Lightning Learning: Bronchiolitis in Children (2021)

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STOP!

Bronchiolitis is a viral respiratory tract infection affecting the lower airways.

Signs & symptoms?

Children up to 2 years (most commonly <12 months) with…

• Cough & coryzal prodrome
• Tachypnoea +/- chest recession
• Wheeze or crackles
• Fever (usually <39°C)

Consider alternate diagnosis?

Pneumonia… fever >39°C and/or focal crackles

Congenital Heart Defects… SpO2 not responding to O2 and/or signs of congestive heart failure

LOOK

When to admit?

Apnoeas (observed or reported).

Persistent O2 sats in room air…

• <92% if under 6 weeks
• <90% if over 6 weeks

Decreased oral fluid intake <50% normal volume.

Persisting severe respiratory distress or RR >70/min.

Treatment?

• Treatment?
• O2 supplementation
• Consider CPAP for impending respiratory failure
• NG feeds if not tolerating by mouth
• IV fluids if not tolerating NG feeds or impending respiratory failure

LEARN

Safety net advice...

Symptoms often peak day 3-5, caregivers should represent if concerned about their child.

Provide both verbal and written advice.

Resources

1. Local bronchiolitis guideline (UHL)
2. National bronchiolitis guidance (NICE)
3. Safety netting for bronchiolitis (Don't Forget The Bubbles)