By: Cheryl Tan

Younger children are more susceptible to Bronchitis as they have smaller airways in their respiratory systems

Even as parents of young children heave a sigh of relief that the H1N1 virus has come and gone another respiratory infection is causing them concern.

This time, it is an older type of virus - bronchitis - that is back with a vengeance, with tots being its primary target.
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Beginning with flu-like symptoms, the virus starts with an innocent-enough cough and fever that leave parents panicking later when it manifests into a full-blown wheeze-fest of laboured breathing and phlegmy coughs.

"I thought it was just the usual cough that kids have and tried to treat it with normal cough syrup," says research nurse Angela Yeo, whose three-year-old son Brayden Sua came down with bronchitis three times in a short span of two months towards the end of last year.

The 34-year-old recalls that her only child would wake up in the middle of the night because he was coughing so badly and it would take a while before he could fall asleep".

To prevent a fourth episode, she bought a medicated inhaler, or aerochamber, that she administers quickly when her son starts coughing badly. She adds: "He was born premature at seven months so his lungs are weaker. I'm very worried this will carry on into his adult life."

According to doctors, the number of children being diagnosed with bronchitis - or bronchiolitis as it is diagnosed for children under two years old - have been on the rise for the past two months.

But there is no need to be alarmed, savs respiratory medicine head and consultant Dr Teoh Oon Hoe at KK Women's and Children's Hospital (KKH). He explains that the "increase in cases could be due to the wetter months" during the monsoon season between December and March.

However, younger kids are hit much worse as they have smaller airways that result in breathing, feeding and sleeping difficulties when they are infected, he says.

Dr Ang Poon Liat, consultant paediatrician at Thomson Medical Centre, says he usually sees about 50 patients a month with symptoms of bronchitis, with 90 per cent of them being under four years old.

However, in recent months, that number has jumped to twice as many children diagnosed with bronchitis at his practice.
 
At KKH, an average of between 4,200 and 4,500 children below the age of two are diagnosed with bronchiolitis in a year, with 40 per cent needing to be warded due to significant symptoms of breathlessness, poor feeding or because they are very young and need closer monitoring.

The hospital also diagnoses between 4,000 and 4,200 children and teens aged two to 16 a year with bronchitis.

Apart from smaller airways that are easily inflamed, children tend to be more susceptible to viral respiratory infections such as bronchitis because of the viruses they come in contact with during playgroup and pre-school, explains Dr Chng Seo Yi, Singapore Baby and Child Clinic paediatrician at Gleneagles Medical Centre's Asthma, Lung, Sleep and Allergy Centre.

"The viruses manifest because children do not have the immunity against them, unlike adults," she says, adding that premature babies are also at a higher risk of getting bronchitis due to their weaker lungs compared to full-term newborns.

While healthy kids usually bounce back after two weeks of treatment, Dr Ang reminds parents that bronchitis during childhood, is not to be trifled with. "The young child is unable to seek help and the severity is often not known or hidden unless the caregiver is experienced and sharp."
 
He adds that if left untreated, it can develop into pneumonia, exhaustion and hypoxia; a condition where the sufferer experiences shortness of breath, headaches and fatigue due to the lack oxygen.

But with symptoms of cough & cold and fever that are similar to the common flu, it is tough for parents to spot the telling signs of bronchitis. 

First-time mum June Koo blamed her daughter Fiona Ong's persistent cough on the weather until her family doctor diagnosed it as bronchitis last October.

"1 felt so guilty when he told me that and I was wondering if I had overlooked it. I felt I didn't take care of the cough quickly enough," says the 39-year-old accountant, who took turns with her husband to take leave and stay home to care for their 3 1/2-year-old daughter during that period.

Fiona has started coughing again and while Madam Koo is trying to self-medicate with common cough syrup, she is worried that it might develop into bronchitis again.

Although the general advice from doctors to parents is to take the child to the doctor immediately once wheezing occurs, she says: "I still don't know what is the difference between a serious cough and bronchitis."