<html>
<head>
<meta charset="UTF-8"/>
<meta name="tikaGenerated" content="true"/>
<meta name="date" content="2018-08-06T02:41:09Z"/>
<meta name="xmp:CreatorTool" content="Microsoft® Word 2016"/>
<meta name="Keywords" content="paediatric clinical practice guideline, bronchiolitis, bronchiolitis in children, high flow oxygen, infant, respiratory distress, auscultation, apnoeic episodes, oxygen saturation, hypoxemia, continuous oximetry, corticosteroids, tachypnoea, upper respiratory tract infection"/>
<meta name="subject" content="Paediatric Clinical Practice Guideline"/>
<meta name="dc:creator" content="South Australian Child and Adolescent Health Community of Practice"/>
<meta name="dcterms:created" content="2018-08-06T02:41:09Z"/>
<meta name="Last-Modified" content="2018-08-06T02:41:09Z"/>
<meta name="dcterms:modified" content="2018-08-06T02:41:09Z"/>
<meta name="title" content="Bronchiolitis in Children"/>
<meta name="Last-Save-Date" content="2018-08-06T02:41:09Z"/>
<meta name="meta:save-date" content="2018-08-06T02:41:09Z"/>
<meta name="dc:title" content="Bronchiolitis in Children"/>
<meta name="modified" content="2018-08-06T02:41:09Z"/>
<meta name="cp:subject" content="Paediatric Clinical Practice Guideline"/>
<meta name="Content-Type" content="application/pdf"/>
<meta name="creator" content="South Australian Child and Adolescent Health Community of Practice"/>
<meta name="meta:author" content="South Australian Child and Adolescent Health Community of Practice"/>
<meta name="dc:subject" content="paediatric clinical practice guideline, bronchiolitis, bronchiolitis in children, high flow oxygen, infant, respiratory distress, auscultation, apnoeic episodes, oxygen saturation, hypoxemia, continuous oximetry, corticosteroids, tachypnoea, upper respiratory tract infection"/>
<meta name="meta:creation-date" content="2018-08-06T02:41:09Z"/>
<meta name="created" content="Mon Aug 06 12:11:09 ACST 2018"/>
<meta name="xmpTPg:NPages" content="13"/>
<meta name="Creation-Date" content="2018-08-06T02:41:09Z"/>
<meta name="meta:keyword" content="paediatric clinical practice guideline, bronchiolitis, bronchiolitis in children, high flow oxygen, infant, respiratory distress, auscultation, apnoeic episodes, oxygen saturation, hypoxemia, continuous oximetry, corticosteroids, tachypnoea, upper respiratory tract infection"/>
<meta name="Author" content="South Australian Child and Adolescent Health Community of Practice"/>
<meta name="producer" content="Microsoft® Word 2016"/>
</head>
<body>
<pre>
South Australian Paediatric Clinical Practice Guidelines 
 

Bronchiolitis in Children 
  Department for Health and Wellbeing, Government of South Australia. All rights reserved. 

 
 

INFORMAL COPY WHEN PRINTED  Page 1 of 13 

Public-I4-A4 
 

 

Note:

This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of published 
evidence and expert opinion.  

Information in this statewide guideline is current at the time of publication.  

SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 

Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 

If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 

This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 

 

Explanation of the aboriginal artwork: 
The aboriginal artwork used symbolises the connection to country and the circle shape shows the strong relationships amongst families and the 
aboriginal culture. The horse shoe shape design shown in front of the generic statement symbolises a woman and those enclosing a smaller horse 
shoe shape depicts a pregnant woman. The smaller horse shoe shape in this instance represents the unborn child. The artwork shown before the 
specific statements within the document symbolises a footprint and demonstrates the need to move forward together in unison. 

 
 
 

 

 

 

 

 

 

 

 

 

 

 

The term Aboriginal  is used to refer to people who identify as Aboriginal, Torres Strait Islanders, or both Aboriginal and Torres Strait 
Islander.  This is done because the people indigenous to South Australia are Aboriginal and we respect that many Aboriginal people prefer the 
term  Aboriginal .  We also acknowledge and respect that many Aboriginal South Australians prefer to be known by their specific language 
group(s). 

