Bronchiolitis: Recognise and Assess
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Published: 28 May 2016
Broncholitiotis is a viral lower respiratory tract infection common in children, generally affecting infants under 12 months of age (PCH 2020).
The infection causes inflammation and mucus build-up in the bronchioles (small airways) in the lungs (Mayo Clinic 2020).
The most common cause of bronchiolitis is respiratory syncytial virus (RSV), which affects almost every child at least once before the age of 2 (SA DoH 2020).
Other viruses such as parainfluenza and adenovirus are also possible causes of bronchiolitis (VIC DoH 2015).
Broncholitiotis is a leading cause of hospitalisation among infants, however, most cases can be managed at home (PCH 2020).
Symptoms of Broncholitiotis
Children presenting with bronchiolitis may have a fever. They often have a cough and sometimes an audible wheeze or ‘crackles’ upon auscultation of the chest. Signs of respiratory distress or work of breathing such as tracheal tug, nasal flaring, recession and head bobbing are usually present (RCHM 2018; PCH 2020).
Vital signs will show tachypnoea, tachycardia and on occasion, hypoxia (RCHSD 2014). Due to the thick secretions associated with bronchiolitis, babies may have difficulty feeding. Secretions block the nares, making breast and bottle feeding difficult. Babies may struggle to breathe and feed at the same time and can tire quickly (PCH 2020).
The natural course of the illness lasts for seven to ten days, with symptoms worsening on days two and three (Healthdirect 2018). The duration of illness is important when assessing the severity and the potential for children to become sicker. If you have a sick-looking baby on day one or two, then it is likely that they will worsen over the course of the following days.
Assessing the Severity of Broncholitiotis
The following guidelines, developed by PREDICT (2016), can aid clinicians in severity assessment:
| Mild | Moderate | Severe | |
|---|---|---|---|
| Behaviour | Normal | Some/ intermittent irritability | Increasing irritability and/ or lethargy/ fatigue |
| Respiratory Rate | Normal | Increased respiratory rate | Marked increase or decrease |
| Accessory Muscle Use | None or minimal | Moderate chest wall retraction
|
Marked chest wall retraction
|
| Feeding | Normal | May have difficulty with feeding or reduced feeding | Reluctant or unable to feed |
| Oxygen | No oxygen requirement (Sa02 > 93%) |
Mild hypoxemia corrected by oxygen (Sa02 90-93%) |
Hypoxemia, may not be corrected by oxygen (Sa02<90%) |
| Apnoeic Episodes | None | May have brief apnoeas | May have increasingly frequent or prolonged apnoeas |
(PREDICT 2016)
Treatment
Bronchiolitis is caused by a virus and therefore does not respond to antibiotics. Treatment is generally supportive, with oxygenation and intravenous fluids administered as required (RCHM 2018). Minimal handling in a calm, quiet environment has been a long-recommended strategy. The more the child becomes distressed, the more they experience respiratory problems.
Normal saline drops to the nares may help to loosen secretions to allow feeding. Nasal suctioning may be required in some cases but is not routinely recommended. Babies who have severe difficulty feeding may require nasogastric (NG) feeding. Frequent small feeds are often preferred over large feeds (either oral or NG) as a distended abdomen can also put pressure on immature lungs and increase respiratory distress (RCHM 2018).
Conclusion
Bronchiolitis is one of the leading causes of hospitalisation of children under twelve months of age. Knowing how to recognise the severity of the infection and manage its symptoms will help nurses to provide the best patient care, particularly in winter months when the illness is most prevalent.
Additional Resources
- PREDICT, Australasian Bronchiolitis Bedside Clinical Guideline
- RCHM, Bronchiolitis Clinical Practice Guidelines
- Common Respiratory Tract Infections (RTI)
- Paediatric Respiratory Assessment
References
- Healthdirect 2018, Bronchiolitis, Healthdirect, viewed 28 August 2020, https://www.healthdirect.gov.au/bronchiolitis
- Mayo Clinic 2020, Bronchiolitis, Mayo Clinic, viewed 28 August 2020, https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565
- Perth Children’s Hospital 2020, Bronchiolitis, Western Australia State Government, viewed 28 August 2020, https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Bronchiolitis
- Paediatric Research in Emergency Departments International Collaborative 2016, Australasian Bronchiolitis Bedside Clinical Guideline, PREDICT, viewed 28 August 2020, https://www.predict.org.au/download/Australasian-bronchiolitis-bedside-clinical-guideline.pdf
- Rady Children's Hospital San Diego 2014, Bronchiolitis, RCHSD, viewed 28 August 2020, https://www.rchsd.org/documents/2014/02/bronchiolitis.pdf/
- Royal Children’s Hospital Melbourne 2018, Bronchiolitis, RCHM, viewed 28 August 2020, https://www.rch.org.au/kidsinfo/fact_sheets/Bronchiolitis/#:~:text=Bronchiolitis%20is%20a%20common%20chest,up%20to%2012%20months%20old.
- South Australia Department of Health 2020, Respiratory Syncytial Virus (RSV), SA DoH, viewed 28 August 2020, https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/respiratory+syncytial+virus+rsv+infection
- Victoria Department of Health 2015, Croup or Bronchiolitis, VIC DoH, viewed 28 August 2020, https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/croup-bronchiolitis
