• 1 week ago

Lower Respiratory Tract Infections in Children (Bronchiolitis & Pneumonia)

What Are Lower Respiratory Tract Infections?

Lower respiratory tract infections (LRTIs) affect the deeper parts of the lungs—bronchi, bronchioles, and alveoli. In children, the two most common forms are bronchiolitis and pneumonia. These illnesses can begin after a mild cold or present with more serious symptoms from the start.

Infants and toddlers are especially vulnerable due to narrow airways and developing immune systems. While some cases can be managed at home, others may require hospitalization—especially if breathing becomes labored or feeding is disrupted.

What Is Bronchiolitis?

Bronchiolitis is a viral infection of the small airways (bronchioles), seen almost exclusively in children under age 2. The most common cause is Respiratory Syncytial Virus (RSV), although other viruses (rhinovirus, influenza, adenovirus) can also be responsible.

Key Symptoms:

  • Wheezing, noisy breathing
  • Rapid, shallow breaths
  • Persistent cough
  • Trouble feeding or breastfeeding
  • Fatigue and poor sleep
  • Nasal congestion or mild fever

Diagnosis:

Usually based on physical exam. Doctors listen for wheezing, assess breathing effort, and may use an RSV rapid test if needed.

Treatment:

Bronchiolitis is viral, so antibiotics are not used. Treatment is supportive:

  • Nasal saline and suction to ease breathing
  • Humidified air or steam
  • Oxygen if needed
  • Hospitalization in moderate to severe cases
  • Hydration and feeding support

What Is Pneumonia (Lung Infection)?

Pneumonia is an inflammation of the lung tissue due to infection—caused by viruses or bacteria. Bacterial pneumonias tend to be more severe and are more common in older infants and children.

Key Symptoms:

  • Fever above 38.5°C (101.3°F)
  • Deep, painful or frequent coughing
  • Breathing difficulty or chest retractions
  • Reduced feeding, dehydration
  • Drowsiness or fatigue
  • Rapid or grunting breathing
  • Pale or bluish lips/skin in severe cases

Diagnosis:

  • Clinical signs on chest exam (e.g., crackles, decreased breath sounds)
  • Chest X-ray (may show consolidation or fluid)
  • Blood tests (CBC, CRP)
  • Pulse oximetry to assess oxygen levels

Treatment:

  • Bacterial: Requires antibiotics
  • Viral: Supportive care only
  • Hospitalization may be needed for breathing support or IV fluids
  • Close follow-up to monitor response to treatment

Bronchiolitis vs. Pneumonia: Key Differences

Feature

Bronchiolitis

Pneumonia

Age

Mostly <2 years

All ages, especially <5 years

Cause

Almost always viral (RSV)

Viral or bacterial

Fever

Mild or none

Usually high fever (>38.5°C)

Breathing

Wheezing, shallow breaths

Deep, painful or labored breathing

Antibiotics

Not needed

Needed for bacterial cases

When to Call a Doctor

Seek immediate medical attention if your child has:

  • Fever lasting more than 3 days
  • Fast or labored breathing (you see ribs or chest pulling in)
  • Refuses to feed or vomits frequently
  • Appears overly sleepy, irritable, or confused
  • Bluish lips or fingernails
  • Recurrent bronchiolitis or persistent cough with fever

These are signs that the infection may have moved into the lungs or is becoming more severe.

Care and Monitoring with Dr. Ekin Pasinlioğlu

  • Careful clinical evaluation to differentiate bronchiolitis from pneumonia
  • Judicious use of tests and imaging only when needed
  • Antibiotic decisions based on clear medical criteria
  • Respiratory support plans for at-home or hospital care
  • Preventive strategies for children with frequent infections
  • RSV risk assessment and seasonal advice