  

 Cultural safety enhances clinical safety.  

To secure the best health outcomes, clinicians must provide a culturally safe health care 
experience for Aboriginal children, young people and their families. Aboriginal children 
are born into strong kinship structures where roles and responsibilities are integral and 
woven into the social fabric of Aboriginal societies. 

Australian Aboriginal culture is the oldest living culture in the world, yet Aboriginal 
people currently experience the poorest health outcomes when compared to non-
Aboriginal Australians. 

It remains a national disgrace that Australia has one of the highest youth suicide rates in 
the world.  The over representation of Aboriginal children and young people in out of 
home care and juvenile detention and justice system is intolerable. 

The accumulative effects of forced removal of Aboriginal children, poverty, exposure to 
violence, historical and transgenerational trauma, the ongoing effects of past and present 
systemic racism, culturally unsafe and discriminatory health services are all major 
contributors to the disparities in Aboriginal health outcomes. 

Clinicians can secure positive long term health and wellbeing outcomes by making well 

informed clinical decisions based on cultural considerations    

 



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 2 of 13 

Public-I4-A4 
 
 

Purpose and Scope of PCPG 

The management of Bronchiolitis in Children is primarily aimed at medical staff working in any of 
primary care, local, regional, general or tertiary hospitals. It may however assist the care 
provided by other clinicians such as nurses. The information is current at the time of publication 
and provides a minimum standard for the assessment (including investigations) and 
management bronchiolitis; it does not replace or remove clinical judgement or the professional 
care and duty necessary for each specific case. 

This guideline has been developed to provide evidence based clinical framework for the 
management of infants (0-12 months) with bronchiolitis. Application of these guidelines for 
children over 12 months may be relevant but there is less diagnostic certainty in the 12-24 
month age group.  (All references to age within this guideline refer to chronological age unless 
stated otherwise.) 

 

Table of Contents 
 

Abbreviations ............................................................................................................................. 3 

Definitions .................................................................................................................................. 3 

Introduction ................................................................................................................................ 3 

Management Summary for Bronchiolitis ................................................................................... 4 

Investigations ............................................................................................................................. 6 

Management .............................................................................................................................. 6 

Discharge planning and community-based management ......................................................... 7 

Education (parent/care-giver) .................................................................................................... 7 

Safety initiatives ......................................................................................................................... 7 

Clinical Recommendations ........................................................................................................ 8 

Diagnosis .............................................................................................................................. 8 

Management ......................................................................................................................... 8 

Diagnosis ................................................................................................................................. 11 

Features ................................................................................................................................... 11 

Risk factors for more serious illness ........................................................................................ 11 

References .............................................................................................................................. 12 

Acknowledgements ................................................................................................................. 12 

  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 3 of 13 

Public-I4-A4 
 
 

Important Points 

? Bronchiolitis is a clinical diagnosis. 

? Patients with more than mild disease need to be managed in hospital. 

? The main treatment of bronchiolitis is supportive. This involves ensuring appropriate 
oxygenation and fluid intake. 

? Other investigations or management are usually not indicated. 

Abbreviations  

CPAP continuous positive airway pressure 

EWT early warning tool 

HDU high dependency unit 

HHFNC heated humidified high flow oxygen/air via nasal cannulae 

HFNC high flow oxygen/air via nasal cannulae 

High Flow Administered 1 2 litres per kg per minute  

IV Intravenous 

NG Nasogastric 

NPO2 Nasal Prong Oxygen 

PICU Paediatric Intensive Care Unit 

ED  Emergency department 

O2 Oxygen 

Definitions 

Bronchiolitis A viral infection of the lower respiratory tract. 

Introduction 

? Bronchiolitis it is a common presentation in infants and may occur in young children up to 24 
months. 

? Bronchiolitis results from a viral infection of the lower respiratory tract. 

? Incidence peaks in winter months. 

