Suspected Bronchiolitis
Infant 1-23 months with viral respiratory illness
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Pediatric Bronchiolitis (AAP 2014)
Pediatric Bronchiolitis (AAP 2014): Suspected Bronchiolitis → Clinical Diagnosis → Assess Severity → Supportive Care (All Patients) → Mild - Discharge H...
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Action Clinical Diagnosis
Bronchiolitis is a clinical diagnosis
- History and physical exam based diagnosis
- First episode of wheezing in infant <24 months
- Viral prodrome (rhinorrhea, cough, low-grade fever)
- DO NOT ROUTINELY:
- • Order chest X-ray (unless pneumonia suspected)
- • Perform viral testing (unless needed for cohorting)
- • Order blood tests
03Action Assess Severity
Clinical assessment of respiratory status
- MILD:
- • SpO2 ≥90%, minimal work of breathing
- • Adequate oral intake
- MODERATE:
- • SpO2 90-92%, moderate retractions
- • Decreased oral intake
- SEVERE:
- • SpO2 <90%, severe retractions
- • Lethargy, apnea, poor perfusion
- • Unable to feed
04Action Supportive Care (All Patients)
Mainstay of treatment
- NASAL SUCTIONING:
- • Bulb suction or nasopharyngeal suction
- • Before feeds and as needed
- HYDRATION:
- • Continue breastfeeding/formula if possible
- • Small frequent feeds
- • NG or IV fluids if unable to feed safely
- OXYGEN: If SpO2 persistently <90%
- Monitor for apnea in high-risk infants
05Outcome Mild - Discharge Home
Safe for outpatient management
- Adequate hydration maintained
- No hypoxia
- Reliable parents with return precautions
- Return if:
- • Breathing gets worse
- • Unable to feed
- • Appears more tired or lethargic
- • Color changes (blue lips)
06Action Moderate-Severe - Admit
Hospital admission criteria
- ADMIT IF:
- • SpO2 <90% on room air
- • Unable to maintain hydration orally
- • Respiratory distress with accessory muscle use
- • Age <12 weeks with RSV
- • History of prematurity (<35 weeks)
- • Underlying cardiopulmonary disease
- • Immunodeficiency
- • Apnea
07Action Inpatient Management
Hospital care
- Continuous pulse oximetry initially
- Nasal suctioning as needed
- IV or NG fluids if not feeding
- HIGH-FLOW NASAL CANNULA:
- • May use for moderate-severe
- • Not standard of care
- Wean O2 once improving
- Target SpO2 ≥90% (can discharge at this)
08Warning ICU Admission
Escalating support needed
- Respiratory failure
- Apnea requiring intervention
- Inability to maintain SpO2 ≥90%
- Impending respiratory failure
- Consider:
- • CPAP/BiPAP
- • Intubation if failing non-invasive support
- • Surfactant (off-label, limited evidence)
09Warning NOT Recommended Routinely
Do NOT give these treatments
- ❌ Bronchodilators (albuterol/salbutamol)
- ❌ Epinephrine (nebulized)
- ❌ Systemic corticosteroids
- ❌ Antibiotics (unless bacterial infection)
- ❌ Hypertonic saline (in ED setting)
- ❌ Chest physiotherapy
- These do NOT improve outcomes and may cause harm
Guideline Source
AAP Clinical Practice Guideline: Diagnosis, Management, and Prevention of Bronchiolitis 2014
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Ages 1-23 months
- Does not address RSV prophylaxis
- Not for recurrent wheezing
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Pediatric Bronchiolitis (AAP 2014)?
The Pediatric Bronchiolitis (AAP 2014) is a management clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on AAP Clinical Practice Guideline: Diagnosis, Management, and Prevention of Bronchiolitis 2014.
What guideline is the Pediatric Bronchiolitis (AAP 2014) based on?
This algorithm is based on AAP Clinical Practice Guideline: Diagnosis, Management, and Prevention of Bronchiolitis 2014 (DOI: 10.1542/peds.2014-2742).
What are the limitations of the Pediatric Bronchiolitis (AAP 2014)?
Known limitations include: Ages 1-23 months; Does not address RSV prophylaxis; Not for recurrent wheezing. Individual patient factors may require deviation from these recommendations.
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