Feeding with bronchiolitis
This winter I have had a number of contacts from mothers of babies who have contracted bronchiolitis and who have needed support and advice with breastfeeding, bottle feeding, expressing and tube feeding during their babies’ illness. I am writing this blog to be a go to for any mum who may find herself with a baby with bronchiolitis and who needs access to feeding advice. The blog was co-written with Dr Stephanie Ooi @the_gp_mum, GP at My Healthcare Clinic.
Bronchiolitis is a common infection of the lower respiratory tract that affects babies and young children under 2 years old. It’s commonest from November to March and unfortunately you can get it more than once during this period.
What causes bronchiolitis?
It’s caused by the respiratory syncytial virus (RSV) which is spread through tiny droplets of liquid from the coughs or sneezes of someone who's infected. The infection causes the smallest airways in the lungs (bronchioles) to become infected and inflamed. This makes it harder to breathe.
What are the symptoms?
Early symptoms of bronchiolitis include a runny nose and a cough. Further symptoms then usually develop over the next few days, including a fever, a persistent cough, difficulty feeding and wheezing. Symptoms are usually worse between day 3 and 5. Unfortunately the cough can be persistent for up to 3 weeks so beware!
How may it affect feeding?
In newborns and young infants you may notice that they become sleepy or have a decreased appetite and don’t feed as much. They may also tire easily during feeding and as a result feed for shorter periods. If your baby is working hard with their breathing they may struggle to co-ordinate their sucking and swallowing with their breathing and may cough or splutter during feeds. For breastfeeding mothers, changes to feeding patterns may impact on your milk supply and place you at risk of mastitis.
Older babies, toddlers and children may have a poor appetite when they are acutely unwell. In the weeks after the illness eating may continue to be hit and miss especially if they have a persisting cough. Once better you may notice an increase in appetite and some catch up eating!
When should I get medical help?
Most cases are mild but it is important to be aware when to seek medical help. Your child requires urgent assessment and should be seen in A&E if you notice:
difficulty breathing such as sucking in the ribs and tummy going in and out
fast breathing
colour changes including the lips and tongue turning blue or the skin looking grey
Also see your GP if:
Your baby’s feeding decreases
There is evidence of dehydration – no wet nappy for 12 hours, lack of tears, dry lips/tongue
Ongoing temperature above 38C which is not controlled with Paracetamol or Ibuprofen
If you are worried as a parent – you know them best!
How is bronchiolitis treated?
There is no medication to kill the virus that causes bronchiolitis and it usually clears up within 2 weeks. Antibiotics and steroids are not recommended for treatment. Most children can be cared for at home. Some general tips:
Encouraging fluids to avoid dehydration
Try not to worry too much if there is decreased intake of solids. Hydration is more important at this stage.
Paracetamol or Ibuprofen to help with their fever if they are distressed (if they are otherwise well then no need to actually give anything).
Keep your child upright as this may be more comfortable.
Being exposed to cigarette smoke can worsen symptoms.
Saline nasal spray can help with congestion
2-3% of babies who develop bronchiolitis during the first year of life will need to be admitted to hospital because they develop more serious symptoms, such as breathing difficulties. This is more common in premature babies (born before 37 weeks) and those with a heart or lung condition.
If your baby is admitted to hospital they will likely require additional oxygen delivered via a thin tube under their nose. Some babies are able to maintain oral feeding but many will need a nasogastric (NG) tube. This is a tube which goes down in through their nose to their tummy and their milk is delivered through this to allow them to rest and recover.
How to help your infant to feed?
If your baby has nasal congestion you can give saline nasal spray a few minutes before feeding
Offer the breast and bottle regularly. You may find your baby gets tired and only takes small feeds. Little and often is the best approach.
If your baby is breathing quickly you can help them by pacing the feed. For bottle fed babies this means removing the teat from your babies mouth after every 7-8 sucks to let them catch their breath. For breastfed babies you can feed them in a laid back position, you can also take them off the breast as you feel your let down reflex and catch it in a muslin, then return them. You may also need to take them on and off the breast if you notice they’re not stopping to catch their breath when feeding
How to maintain your milk supply?
As soon as you notice that your breastfed baby is feeding less often or for shorter periods due to their illness then begin to pump after feeds. If your baby is struggling to feed at all then express and offer the milk via a syringe, spoon, cup or bottle depending on their age and your preference.
How to help your tubefed baby?
Babies with bronchiolitis are at increased risk of milk being aspirated (going down the wrong way) onto the lungs. This is due to fast breathing or effortful breathing. For this reason they may need to stop feeding for a short time as they get over their illness. If your baby has a nasogastric tube you can do the following things to help them during this time:
Discuss with your medical team if it is safe for your baby to have a short feed and then a NG tube top up. If you are breastfeeding this can really help with supply
Pump your milk 3 hourly including through the night. This pumped milk can then be given to your baby via the NG tube. See my expressing tips here. Ask your hospital to provide you with a hospital grade pump.
Give your baby cuddles during their tube feeds, this is an ideal time to practice skin to skin contact. During the feed you can offer an expressed breast for comfort and sucking practice or a dummy if you are bottle feeding and using one.
How to help your toddler or child with eating?
If they have fever and are distressed give paracetamol and then offer food/drinks once they are feeling better
Offer fluids little and often
Offer favourite or ‘easy’ foods.
Keep a grazing plate nearby so they can just help themselves when they feel like throughout the day.