Bronchitis in Children
Bronchitis is a condition that affects the large airways (called the bronchi) in the lungs. These airways can become inflamed and filled with mucus, which can lead to coughing, wheezing, and breathing difficulties. Bronchitis can be acute (short-term) or chronic (long-term), though chronic bronchitis is rare in children.
What is Acute Bronchitis?
Acute bronchitis is a short-term inflammation of the bronchial tubes, often caused by a viral infection. It typically follows a cold or upper respiratory tract infection and usually resolves within two weeks without the need for antibiotics.
Causes of Acute Bronchitis:
- Viruses (most common) – e.g. rhinovirus, influenza, RSV
- Post-viral airway inflammation
- Environmental triggers – exposure to smoke, fumes, or allergens
- Occasionally bacteria, including Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Bordetella pertussis
- Foreign body aspiration – especially in toddlers
- Underlying conditions like asthma or allergic rhinitis
What is Chronic Bronchitis?
Chronic bronchitis is defined by a wet or productive cough lasting more than 4 weeks. In children, chronic cough may be due to a condition called Protracted Bacterial Bronchitis (PBB), or may signal other underlying diseases like suppurative lung disease, bronchiectasis, or primary ciliary dyskinesia.
When to suspect chronic or recurrent bronchitis:
- Cough lasting more than 4 weeks
- Repeated episodes of protracted bacterial bronchitis (e.g. >3 per year)
- Ongoing wet cough, especially with abnormal breathing sounds
- Poor weight gain, fatigue, or history of severe chest infections
Symptoms of Bronchitis in Children
- Frequent or persistent cough, which may be dry or productive (wet)
- Wheezing (a high-pitched sound when breathing out)
- Chest discomfort or pain, especially when coughing
- Shortness of breath, particularly with activity
- Low-grade fever, chills, or fatigue
- Sore throat or nasal symptoms if associated with a cold
In acute cases, the cough may linger for 2–4 weeks even after other symptoms resolve.
Diagnosis
Most cases of acute bronchitis are diagnosed based on symptoms and clinical examination. However, if symptoms persist or there are red flags, further tests may be needed.
Possible investigations:
- Chest X-ray – to rule out pneumonia or structural lung problems
- Spirometry – to assess lung function, especially if asthma is suspected
- FeNO testing – to assess airway inflammation
- Flexible bronchoscopy – in selected cases with suspected aspiration or PBB
- Cough or Throat or sputum cultures – to identify bacteria like pertussis or mycoplasma
- Allergy or immune workup – if recurrent or persistent infections
Treatment of Bronchitis
For Acute Bronchitis:
- Supportive care is the mainstay
- Fluids – encourage hydration to loosen mucus
- Rest and comfort – especially during the early days
- Paracetamol or ibuprofen – to manage fever or discomfort
- Saline nasal drops or steam inhalation for congestion
- Avoidance of smoke or triggers at home
Antibiotics are usually not needed unless there is a confirmed bacterial infection or high risk of complications.
For Chronic or Protracted Bacterial Bronchitis:
- A trial of oral antibiotics (e.g. amoxicillin-clavulanate) for 2–4 weeks may be prescribed
- If recurrent, further investigations may be needed to rule out underlying causes
Complications to Watch For
- Progression to pneumonia
- Worsening asthma symptoms or missed diagnosis of asthma
- Persistent or recurrent bronchitis indicating possible PBB, bronchiectasis, or other lung disease
- Dehydration from poor fluid intake or persistent fever
- Secondary bacterial infection
Prevention Strategies
- Avoid exposure to cigarette smoke – this is one of the most important steps
- Good hand hygiene – helps reduce spread of viruses
- Flu vaccination – recommended annually for children with underlying respiratory problems
- Avoid known environmental or allergy triggers
- Healthy diet and adequate sleep – support immune function
- Early management of colds and allergies – to reduce progression to lower respiratory tract symptoms
When to Seek Medical Advice
- Cough lasting more than 3 weeks
- High fever or breathing difficulty
- No improvement after 7–10 days
- Wheezing, chest pain, or fast breathing
- Poor feeding, fatigue, or reduced activity
- History of choking or foreign body inhalation
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