Last reviewed: 24 Oct 2020
Last updated: 03 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough
  • tachypnoea
  • wheezing
  • retractions, grunting, and nasal flaring

Other diagnostic factors

  • rhinitis
  • fluctuating clinical findings
  • irritability, malaise and poor feeding 
  • fever <40°C (<104°F)
  • crackles
  • apnoea
  • thoracoabdominal asynchrony

Risk factors

  • infants <3 years
  • winter months
  • prematurity or bronchopulmonary dysplasia
  • passive tobacco smoke exposure
  • impaired airway clearance and function
  • congenital heart disease
  • immunodeficiency

Diagnostic investigations

Investigations to consider

  • enzyme-linked immunosorbent assay (ELISA) rapid antigen detection
  • chest x-ray
  • reverse transcriptase polymerase chain reaction (RT-PCR)
More investigations to consider

Emerging tests

  • infant pulmonary function tests
More emerging tests

Treatment algorithm

Contributors

Professor

Division of Pulmonary Medicine

Children's Hospital of Philadelphia

Philadelphia

PA

Disclosures

HP is a consultant for the development of a portable ventilator by Philips Respironics. He is a member of the American Thoracic Society's Guideline Committee, Long-Term Oxygen Therapy for Infants and Children, and Chair of the American College of Chest Physicians' Home Based Mechanical Ventilation and Neuromuscular Disease NetWork, a member of the ATS guideline committee on bronchopulmonary dysplasia (BPD), and current new guideline committee updating the BPD Statement. He is a member of the planning committee of the Pediatric Assembly of the American Thoracic Society, and receives royalties from Up-To-Date for the review of two topics.

Professor Panitch would like to gratefully acknowledge Dr Isaac Desheng Liu, Dr Woon Li Seo, Dr Jennifer L. Nayak, Dr Caroline B. Hall, and Dr Clement L. Ren, previous contributors to this topic. IDL, WLS, JLN, and CLR declare that they have no competing interests. CBH is an author of a number of references cited in this topic.

Peer reviewersVIEW ALL

Professor of Pediatrics

Women and Children's Hospital

Buffalo

NY

Disclosures

RW declares that he has no competing interests.

Wyeth Research Scholar Professor and Chair

Department of Pediatrics

WVU School of Medicine

Physician-in-Chief

WVU Children's Hospital

Morgantown

WV

Disclosures

GP declares that he has no competing interests.

Professor of Pediatrics

Infectious Disease

Department of Pediatrics

Tufts-New England Medical Center

Boston

MA

Disclosures

HCM is an author of a number of references cited in this topic.

Professor of Paediatric Respiratory Medicine

University of Bristol

Bristol

UK

Disclosures

JH declares that he has no competing interests.

Use of this content is subject to our disclaimer