? It is one of the most common causes for presentation to primary care, emergency 
departments and for admission to hospital. 

  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 4 of 13 

Public-I4-A4 
 
 

Management Summary for Bronchiolitis  

Initial Assessment  

This table is meant to provide guidance in order to stratify severity. 

The more symptoms the infant has in the moderate-severe categories, the more likely they are 
to develop severe disease. 

 
Mild Moderate  Severe 

Behaviour  ? Normal  ? Some/intermittent 
irritability  

? Increasing irritability 
and/or lethargy  

? Fatigue  

Respiratory Rate  ? Normal   mild 
tachypnoea  

? Increased 
respiratory rate  

? Marked increase or 
decrease in 
respiratory rate  

? Respiratory rate may 
slow with exhaustion 
or severe obstruction 

Use of accessory  
muscles  

? Nil to mild chest 
wall retraction  

? Moderate chest 
wall retractions  

? Tracheal tug  

? Nasal flaring  

? Marked chest wall 
retractions  

? Marked tracheal tug  

? Marked nasal flaring  

Auscultation ? Scattered wheeze / 
crepitation 

? Wide spread 
wheeze 
crepitation s 

? Wheeze crepitation 
may decrease with 
reduced air entry 

Oxygen saturation / 
oxygen 
requirement  

? O2 saturations 
greater than 92%  
(in room air)  

? O2 saturations 90 - 
92%  
(in room air)  

? O2 saturations less 
than 90%  (in room 
air)  

? Hypoxemia, may not 
be corrected by O2  

Apnoeic episodes  ? None  ? May have brief 
apnoea  

? May have 
increasingly frequent 
or prolonged apnoea  

Feeding  ? Normal  ? May have difficulty 
with feeding or 
reduced feeding  

? Reluctant or unable 
to feed  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 5 of 13 

Public-I4-A4 
 
 

Initial Management 

The main treatment of bronchiolitis is supportive. This involves ensuring appropriate 
oxygenation and fluid intake. 

 Mild Moderate  Severe 

Likelihood of 
Admission 

? Suitable for discharge  

? Consider risk factors  

? Likely admission, may be 
able to be discharged  

? after a period of observation  

? Management should be 
discussed with a local 
senior physician  

? Requires admission and 
consider need for transfer to 
an appropriate children s 
facility/PICU  

? Threshold for referral is 
determined by local 
escalation policies but 
should be early  

Observations  

 
Vital signs 
(respiratory 
rate, heart rate, 
O2 saturations, 
temperature)  

? Adequate assessment in ED 
prior to discharge (minimum 
of two recorded 
measurements or every four 
hours as per local hospital 
guidelines and EWT)  

? Hourly - dependent on 
condition (as per local 
hospital guidelines and 
EWT)  

? Hourly with continuous 
cardiorespiratory (including 
oximetry) monitoring and 
close nursing observation - 
dependent on condition (as 
per local hospital guidelines 
and EWT)  

Hydration/ 

Nutrition  

? Small frequent feeds  ? If not feeding adequately 
(less than 50% over 12 
hours), administer NG or IV 
hydration  

? If not feeding adequately 
(less than 50% over 12 
hours), or unable to feed, 
administer NG or IV 
hydration  

Oxygen 
saturation/ 
oxygen 
requirement  

? Nil requirement  ? Administer O2 to maintain 
saturations greater than or 
equal to 92%  

? Administer O2 to  

? maintain saturations greater 
than or equal to 92%  

Respiratory  

Support  

? Nasal oxygen 

? Consider HFNC if a trial of 
NPO2 is ineffective  

? Nasal oxygen 

? Consider HFNC or CPAP  

? HFNC or Respiratory 
Support  

Disposition/ 

Escalation  

? Consider further medical 
review if early in the illness 
and any risk factors are 
present or if child develops 
increasing severity after 
discharge  

? Decision to admit should be 
supported by clinical 
assessment, social and 
geographical factors and 
phase of illness  

? Consider escalation if 
severity does not improve.  

