Introduction听
Aim听
Definition of Terms
Assessment
Management听
Special Considerations
Companion Documents
Evidence Table
Introduction
Bronchiolitis is an acute viral infection of the lower respiratory tract (LRTI). It听generally affects听children less than 12 months of听age,听and it is the most frequent cause of hospitalisation in infants under 6 months of age. There is a higher risk of severe bronchiolitis if the child is less than 6 weeks of age.听Viruses that enter and infect the respiratory tract cause viral bronchiolitis. Most cases of viral bronchiolitis are due to respiratory syncytial virus (RSV) however other causal听agents include听Rhinovirus/Adenovirus,听Human metapneumovirus听(hMPV),听Influenza听and听Parainfluenza. Viral outbreaks occur seasonally. 听
Symptoms align with听an upper respiratory tract infection (URTI) and听are characterised听by cough, tachypnoea, poor feeding, wheeze, crackles, apnoea, mucous听production听and inflammation causing obstruction at the level of the bronchioles.听The illness听typically reaches听peak severity around days听2-3听with听a resolution of the wheeze and respiratory distress over 7听鈥撎10 days. The cough may continue for up to 4 weeks. 听
Bronchiolitis听is听usually听a听self-limiting听condition,听however,听can be life threatening in infants who have been premature听and/or have underlying respiratory, cardiac,听neuromuscular听or听immunological conditions. 听
Aim
To outline hospital management of infants with bronchiolitis admitted to the ward. Children who require additional support may be managed in the Paediatric Intensive Care Unit (PICU) or Neonatal Intensive Care Unit (NICU).
Initial Assessment
Refer to Clinical Guidelines (Nursing) : Nursing assessment
History
Primary Assessment
Primary assessments should be completed at the start of every shift and then as clinically听indicated听or if the patient's condition changes. This assessment is documented in flowsheets, further assessments, or changes to be documented in the progress notes. Clinical judgment should be used to decide on the extent of assessment听required.听Refer听to听Nursing Guideline: Nursing Assessment听
| 听 | 听Assessment Conditions听听 |
| 听Airway听听 | Patent, partially obstructed or obstructed 听 Secretions, cough 听 |
| 听Breathing听 | Respiratory Rate, Regularity 听 Breathing Effort 听 Respiratory Effort (Nil, Mild, Moderate or Severe)听 Breath Sounds (Clear, absent, decreased, crackles, wheeze, bilateral air听entry听and movement)听听 |
| 听Circulation听听 | Skin Temperature (warm, cool, cold, hot, diaphoretic) 听 Skin Colour (normal, pink, pale, dusky, mottled, cyanotic)听 Central Capillary Refill (Quick Return, slow return, tenting) 听 Pulses Palpated听 |
| Disability听听听 | Level Of Consciousness (AVPU score) 听 Level of Sedation Score (UMSS)听 |
Infection Control听
Investigations听
In most presentations, investigations are not听required.听Guidance for the use of Chest听X-ray听and Laboratory including virology 鈥 refer to听Bronchiolitis CPG听
Acute Management
Nursing care for infants with bronchiolitis is听largely supportive听and includes airway clearance, maintenance of oxygenation and hydration. 听
Minimal handling and clustering of cares is recommended to avoid exhaustion as infants with bronchiolitis are听generally intolerant听of interventions. Refer to听Nursing guidelines : Ward management of a neonate听
听
| Mild听听
| Moderate听听
| Severe听听
|
|---|
Behaviour 听 | Normal 听
| Irritability 听 Reduced Activity 听
| Increased Irritability 听 Lethargy 听 |
Colour 听 | Normal听 | Pallor 听 | Cyanosis听 |
Respiratory听Rate 听听 | Normal 听 | Increased 听 | Increased 听 |
Increased work of Breathing听*听 | Normal 听 Mild 听 | Moderate 听 | Severe 听 |
Heart Rate 听 | Normal听 Slightly听increased听 | Mildly Increased 听 | Significant听Increased or听Bradycardia 听 |
Apnoeic 听 | None 听 | Brief Apnoea听 | Increasing frequent or prolonged apnoea听 |
Blood Pressure 听 | Normal 听 | Increased 听 | Increased 听 Hypotensive听
|
Feeding 听 | Normal听 | Difficulty feeding 听 reduced feeding 听 | Unable to feed 听 |
