Summary
Definition
History and exam
Key diagnostic factors
- cough
- tachypnea
- wheezing
- retractions, grunting, and nasal flaring
Other diagnostic factors
- rhinitis
- fluctuating clinical findings
- irritability, malaise, and poor feeding
- fever <104°F (<40°C)
- crackles
- apnea
- thoracoabdominal asynchrony
Risk factors
- children <2 years
- winter months
- prematurity or bronchopulmonary dysplasia
- passive tobacco smoke exposure and air pollution
- impaired airway clearance and function
- congenital heart disease
- immunodeficiency
Diagnostic tests
1st tests to order
- pulse oximetry
Tests to avoid
- broad respiratory pathogen panels
Tests to consider
- enzyme-linked immunosorbent assay (ELISA) rapid antigen detection
- chest x-ray
- reverse transcriptase polymerase chain reaction (RT-PCR)
Treatment algorithm
confirmed bronchiolitis
Contributors
Authors
Howard B. Panitch, MD
Emeritus Professor
Division of Pulmonary and Sleep Medicine
Children's Hospital of Philadelphia
Philadelphia
PA
Disclosures
HBP is a member of the American Thoracic Society's Guideline Committee, Long-Term Oxygen Therapy for Infants and Children, past 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 a member of the 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 (Spirometry in Children and Bronchopulmonary Dysplasia).
Acknowledgements
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.
Disclosures
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 reviewers
Michael D. Patrick, Jr. MD
Associate Professor of Pediatrics
The Ohio State University College of Medicine
Columbus
OH
Disclosures
MDP declares that he has no competing interests.
References
Key articles
American Academy of Pediatrics Publications. AAP recommendations for the prevention of RSV disease in infants and children. Jul 2025 [internet publication].Full text
Canadian Paediatric Society. Bronchiolitis: recommendations for diagnosis, monitoring and management of children one to 24 months of age. Nov 2021 [internet publication].Full text
Cunningham S, Rodriguez A, Adams T, et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet. 2015 Sep 12;386(9998):1041-8.Full text Abstract
Lin J, Zhang Y, Xiong L, et al. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child. 2019 Jun;104(6):564-76. Abstract
Farley R, Spurling GK, Eriksson L, et al. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014 Oct 9;(10):CD005189.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Bacterial pneumonia
- Chlamydial pneumonia
- Cystic fibrosis (CF)
More DifferentialsGuidelines
- Australasian bronchiolitis guideline
- 2022 Italian guidelines on the management of bronchiolitis in infants
More GuidelinesPatient information
Bronchiolitis
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