American Academy of Pediatrics guidance on bronchiolitis

Care focuses on breathing, hydration and feeding. A clinician uses the child's history and examination to judge severity and checks for factors that can increase risk, such as very young age, premature birth, heart or lung disease, or a weakened immune system.

Bronchiolitis is a viral infection of the small airways in babies and young children. It often begins with a blocked or runny nose, then may present with cough, wheezing, faster breathing and reduced feeding. The examination looks at breathing effort, alertness, hydration and the child's ability to feed.

Chest X-rays and laboratory tests are not routinely needed when the history and examination fit uncomplicated bronchiolitis. Antibiotics do not treat the virus and are reserved for a separate bacterial infection. Albuterol or salbutamol, adrenaline, systemic steroids and chest physiotherapy are also not recommended as routine bronchiolitis treatments. Nebuliser treatment therefore should not be assumed to be necessary for every wheezing child.

Offer smaller feeds more often if a full feed is tiring, and watch for fewer wet nappies, a dry mouth or increasing sleepiness. Saline nose drops and gentle clearing of visible nasal mucus may make feeding easier. Keep the child away from tobacco smoke and vaping aerosols, and check breathing and responsiveness regularly, including during sleep.

Use fever or comfort medicine only when it is suitable for the child's age and health, following the product instructions or a clinician's advice. Do not give cough and cold remedies to a baby unless specifically directed. If hospital support is needed, clinicians may provide oxygen or fluids through a feeding tube or vein according to the child's breathing and hydration.

Get same-day medical advice if the child is feeding much less than usual, has noticeably fewer wet nappies, is increasingly irritable or sleepy, has a fever that concerns you, or is breathing faster or working harder than before. Earlier assessment is sensible for a very young infant or a child with premature birth, heart disease, lung disease or reduced immunity.

Call the UAE ambulance service or go to the nearest emergency department if there are pauses in breathing, blue or grey lips or tongue, grunting, marked pulling-in beneath or between the ribs, severe difficulty feeding because of breathlessness, limpness, confusion, or difficulty waking. These are breathing and responsiveness red flags, regardless of whether a fever is present.

Ask what breathing changes should trigger an emergency visit, how to judge whether feeds and wet nappies are adequate, and which medicine is safe for discomfort. If a nebuliser has been suggested, ask what diagnosis or finding it is intended to treat, because wheeze can occur in conditions other than bronchiolitis.