? Consider ICU review/ 
admission or transfer to 
local centre with paediatric 
HDU/ICU capacity if:  

- Severity does not improve  

- Persistent desaturations  

- Significant or recurrent 
apnoea s associated with 
desaturations  

Parental  

Education  

? Provide advice on the 
expected course of illness 
and when to return 
(worsening symptoms and 
inability to feed adequately)  

? Provide Parent Information 
Sheet  

? Provide advice on the 
expected course of illness 
and when to return 
(worsening symptoms and 
inability to feed adequately)  

? Provide Parent Information 
Sheet  

? Provide advice on the 
expected course of illness  

? Provide Parent Information 
Sheet  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 6 of 13 

Public-I4-A4 
 
 

Investigations  

In most infants presenting to hospital and/or hospitalised with bronchiolitis, no investigations are 
required.  

Chest x-ray (CXR)  

? Is not routinely indicated in infants presenting with bronchiolitis and may lead to 
unnecessary treatment with antibiotics with subsequent risk of adverse events  

Blood tests (including full blood count (FBC), blood cultures)  

? Have no role in management  

Virological testing (nasopharyngeal swab or aspirate)  

? Has no role in management of individual patients  

Urine microscopy and culture  
? May be considered to identify urinary tract infection if a temperature over 38 degrees in an 

infant less than two months of age with bronchiolitis. 

 
Management  

Respiratory Support  

? Oxygen therapy should be instituted when oxygen saturations are persistently less than 
92%  

? It is appreciated that infants with bronchiolitis will have brief episodes of mild/moderate 
desaturations to levels less than 92%. These brief desaturations are not a reason to 
commence oxygen therapy.  

? Oxygen should be discontinued when oxygen saturations are persistently greater than or 
equal to 92% + patient otherwise stable or improving.  

? Heated humidified high flow oxygen/air via nasal cannulae (HHFNC) can be considered 
in the presence of hypoxia (oxygen saturation less than 92%) and moderate to severe 
recessions. Its use in infants without hypoxia should be limited to the randomised controlled 
trial (RCT) setting only. 

? HFNC is usually administered at a flow rate of 1 2 l./kg/Min with inspired oxygen 
concentration to maintain oxygen saturation &gt; 92%. 

Monitoring  

? Observations as per local hospital guidelines and Early Warning Tools (EWTs). 

? Continuous oximetry should not be routinely used to dictate medical management unless 

disease is severe.  

Hydration/Nutrition  

? When non-oral hydration is required either intravenous (IV) or nasogastric (NG) hydration 
are appropriate.  

? If IV fluid is used it should be isotonic (0.9% Sodium Chloride with Glucose or similar).  

? The ideal volume of IV or NG fluids required to maintain hydration remains unknown; 
between 60% - 100% of maintenance fluid is an appropriate volume to initiate.  

  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 7 of 13 

Public-I4-A4 
 
 

Medication  

? Beta 2 agonists   Do not administer beta 2 agonists (including those with a personal or 
family history of atopy). 

? Corticosteroids   Do not administer systemic or local glucocorticoids (nebulised, oral, 
intramuscular (IM) or IV)  

? Adrenaline   Do not administer adrenaline (nebulised, IM or IV) except in peri-arrest or 
arrest situation.  

? Hypertonic Saline   Do not administer nebulised hypertonic saline  

? Antibiotics   Including Azithromycin are not indicated in bronchiolitis  

? Antivirals   Are not indicated  

Nasal Suction  

? Nasal suction is not routinely recommended. Superficial nasal suction may be considered 

in those with moderate disease to assist feeding  

? Nasal sodium chloride 0.9% drops may be considered at time of feeding  

Chest Physiotherapy  

? Is not indicated  

? May be required for complications such as aspiration or pneumonia. 

Ongoing management  

? HFNC or Nasal CPAP therapy may be considered in the appropriate ward setting  

Discharge planning and community-based management  

? Infants can be discharged when oxygen saturations are greater than or equal to 92%; there 
is no more than mild recession and feeding is adequate  

? Infants younger than 8 weeks of age are at an increased risk of representation  

? Discharge on home oxygen can be considered after a period of observation in selected 
infants as per local policies, if appropriate community short term oxygen therapy is 
available.  

