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Bronchiolitis

Checked: 03-05-2024 by Vicky Ryan Next Review: 03-05-2026

Overview

Bronchiolitis is a seasonal respiratory viral illness affecting babies and children under two and is most prevalent in the first year of life, peaking between 3-6 months of age. The incidence is highest from October to March in the UK. Symptoms usually peak from days 3-5 of the illness, but can persist for 14 days or more (2).

Clinical Knowledge Summary

Cough - acute with chest signs in children | CKS | NICE (1)

Other Common Respiratory Conditions in Children

Guidance

Clinical Guidelines from the Children's Hospital (BRHC)

Bronchiolitis - Diagnosis and Management - includes assessment flow chart and indications for admission.

Management in Primary Care

Children with mild bronchiolitis and no red flags can often be assessed and managed in primary care without need for admission using the guidelines above.

Safety-netting advice should be given and parent information issued (see below).

Consider regular analgesia if signs of discomfort.

There is no role for bronchodilators, adrenaline, antibiotics, steroids, antivirals or nebulised saline in uncomplicated bronchiolitis (2).

If in doubt about need for admission then consider using the Children’s Hospital ED advice line 0117 342 8666

Urgent Care Referrals (Remedy BNSSG ICB)

Red Flags

Immediately refer children with bronchiolitis for emergency hospital care (usually by 999 ambulance) if there are any of the following:

Apnoea (observed or reported).
Child looks seriously unwell.
Severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute.
Central cyanosis.
Note: Impending respiratory failure may be indicated by listlessness or decreased respiratory effort, recurrent apnoea, and/or failure to maintain adequate oxygen saturation despite oxygen supplementation.

Consider referral for children with any of the following:

Respiratory rate of over 60 breaths/minute.
Difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume).
Clinical dehydration (indicated by reduced skin turgor and/or a capillary refill time of more than three seconds, and/or dry mucous membranes, and/or reduced urine output).
Persistent oxygen saturation of less than 92% when breathing air.
Factors which should lower the threshold for hospital admission include:
- - Chronic lung disease (including bronchopulmonary dysplasia).
  - Haemodynamically significant congenital heart disease.
  - Neuromuscular disorders.
  - Immunodeficiency.
  - Age under three months.
  - The infant having been born prematurely, particularly before 32 gestational weeks.
  - Factors that might affect a carer's ability to look after a child with bronchiolitis, such as adverse social circumstances, or concerns about the skill and confidence of the carer in looking after a child with bronchiolitis at home, or the carer being able to spot red flag symptoms.
  - Longer distance to healthcare in case of deterioration.

Taken from Clinical Knowledge Summaries (1)

Parent Information

Parent Information Leaflets (from BRHC and the BNSSG ICB)

Bronchiolitis

A version in Urdu is also available: Bronchiolitis

Parent Information Video

Please also see the below video to support patients looking after children with bronchiolitis during the winter cold season. The video has been developed by the children's hospital

Video - Supporting Your Baby During Bronchiolitis Season

NHS website

Bronchiolitis - NHS (www.nhs.uk)

Resources

(1) Cough - acute with chest signs in children | CKS | NICE

(2) Bronchiolitis - Diagnosis and Management

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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