What is the correct management of bronchiolitis?

  1. Children with mild bronchiolitis may be managed at home provided they are carefully observed, they take adequate fluids, the home circumstances are good and that communication and transport are available if needed.
  2. All other children with bronchiolitis must be admitted to hospital, especially if they are under 3 months, or if there is an inability to feed, tachycardia or low oxygen saturation.
  3. Oxygen therapy with nasal prongs (flow 1 to 2 litres/minute) is indicated if there are signs of respiratory distress or the oxygen saturation is low (below 90%).
  4. Bronchodilators usually do not help in bronchiolitis.
  5. Steroids are of little help.
  6. Ensure an adequate fluid intake. If the child will not drink give nasogastric fluid. Intravenous fluid should only be given with great caution as overhydration is dangerous.
  7. Antibiotics are usually not given unless there are also signs of pneumonia or the child is less than 3 months. If pneumonia is suspected give amoxycillin.
  8. If the child has a fever give paracetamol.
  9. Physiotherapy is contraindicated and can be dangerous.
  10. Careful observation is important for signs of respiratory failure or apnoea.
  11. Intubation and ventilation for respiratory failure

Oxygen is the treatment for severe bronchiolitis.

Bronchodilators by nebulisation, e.g. salbutamol, are sometimes used in severe bronchiolitis with variable results. Children with a history of 2 or more attacks of bronchiolitis and respond to inhaled bronchodilators probably have early asthma. Do not use aminophylline as it is dangerous.

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