Bronchitis in children: what the diagnosis means and when a repeat examination is needed

Bronchitis is inflammation of the lining of the bronchi. In children it most often develops against the background of an ordinary respiratory viral infection: the infection “moves down”, and the cough becomes the main symptom. The word sounds more serious than “a cold”, but on its own it means neither a severe course nor the need for an antibiotic.

How it relates to colds and coughs

In most children bronchitis is not a separate illness “caught” instead of a cold, but part of the course of the same viral infection. That is why the start is usually the same: a few days of a runny nose, fever, and malaise, and then the cough takes centre stage.

The usual symptoms

• a cough — the leading symptom, usually dry at first, then with phlegm;
• a raised temperature, usually in the first days of the illness;
• a runny nose and congestion as remnants of the initial infection;
• tiredness, reduced appetite, restless sleep because of the cough;
• sometimes — an audible whistling breath or a feeling of “rattling” in the chest.

How long it lasts

The child's wellbeing usually improves within a few days, while the cough lasts longer — sometimes several weeks, gradually weakening. A “tail” like this does not mean the treatment is not working: the airway lining recovers more slowly than the fever goes away.

Prolonged fever with bronchitis: how to think about it

This is one of the most frequent questions from parents, and it is important to answer it precisely. A raised temperature in the first days of bronchitis is expected. But a lingering fever is not among the symptoms that “just last a long time” and call for patience.

• A temperature at the start of the illness, gradually falling as the child feels better — the expected picture.
• A temperature that stays up for several days with no tendency to improve — a reason for an examination.
• A temperature that returned or rose after the child had started to feel better — a reason for an examination, even if the cough has not changed.
• A temperature together with rapid or difficult breathing — a reason for prompt assessment.

Why a long cough does not prove a bacterial infection

The duration of a cough is a poor argument for an antibiotic. With viral bronchitis a cough can drag on for weeks, and that is not a sign of bacteria. The colour of the phlegm and the “wheezes” a parent can hear from a distance prove nothing either.

Modern guidelines on acute cough are built directly on the principle that an antibiotic is not prescribed automatically: the doctor assesses in whom it will genuinely change the outcome. The decision is made from the child's condition, the breathing, the findings of the examination, and the course of the illness.

What the doctor assesses

• breathing: rate, effort, indrawing, blood oxygen saturation where needed;
• listening to the chest: what exactly is heard in the lungs and whether it is the same on both sides;
• the general condition, drinking, activity;
• the trend: what has changed since the previous examination;
• additional investigations where needed; an X-ray is performed when indicated, not with every case of bronchitis.

General principles of care

• enough to drink;
• free nasal breathing and cool, humidified air in the room;
• no tobacco smoke indoors — it sustains the cough;
• rest, without forcing the usual routine;
• watching the breathing and temperature, ready to come back for a repeat examination.

This page is for general information only and is not a substitute for a consultation with a doctor. A child's diagnosis and treatment are determined by a doctor during an examination.