needed a ventilator for 9 days.
Although in the photograph below right I am holding my daughter, when she was severely ill with bronchiolitis this was not possible. Like her, if your baby needs ventilating, she is likely to be in an intensive care cot or crib, and will be monitored carefully. She will also need to be fed through a tube or by given a drip.
Sometimes nurses also needed to remove the excess mucus from my daughter lungs when she was very ill. This meant suctioning off the mucus by use of a long tube. To do that they had to take her off the ventilator, and so they also performed a procedure known as "hand bagging" that means manually ventilating the lungs. Only seriously ill babies will require this treatment.
Bronchiolitis Can Escalate Rapidly
Sometimes the condition of babies with bronchiolitis can deteriorate very rapidly and this is what happened with our daughter. When we brought her to hospital she was breathing unaided and her color looked fine, so the staff were not unduly concerned. When a nurse checked oxygen saturation, she at first thought the monitor must be wrong because the level was so low. Our daughter was then given oxygen and her saturation increased. But by the time doctors had taken a chest x-ray, she needed a CPAP machine and about an hour later was on the ventilator and 80% oxygen. (Air is 21% oxygen.) Even so, after 9 days in intensive care, she was well enough to return to a children’s ward and after 4 weeks in hospital she came home.
The second time our daughter had bronchiolitis was a year later, and after a night receiving medication through a nebulizer, by morning she was bouncing in her hospital crib.
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