Acute bronchiolitis treatment and supportive care

The care setting depends on breathing effort, oxygen level, feeding, hydration, alertness, age, and underlying health. A mildly affected child may be cared for at home, while a child needing oxygen, feeding support, or closer observation may require hospital care.

Support can include clearing nasal secretions, offering manageable amounts of fluid, and checking that the child is not tiring. In a medical setting, clinicians may provide oxygen when levels are low and fluids through a tube or vein when drinking is inadequate.

Antibiotics treat bacterial infections, not the virus causing bronchiolitis. Cough medicines, decongestants, steroids, and nebulised medicines are not routine solutions for every child. A clinician may consider a different approach when the history or examination suggests another diagnosis.

Give small drinks or feeds more frequently and allow rest. For a congested infant, saline nose drops and gentle suction shortly before feeding can help. Keep the child away from tobacco smoke, incense smoke, and vaping aerosol, which can further irritate the airways.

Use fever or comfort medicine only if it is suitable for the child's age and weight, and follow professional dosing instructions. Do not combine products without checking their ingredients. Continue watching breathing and urine output because either can worsen even when congestion initially appears manageable.

Obtain emergency help for blue or grey lips, breathing pauses, severe pulling in around the ribs, grunting, extreme tiredness, confusion, or difficulty waking the child. These are not symptoms to manage with another dose of home medicine.

Request prompt assessment if the child is drinking much less, has fewer wet nappies or toilet visits, vomits repeatedly, or breathes progressively faster or harder. Very young infants and children with significant medical conditions should be assessed with a lower threshold when symptoms change.

Confirm how to give any recommended medicine, which nasal-clearing method is suitable, what counts as adequate fluid intake, and how long to continue monitoring closely. Ask why a nebuliser or antibiotic is or is not being considered for this particular child.