? Follow up and review as per local practice  

Education (parent/care-giver)  

? A Bronchiolitis Parent Information Sheet should be provided  

? Parents should be educated about the illness, the expected progression and when and 
where to seek further medical care  

Safety initiatives  

? Use simple infection control practices such as hand washing  

? Cohorting of infants (based on virological testing) has not been shown to improve 

outcomes; however is not unreasonable when facilities allow for it. 



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 8 of 13 

Public-I4-A4 
 
 

Clinical Recommendations  

Diagnosis   

1. Infants can be diagnosed with bronchiolitis if they have an upper respiratory tract infection 

followed by onset of respiratory distress with fever, and one or more of: cough, 

tachypnoea, retractions and diffuse crackles or wheeze on auscultation.  

(NHMRC: C, GRADE: Weak)  

2. Clinicians should consider as risk factors for more serious illness: gestational age less 

than 37 weeks; chronological age at presentation less than 10 weeks; exposure to 

cigarette smoke; breast feeding for less than two months; failure to thrive; having chronic 

lung disease; having chronic heart and/or chronic neurological conditions; being 

Indigenous ethnicity, and should take these into account when managing infants with 

bronchiolitis.  

(NHMRC: C, GRADE: Conditional)  

3. Routine CXR is not recommended as it does not improve management in infants 

presenting with simple bronchiolitis, and may lead to treatments of no benefit.  

(NHMRC: D, GRADE: Conditional)  

4. There is no role for blood tests in managing infants presenting to hospital and hospitalised 

with bronchiolitis. Routine bacteriological testing of blood and urine is not recommended.  

(NHMRC: D, GRADE: Conditional)  

In infants less than two months of age presenting to hospital or hospitalised with 
bronchiolitis with a temperature over 38 degrees, there is a low risk of urinary tract 
infection (UTI). If clinical uncertainty exists clinicians may consider collecting a urine 
sample for microscopy, culture and sensitivity looking for the concurrent presence of UTI.  

5. In infants with bronchiolitis, routine use of viral testing is not recommended for any 

clinically relevant end-points, including cohorting of bronchiolitis patients.  

(NHMRC: C, GRADE: Conditional)  

 

Management  

6. For infants presenting to hospital or hospitalised with bronchiolitis, there is insufficient 

evidence to recommend the use of a scoring system to predict need for admission or 

hospital length of stay.  

(NHMRC: D, GRADE: Weak)  

7. Oxygen saturations, adequacy of feeding, age (infants younger than eight weeks), and 

lack of social support should be considered at the time of discharge as a risk for 

representation. There is insufficient evidence to recommend absolute discharge criteria 

for infants attending the ED, or hospitalised with bronchiolitis  

(NHMRC: Practice Point, GRADE: Weak)  

8. a) Do not administer beta 2 agonists to infants, less than or equal to 12 months of age,  

      presenting to hospital or hospitalised with bronchiolitis.  

(NHMRC: A, GRADE: Strong)  

b) Do not administer beta 2 agonists to infants, less than or equal to 12 months of age,  
      presenting to hospital or hospitalised with bronchiolitis, with a personal or family  
      history of atopy.  

(NHMRC: D, GRADE: Weak)  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 9 of 13 

Public-I4-A4 
 
 

9. Do not administer adrenaline/epinephrine to infants presenting to hospital or hospitalised 

with bronchiolitis.  

(NHMRC: B, GRADE: Strong)  

10.  Do not administer nebulised hypertonic saline in infants presenting to hospital or  

 hospitalised with bronchiolitis.  

(NHMRC: D, GRADE: Conditional)  

11. a) Do not administer systemic or local glucocorticoids to infants presenting to hospital  

      or hospitalised with bronchiolitis.  