Signs of increased work of breathing include: 听
- Use of accessory muscles and/or retractions e.g. subcostal, intercostal, suprasternal, costal margins
- Nasal flaring, head bobbing, forward posturing听
- Grunting 听
Auscultate chest for breath sounds and air entry once a shift and document findings in Focused Assessment听
If any staff member or parent is concerned about the patient deteriorating, escalate to the medical team or notify the听Medical Emergency Team (MET) urgently by dialling 22 22听(state MET, building, level, ward,听room听and specialty).听听
听
Monitoring
Regular measurements and documentation of primary assessment and physiological observations are requirements for patient monitoring and the recognition of deteriorations. Each set of observations must be recorded in the EMR flowsheets and then trends should be viewed on the VICTOR graph. 听
Perform observations hourly for Moderate and Continuous for Severely unwell.听
For further guidance refer to -听Nursing guidelines : Observation and continuous monitoring听
As per 2025 Australasian Bronchiolitis Guidelines, continuous pulse oximetry monitoring is not usually recommended for non-hypoxic infants. 听
*听These recommendations serve as a general guide and should not be used as a substitute for clinical judgement听
Ongoing Management听
Low Flow听Oxygen Therapy听
Titrate and wean oxygen as per CPG听-听Clinical Practice Guidelines : Bronchiolitis听
Please note:听For infants with cardiopulmonary disease,听commence听supplemental oxygen in line with specific SpO2 targets as set by the medical team听
Low Flow oxygen therapy failure can be听determined听by lack of improvement in respiratory rate, heart rate by signs of worsening respiratory distress.
High Flow Oxygen Therapy听(HFNP)听
Flow Rate听for HFNP Therapy 听
Weight听听
| Flow听听
|
鈮ぬ12 kg听听
| 2L/Kg/minute听听
|
> 12 kg听听
| 2 L/kg/minute for the first 12kg + 0.5L/kg/minute for each kg thereafter (maximum flow 50L/min)听
|
Refer to HFNP guideline for weaning flow and offering oral feeds听听Nursing guidelines : High flow nasal prong (HFNP) therapy.听
If听the infant does not听exhibit听signs of clinical听stabilization听within 4 hours of the commencement of听HFNP听discuss with bed card team the need for PICU involvement.
Humidification 听
Humidification of oxygen should be considered where possible to prevent mucous obstruction, mucosa dryness,听ulceration听and bronchospasms. Refer to听Nursing guidelines : Oxygen delivery.听听
Medication听
Nasal听Aspiration听
Nutrition/Hydration听
Oral Feeding 听
Breastfeeding Support 听
Indications for Nasogastric Feeding 听听
If increased coughing, respiratory distress, apnoeic episodes, visible tiring during oral feeds and/or not tolerating oral feeds >50% of normal intake, or hyponatremic contact medical team to discuss NG feeds. 听
Indications for Intravenous Fluids 听
Comfort Feeding听
Infants may not be capable of tolerating听large amounts听of oral feeds. 鈥楥omfort feeds refer to small feeds, often 10-30ml听or听a听breastfeed less than 5 minutes听for children听whilst the infant is also听receiving intravenous听(IV) therapy, which can settle their hunger. These听feeds should听be given with extreme caution and under strict supervision. 听
Fluids balance monitoring 听
Family Centred Care听
Breastfeeding: 听
- Nursing听guidelines :听Breastfeeding support and promotion听
- Mothers who experience a temporary drop in milk supply should be referred to a听Maternal听Child听Health听Nurse for听appropriate lactation听support.听Consider environmental factors such as lowering lighting and reducing noise level.听
Discharge Planning and Criteria Led Discharge (CLD) 听
Companion Documents听
Evidence table
Evidence Table for this guideline can be viewed here.听听
Please remember to read the .
听
The development of this nursing guideline was coordinated by听Natalie Fung, CNS, Sugar Glider and approved by the Nursing Clinical Effectiveness Committee. Updated March 2026.听听
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