Bronchiolitis: Recognise and Assess

CPD
2m

Published: 29 May 2016

This article is intended to be read in conjunction with Paediatric Respiratory Assessment


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).

mother with sick infant

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
  • Tracheal tug
  • Nasal flaring
Marked chest wall retraction
  • Marked tracheal tug
  • Marked nasal flaring
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


References

Author

Portrait of Abbie Blog
Abbie Blog

Abbie is a Nurse Practitioner currently working in a Specialist Allergy Clinic in Brisbane. She has been a paediatric nurse for over 20 years originally working in the UK before moving to Australia with her young family 8 years ago. Abbie has a diverse career working with some of the most vulnerable patients. She has worked in paediatric oncology , emergency and general paediatrics. She has worked for NGO's in the fields of child protection and parental support as well as currently working with re- settled refugees. Abbie is a passionate nursing advocate and has just started the new challenge of blogging. See Educator Profile

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