(NHMRC: B, GRADE: Strong)  

b) Do not administer systemic or local glucocorticoids to infants presenting to hospital  
      or hospitalised with bronchiolitis, with a positive response to beta 2 agonists.  

(NHMRC: D, GRADE: Weak)  

c) Do not administer a combination of systemic or local glucocorticoids and  
      adrenaline/epinephrine to infants presenting to hospital or hospitalised with  
      bronchiolitis.  

(NHMRC: D, GRADE: Weak)  

12. a) Consider the use of supplemental oxygen in the treatment of hypoxic (oxygen  

      saturations less than 92%) infants with bronchiolitis.  

(NHMRC: C, GRADE: Conditional)  

b) In uncomplicated bronchiolitis oxygen supplementation should be commenced if the  
      oxygen saturation level is sustained at a level less than 92%. At oxygen saturation  
      levels of 92% or greater, oxygen therapy should be discontinued.  

(NHMRC: C, GRADE: Conditional)  

13. Routine use of continuous pulse oximetry is not required for medical management of non-

hypoxic (saturations greater than or equal to 92%) infants not receiving oxygen, or stable 

infants receiving oxygen.  

(NHMRC: C, GRADE: Conditional)  

14. High Flow Nasal Cannulae Oxygen (HFNC) in bronchiolitis can be considered in the 

inpatient setting on infants with bronchiolitis with hypoxia (oxygen saturations less than 

92%). Its use in children without hypoxia should be limited to the RCT setting only.  

(NHMRC: C, GRADE: Conditional)  

15. Chest physiotherapy is not recommended for routine use in infants with bronchiolitis.  

(NHMRC: B, GRADE: Strong)  

16. a) Nasal suction is not recommended as routine practice in the management of infants 

with bronchiolitis. Superficial nasal suction may be considered in those with moderate 

disease to assist feeding.  

(NHMRC: D, GRADE: Conditional)  

b) Deep nasal suction for the management of bronchiolitis is not recommended.  

(NHMRC: D, GRADE: Conditional)  

17. Routine nasal saline drops are not recommended. Trial of intermittent saline drops may 

be considered at time of feeding.  

(NHMRC: Practice Point, GRADE: Weak)  

18. Nasal CPAP therapy for infants with bronchiolitis may be considered for the management 

of infants.  

(NHMRC: C, GRADE: Conditional)  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 10 of 13 

Public-I4-A4 
 
 

19. After a period of observation, infants at low risk for severe bronchiolitis can be considered 

for discharge on home oxygen as part of an organised  Home Oxygen Program  which 

has clear  Return to Hospital  advice.  

(NHMRC: C, GRADE: Conditional)  

20. a) Do not use antibiotics to treat infants with bronchiolitis.  

(NHMRC: B, GRADE: Conditional)  

b) Do not use azithromycin for treatment of infants admitted to hospital with bronchiolitis.  

(NHMRC: B, GRADE: Conditional)  

c) Do not use azithromycin for treatment of infants admitted to hospital with bronchiolitis 
who are at risk of developing bronchiectasis.  

(NHMRC: C, GRADE: Conditional)  

21. a. Supplemental hydration is recommended for infants who cannot maintain hydration 

orally.  

(NHMRC: Practice Point, GRADE: Weak)  

b) Both NG and IV routes are acceptable means for non-oral hydration in infants admitted 
to hospital with bronchiolitis.  

(NHMRC: B, GRADE: Strong)  

c) There is insufficient evidence to recommend a specific proportion of maintenance fluid. 
There is a risk of fluid overload therefore judicious and vigilant use of hydration fluid is and 
regular clinical review is recommended. Isotonic fluid is recommended.  

(NHMRC: Practice Point, GRADE: Weak)  

22. Hand hygiene is the most effective intervention to reduce hospital acquired infections and 

is recommended. There is inadequate evidence for benefits in cohorting infants with 

bronchiolitis.  

(NHMRC: D, GRADE: Weak)  

 

  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 11 of 13 

Public-I4-A4 
 
 

Diagnosis 

Viral bronchiolitis is a clinical diagnosis, based on typical history and examination. Peak 
severity is usually at around day two to three of the illness with resolution over 7-10 days. The 
cough may persist for weeks. Bronchiolitis most commonly occurs in the winter months, but can 
be seen all year round. 

