AAP bronchiolitis guidance: what parents should know

AAP refers to the American Academy of Pediatrics. Its approach helps clinicians avoid treatments that generally do not change the course of uncomplicated viral bronchiolitis, while identifying children who need oxygen, fluids or closer observation.

Bronchiolitis is a viral infection of the smallest breathing tubes, usually affecting babies and young children. Children with bronchiolitis often develop a runny nose followed by cough, faster breathing, noisy breathing or wheezing. Feeding may become harder because coordinating sucking and breathing takes more effort.

Diagnosis is usually based on the child's symptoms and examination. A clinician checks breathing effort, oxygen level, alertness and hydration. Chest X-rays and blood tests are not routinely needed when the presentation is typical. Antibiotics do not treat the viruses that cause bronchiolitis. Bronchodilator nebulisers and steroid medicines are also not routine treatments, although a clinician may consider another diagnosis if the history or examination is unusual.

Offer smaller, more frequent breastfeeds or bottle feeds and watch for regular wet nappies or urination. Saline nose drops followed by gentle nasal suction can make feeding easier when the nose is blocked. Keep the child upright while awake and supervised, and keep smoke, incense and vaping aerosols away from them.

For fever or discomfort, use only a child-appropriate medicine and dose advised for the child's age and weight. Do not start leftover antibiotics, cough remedies, steroids or a nebuliser unless a clinician has recommended them for this child. Check breathing and fluid intake regularly, including during the night.

Seek emergency help now if the child has pauses in breathing, blue or grey lips, severe chest pulling, grunting, marked difficulty breathing, unusual limpness, or is hard to wake. These signs require urgent assessment regardless of whether fever is present.

Arrange prompt medical assessment if breathing is becoming faster or harder, the child takes much less fluid than usual, has noticeably fewer wet nappies, repeatedly vomits feeds, or seems increasingly sleepy or irritable. Babies born prematurely and children with heart, lung or immune conditions may need earlier review because they can have less reserve during a respiratory illness.

Ask how to judge your child's breathing effort, what fluid intake and urine output are reassuring, and which change should trigger another assessment. Confirm the correct fever medicine and dose, whether nasal saline or suction is appropriate, and whether any existing heart, lung or immune condition changes the care plan.