Last updated March 14, 2022

The Diagnosis, Management, and Prevention of Bronchiolitis

Recommendations

Diagnosis

Clinicians should diagnose bronchiolitis and assess disease severity on the basis of history and physical examination. (BStrong)
328602
Clinicians should assess risk factors for severe disease, such as age less than 12 weeks, a history of prematurity, underlying cardiopulmonary disease, or immunodeficiency, when making decisions about evaluation and management of children with bronchiolitis. (BModerate)
328602
When clinicians diagnose bronchiolitis on the basis of history and physical examination, radiographic or laboratory studies should not be obtained routinely. (BModerate)
328602

Treatment

Clinicians should not administer albuterol (or salbutamol) to infants and children with a diagnosis of bronchiolitis. (BStrong)
328602
Clinicians should not administer epinephrine to infants and children with a diagnosis of bronchiolitis. (BStrong)
328602
Nebulized hypertonic saline should not be administered to infants with a diagnosis of bronchiolitis in the emergency department. (BModerate)
328602
Clinicians may administer nebulized hypertonic saline to infants and children hospitalized for bronchiolitis. (BWeak)
328602
Clinicians should not administer systemic corticosteroids to infants with a diagnosis of bronchiolitis in any setting. (AStrong)
328602
Clinicians may choose not to administer supplemental oxygen if the oxyhemoglobin saturation exceeds 90% in infants and children with a diagnosis of bronchiolitis. (DWeak)
328602
Clinicians may choose not to use continuous pulse oximetry for infants and children with a diagnosis of bronchiolitis. (DWeak)
328602
Clinicians should not use chest physiotherapy for infants and children with a diagnosis of bronchiolitis. (BModerate)
328602
Clinicians should not administer antibacterial medications to infants and children with a diagnosis of bronchiolitis unless there is a concomitant bacterial infection, or a strong suspicion of one. (BStrong)
328602
Clinicians should administer nasogastric or intravenous fluids for infants with a diagnosis of bronchiolitis who cannot maintain hydration orally. (XStrong)
328602

Prevention

Clinicians should not administer palivizumab to otherwise healthy infants with a gestational age of 29 weeks, 0 days or greater. (BStrong)
328602
Clinicians should administer palivizumab during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity defined as preterm infants <32 weeks 0 days’ gestation who require >21% oxygen for at least the first 28 days of life. (B, Moderate)
328602
Clinicians should administer a maximum 5 monthly doses (15 mg/kg/dose) of palivizumab during the respiratory syncytial virus season to infants who qualify for palivizumab in the first year of life. (BModerate)
328602
All people should disinfect hands before and after direct contact with patients, after contact with inanimate objects in the direct vicinity of the patient, and after removing gloves. (BStrong)
328602
All people should use alcohol-based rubs for hand decontamination when caring for children with bronchiolitis. When alcohol-based rubs are not available, individuals should wash their hands with soap and water. (BStrong)
328602
Clinicians should inquire about the exposure of the infant or child to tobacco smoke when assessing infants and children for bronchiolitis. (CModerate)
328602
Clinicians should counsel caregivers about exposing the infant or child to environmental tobacco smoke and smoking cessation when assessing a child for bronchiolitis. (BStrong)
328602
Clinicians should encourage exclusive breastfeeding for at least 6 months to decrease the morbidity of respiratory infections. (BModerate)
328602
Clinicians and nurses should educate personnel and family members on evidence-based diagnosis, treatment, and prevention in bronchiolitis. (CModerate)
328602

Recommendation Grading

Overview

Title

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Authoring Organization

Publication Month/Year

November 1, 2014

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Infant

Health Care Settings

Ambulatory, Emergency care, Home health, Hospital, Outpatient

Scope

Assessment and screening, Diagnosis, Management, Treatment

Keywords

bronchiolitis, infant, child

Source Citation

Shawn L. Raston, et. al. Clinical Practice Guidelines: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014 (134(5); e1474-e1502.