Features 

Bronchiolitis typically begins with an acute upper respiratory tract infection followed by onset of 
respiratory distress and fever and one or more of: 

? Cough 

? Tachypnoea 

? Retractions 

? Widespread crackles or wheeze 

Bronchiolitis is usually self-limiting, often requiring no treatment or interventions. 

Risk factors for more serious illness 

? Gestational age less than 37 weeks 

? Chronological age at presentation less than 10 weeks 

? Postnatal exposure to cigarette smoke 

? Breast fed for less than two months 

? Failure to thrive 

? Chronic lung disease 

? Congenital heart disease 

? Chronic neurological conditions 

? Indigenous ethnicity 

Infants with any of these risk factors are more likely to deteriorate rapidly and require escalation 
of care. Consider hospital admission even if presenting early in illness with mild symptoms. 

 

  



Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 12 of 13 

Public-I4-A4 
 
 

References 

This guideline is an adaptation of the Australasian Bronchiolitis Guideline developed by the 
Paediatric Research in Emergency Departments International Collaborative (PREDICT) 
research network.  

? Australasian Bronchiolitis Guideline (short version), Paediatric Research in Emergency 
Departments International Collaborative (PREDICT),   [Internet].  Parkville Victoria 3052: 
Murdoch Children s Research Institute West; 2016 [cited 2017 10 Oct]. Available from: 
http://www.predict.org.au/publications/2016-pubs/. 

The following article was found to be relevant: 

? Florin T. A., Plint A. C., Zorc J. J. (2017). Viral bronchiolitis. Lancet 389, 10065, 211 224. 
DOI: 10.1016/S0140-6736(16)30951-5. 

Acknowledgements 

The South Australian Child and Adolescent Health Community of Practice gratefully 
acknowledge the contribution of clinicians and other stakeholders who participated throughout 
the development process of the Australasian Bronchiolitis Guideline particularly the Paediatric 
Research in Emergency Departments International Collaborative (PREDICT) Guideline Advisory 
Group and Multidisciplinary Guideline Development Committee.  

 
Other major contributors 

Dr David Thomas 
 
 

SAPCPG Reference Group Members 

Dr Gavin Wheaton 

Dr Malcolm Higgins 

Dr Brett Ritchie 

Dr Brian Coppin 

Dr Noha Soliman 

Dr David Thomas 

Dr Keiko Morioka 

Dr Gillian Watterson  

Dr Shirley Sthavan 

Carol La Vanda 

Carey Aylmer 

Rachael Sobczak 

Jayne Wilkie 

Susan Cameron 
  




Bronchiolitis in Children 
 

 

INFORMAL COPY WHEN PRINTED  Page 13 of 13 

Public-I4-A4 
 
 

Document Ownership &amp; History 

 

Developed by: SA Child &amp; Adolescent Health Community of Practice 
Contact: Health.PaediatricClinicalGuidelines@sa.gov.au 
Endorsed by: SA Safety and Quality Strategic Governance Committee 
Next review due:  05/07/2023   
ISBN number:  978-1-74243-898-6 
PDS reference:  CG091  
Policy history: Is this a new policy (V1)?  N 
 Does this policy amend or update and existing policy?   Y 
 If so, which version? V1 
 Does this policy replace another policy with a different title?  N 
 If so, which policy (title)?  
 
 
 

Approval 

Date 
Version 

Who approved 

New/Revised Version 
Reason for Change 

05/07/18 V2 

SA Health Safety &amp; Quality 

Strategic Governance 

Committee 

Reviewed in line with scheduled review 

period.  This version is an adaptation of the 

Australasian Bronchiolitis Guideline by 

PREDICT (31 August  2016) 

01/07/13 V1 

SA Health Safety &amp; Quality 

Strategic Governance 

Committee 

Original 

 



</pre>
</body>
</html>