Acute Bronchiolitis in Children

Description

Diagnostic Criteria

General Measures 

Medicine Treatment 

Referral

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J20.0-9/J21.0-1/J21.8-9

DESCRIPTION

• Acute bronchiolitis is a common cause of wheezing and cough in the first two years of life. It is caused by viral infections and presents with lower airway obstruction due to inflammation and plugging of the small airways. Recurrent episodes can occur, usually during winter
• It can be difficult to distinguish between bronchiolitis and asthma. Bronchiolitis does not respond to salbutamol. If there is a good response to a single dose of salbutamol, asthma is the likely diagnosis. See: Acute asthma, children 
• Bronchiolitis is extremely rare in children >2 years of age. Consider other causes of wheeze in children >2 years of age. See: Acute asthma, children and Pneumonia in children

Child presents with: 

• Rapid breathing
• Decreased breath sounds
• Chest indrawing
• An audible wheeze or crackles

Risk factors for severe bronchiolitis:

• Infants <3 months of age
• Ex-premature babies
• Chronic lung disease
• Congenital heart disease

Signs of severe disease: 

• Increased respiratory effort: tachypnoea, nasal flaring, severe lower chest wall indrawing, accessory muscle use, grunting
• Central cyanosis or hypoxia (oxygen saturation <90% in room air)
• Apnoea
• Inability to feed
• Lethargy or decreased level of consciousness

DIAGNOSTIC CRITERIA

• Prodrome of viral infection: irritability and rhinorrhoea
• A wheeze that is slowly responsive or non-responsive to bronchodilators
• Tachypnoea: age dependent:

Age	Respiratory rate
Birth–2 months	≥60 breaths/minute
2–12 months	≥50 breaths/minute
1–5 years	≥40 breaths/minute

GENERAL MEASURES

• Minimise contact with other children
• Avoid routine use of antibiotics and corticosteroids
• Do not sedate child

MEDICINE TREATMENT

• Mild cases, without risk factors may be managed as an outpatient.

Refer severe bronchiolitis or those with risk factors:

• Oxygen, humidified, using nasal prongs or nasal cannula, at 1–2 L/minute

REFERRAL

• Signs of severe bronchiolitis (respiratory distress, hypoxia, apnoea, inability to feed, lethargy/ decreased level of consciousness)
• Bronchiolitis with risk factors for severe disease
• Previous admission for same problem

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4-Version 1.0_16 September 2024

Chapter 17: Respiratory Conditions_17.1. Conditions with Predominant Wheeze_17.1.4. Acute Bronchiolitis in Children