Diagnosing bronchiolitis

Bronchiolitis is an infection that causes swelling and mucus in the small airways of a baby or young child. It often begins like a cold, then breathing may become faster or noisier. A child may have a cough, reduced feeding, fever, or [Wheezing]. The diagnosis comes from the pattern, examination, and how hard the child is working to breathe.

A clinician may check breathing rate, chest movement, hydration, temperature, and oxygen saturation. A swab or chest X-ray is not routinely needed, but may be considered when the presentation is unusual or another illness is suspected. Antibiotics do not treat the usual viral cause.

Offer smaller, more frequent feeds and keep the child upright while awake. Clear nasal mucus gently if it interferes with feeding, and monitor wet nappies and alertness. Keep the child away from smoke. Use fever medicine only as directed for the child’s age and weight, and do not give cough medicines unless a clinician recommends them.

Breathing can change over hours, so watch the child rather than relying on one examination. A [Child Health Consultation] can review feeding, hydration, and breathing. Nebuliser treatment is not suitable for every child; ask before using [Nebuliser Treatment].

Call emergency services if the child has pauses in breathing, blue or grey lips, severe chest sucking-in, grunting, extreme sleepiness, or cannot be woken. Seek urgent assessment if feeding falls markedly, wet nappies become much less frequent, breathing is persistently fast, or the child is struggling to breathe. A worsening [Cough] or [Fever] should be discussed with a clinician, especially in a very young baby.

Ask: How severe is the breathing difficulty? Is the oxygen level reassuring? How much should my child drink? Which signs show dehydration? How should I check breathing at home? When should we return? Could another illness explain the symptoms?