Bronchiolitis: red flag symptoms requiring emergency care
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Bronchiolitis: red flag symptoms requiring emergency care

Lynne Pearce Health journalist

Essential facts

Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life, with about one in three babies developing it. It most commonly affects babies aged between three and six months. Although serious complications are rare, about 45,000 children with bronchiolitis are admitted to hospital in England each year for further monitoring or treatment, according to the NHS.

Primary Health Care. 31, 6, 12-12. doi: 10.7748/phc.31.6.12.s4

Published: 29 November 2021

Almost always caused by a viral infection, early symptoms are similar to those of the common cold, including a cough and a runny nose, says the NHS. Further symptoms then develop, including a dry, persistent cough, wheezing, a fever and difficulty feeding.

Most cases are mild and will clear up within two to three weeks, but about 2% to 3% need to be admitted to hospital because they develop more serious symptoms, such as breathing difficulties. Babies born prematurely or with underlying health issues, such as heart or lung conditions, are more likely to need hospital care.

Bronchiolitis is most widespread during the winter months and it’s possible to get it more than once during the same season.

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Picture credit: Alamy

What’s new?

In August this year, the National Institute for Health and Care Excellence (NICE) published updated guidance on diagnosing and managing bronchiolitis in children. The overall aim is to help healthcare professionals diagnose the condition, assessing whether babies and children should be cared for at home or in hospital. It also describes treatments and interventions that may help manage symptoms.

How you can help your patient

Advising parents on how to care for their baby – including how to recognise symptoms – is key, says NICE. Red flag symptoms include:

  • » Worsening breathing, such as grunting, nasal flaring or a marked chest recession.

  • » Reduced fluid intake and/or no wet nappies for 12 hours.

  • » Apnoea or cyanosis.

  • » Exhaustion, with signs such as not responding normally to social cues or waking only with prolonged stimulation.

Parents or carers should be advised on where to seek help if any of these symptoms develop, including calling 999 if the baby or child has severe breathing difficulties.

Healthcare professionals should also advise that smoking in the child’s home increases the risk of more severe symptoms in bronchiolitis and should be avoided.

Expert comment

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Lorrie Lawton Senior head of nursing, emergency and trauma care, King’s College Hospital London

‘These National Institute for Health and Care Excellence (NICE) guidelines are clear and concise, especially regarding the assessment of differential diagnosis of children presenting with respiratory symptoms in the emergency department. The guidance flags the differences between pneumonia, viral induced wheeze and bronchiolitis.

‘There is also clear guidance on the level of oxygen saturations and when to be concerned – that is, persistently less than 90% for children aged six weeks and over; and persistently less than 92% for babies under six weeks or children of any age with underlying health conditions.

‘NICE also clearly sets out the additional concerns in the child’s past medical history that could indicate a potentially worsening outcome, such as prematurity or neurological disease. This is especially important for those nurses who are completing initial assessments.’

Find out more

National Institute for Health and Care Excellence (2015): Bronchiolitis in Children: Diagnosis and Management

NHS (2018): Overview: Bronchiolitis

Royal College of Paediatrics and Child Health (2021): National Guidance for the Management of Children with Bronchiolitis

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