Nice | Bronchiolitis in children

This is a new guideline from Nice on diagnosing and managing bronchiolitis. It really doesn’t add much new as it mainly lays out criteria for referral and this is just around recognition of a sick child. I’ve outlined a few interesting points.

1. Symptoms usually peak at 3 – 5d.
2. 90% have recovered from the cough by 3w.
3. Fever is common (30%) in babies but be suspicious of pneumonia if the temperature is over 39.
4. Ask about apnoea. Recurrent episodes are a sign of severity. In young babies (eg 6w or under) this can be the only presenting feature.
5. Don’t use salbutamol in the treatment of bronchiolitis.
6. They’ve outlined very specific red flags to warn parents of.

• Increased work breathing (eg grunting, nasal flaring or recession).
• Apnoea or cyanosis.
• Reduced fluid intake (eg 50 – 75% of normal) or no wet nappy for 12 hrs.
• Exhaustion