Bronchitis in children: What causes it?

I have a five-month old son who was diagnosed yesterday with ear infections in both ears and the beginnings of bronchitis. Although I have read a substantial amount on ear infections, I have not heard much about bronchitis in infants. Can you tell me what causes bronchitis and what can be done to prevent its recurrence?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

To understand bronchitis, it is best to have a basic understanding of the anatomy of the airway system in our bodies. I think the easiest way to think of the human airway is to liken it to a tree turned upside-down. The trunk is the mouth and throat. Then the main portion of the tree divides into to large branches. These are the bronchi of the lungs. From there each main branch divides multiple times into smaller and smaller branches. These are the bronchioles of the lungs. And finally come the leaves that represent the alveoli which are the microscopic structures of the lungs responsible for allowing oxygen to get into the bloodstream.

Much is written about the trunk, smaller branches, and leaves (mouth & throat, bronchioles, and alveoli) because infections of these parts cause significant problems in childhood. Most people know the infections of the mouth and throat (Strep throat, cold sores, etc.), but infections of the bronchioles called bronchiolitis cause many children to be hospitalized each year which is also true of infections of the alveoli more commonly known as pneumonia. So, what is the deal about bronchitis? Don't infections of the bronchi cause problems too?

The simple answer to this is "No." But then, the next question is, "Then, why do doctors treat children with bronchitis with antibiotics much of the time?" And to this, I have no easy answer except to say it is almost always unnecessary to give any child with bronchitis anything other than tender loving care and some Tylenol for discomfort. You see, bronchitis in children is almost invariably caused by a viral infection. Antibiotics treat bacterial infections not ones caused by viruses. This is opposed to adults who smoke. These individuals already have significantly damaged bronchi due to smoking, so the tissues of the bronchus are more prone to acquiring bacterial infections. But even in adults, the diagnosis and treatment of bacterial bronchitis is not made until the person has had a persistent productive cough for at least 2 weeks.

You don't read a whole lot about bronchitis in children primarily because there isn't much to talk about. It is caused by viruses we can't treat, and the infections don't cause significant problems except to keep parents awake due to their children coughing, and children recover by themselves. The viruses which cause bronchitis are the same ones that give children the stuffed-up runny nose and post-nasal drip. Therefore, there isn't anything additional that needs to be done to prevent these infections that isn't already being done to prevent getting the common cold, namely everyone carefully washing their hands.

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