AKT · Child health/Infection & rash

Bronchiolitis

Respiratory syncytial virus (RSV) mostly

Overview

A lower respiratory tract infection of infants (<1–2 years, peak <6 months), usually RSV, causing coryza then a wheezy/cracklling respiratory illness. Management is supportive — there is no role for bronchodilators, steroids or antibiotics.

Recognise

Coryzal prodrome → cough, tachypnoea, wheeze and fine bibasal crackles
Poor feeding, increased work of breathing
Apnoea in young/preterm infants

Red flags

Apnoea, grunting, marked recession, <50% feeds, sats <90%, dehydration → admit

Differentials & how to tell them apart

Viral-induced wheezeolder infant/child, responds to bronchodilators, recurrent

Pneumoniafocal signs, high fever, focal CXR consolidation

Heart failuremurmur, hepatomegaly, cardiomegaly

Pertussisparoxysmal cough with whoop/vomiting/apnoea

Investigations

Clinical diagnosis (NICE NG9). Pulse oximetry. NPA/viral PCR confirms RSV but does not change management. CXR not routine.

Management

Supportive care only (oxygen and feeding support as needed)

1Supportive: oxygen if sats persistently <90%, fluids (NG/IV) if feeding poorly, minimal handling.Gate: Do NOT give salbutamol, steroids, antibiotics or nebulised adrenaline routinely — no benefit in bronchiolitis
2Admit if apnoea, severe distress, <50–75% feeds, or sats <90%. Palivizumab is prophylaxis for high-risk infants only.

Supportive only — oxygen if sats <90–92%, NG/IV fluids if not feeding

Palivizumab — PREVENTION in high-risk infants — not a treatment

Key points

The classic "do not treat" condition — bronchodilators/steroids/antibiotics do not help. Distinguish from viral-induced wheeze (which does respond to bronchodilators).

Monitor & prognosis

Work of breathing, feeding, sats, apnoea.

Self-limiting over 1–2 weeks; small risk of severe disease in young/preterm/cardiac infants.

Source: NICE NG9 (bronchiolitis)