Management of acute bronchiolitis

For all children with acute bronchiolitis:

• reassure carers
• educate carers about minimal handling
• provide carer information sheet [NB1]
• give small, frequent feeds.

For children with moderate to severe acute bronchiolitis, provide symptomatic care in hospital, including:

• supplemental oxygen, if required, to maintain SpO₂ 92% or more
• nasogastric feeds or intravenous fluids if normal feeding is not possible [NB2].

For children with severe bronchiolitis, noninvasive ventilation (eg CPAP), high-flow nasal cannula therapy or invasive ventilation may be required.

Bronchodilators are not recommended (they do not reduce hospital length of stay or requirement for supplemental oxygen). However, a one-off trial may be considered in children hospitalised with severe bronchiolitis who are older than 10 months:

• if symptoms do not improve, do not continue therapy
• if symptoms improve (ie reduction in breathing effort, cough or wheeze), bronchodilator use may be continued with specialist input; dosage is lower than that used in asthma. If asthma is suspected, refer to a specialist.

Do not routinely give antibiotics; however, in very ill hospitalised children with bronchiolitis and suspected secondary bacterial infection, antibiotics may be indicated (see Community-acquired pneumonia in children).

Do not prescribe corticosteroids.

Do not prescribe nebulised hypertonic saline.

Do not prescribe adrenaline except in peri-arrest or arrest situation.