Management of bronchiolitis in infants in primary care settings: What to do and what not to do

Article Figures & Data

Table 1.

Bronchiolitis management approach based on illness severity

SEVERITY	CLINICAL FEATURES	DISPOSITION MANAGEMENT
Mild	No or mild respiratory distress Well hydrated, feeding adequately “Happy wheezer”	Usually managed as outpatient and at home
Moderate	Moderate respiratory distress Tachypnea with respiratory rate >60 breaths/min Inadequate feeding Brief apnea	Often needs observation, including assessment in the ED; hospitalization may be required^*
Severe	Severe respiratory distress Unable to feed or clinically dehydrated Lethargic Frequent apneas	ED assessment and hospitalization required^*

ED—emergency department.
↵* Indications for admission include severe respiratory distress, dehydration or poor fluid intake, cyanosis or apnea, family unable to cope, and infants at risk of severe disease.¹

Table 2.

Strategies for overcoming barriers to evidence-based management of patients with bronchiolitis

BARRIER	EXPLANATION	WAYS TO OVERCOME BARRIER
Caregiver anxiety or lack of understanding	Families may not understand the disease or may believe there is a treatment that can resolve symptoms	Empower families by educating them Provide resources for home management¹⁴ Ensure close follow-up
Diagnostic uncertainty	Providers may worry they will miss an alternative diagnosis, especially as examination findings often reveal crepitations and wheezing Providers may not be confident in diagnosing bronchiolitis based on the patient’s clinical history and examination alone	Educate families on signs and symptoms of differential diagnoses (eg, pneumonia: fever >39°C, persisting unilateral symptoms) and ensure close follow-up. Asthma is less common in children younger than 12 mo but could be considered with atopy history and symptom improvement with short-acting β₂-agonists¹⁰ Improve your knowledge of bronchiolitis management through continuing professional development programs, such as the Canadian Paediatric Society’s Pedagogy module Diagnosis and Management of Paediatric RSV infections¹⁶
Provider feels the need to “do something”	Providers may feel an urge to do something to help infants and their families with the symptoms or symptom duration	Focus on providing supportive care management (eg, feeding, suctioning, comfort) and close follow-up