New QS on bronchiolitis in children

NICE has published a new quality standard today on bronchiolitis in children.

Assessment and diagnosis

The document explains that bronchiolitis symptoms are usually those of a common cold, including a blocked or stuffy nose, cough and sneezing. After several days, breathing and feeding difficulties develop. Until this point, it is not possible to tell that the infection will cause bronchiolitis. If there are wheeze and/or crackles heard on clinical examination, a diagnosis of bronchiolitis can be made.

Bronchiolitis symptoms are usually mild and may only last for a few days, but in some cases the disease can cause severe illness. Approximately 1 in 3 infants will develop clinical bronchiolitis in the first year of life, and 2–3% of these will need hospitalisation.

Quality statements

Three quality statements in this document relevant to primary care are:

• Bronchiolitis is caused by a viral infection so antibiotics should not be used as treatment. The number of children who have bronchiolitis and who then develop a bacterial infection is extremely low.  

• Parents and carers of children with bronchiolitis should be informed that medication is not being used because the condition is usually self-limiting. Helping parents or carers to understand this can increase their confidence in caring for their child at home if hospital admission is not needed.

• Parents and carers of children with bronchiolitis should be given key safety information about what to expect and when to be concerned if caring for the child at home. Children may deteriorate rapidly, so it is vital that parents or carers can identify the signs and symptoms that mean they need to seek appropriate help from a healthcare professional.

Dr Gruffydd Jones, GP Principal and Joint Policy Lead PCRS-UK, says:  “These Quality Standards emphasise that antibiotics are not needed for the treatment of bronchiolitis and that parents should be educated about this. Clinicians should however also consider the circumstances in which more immediate treatment including antibiotics might be necessary. These include:  fever> 38 deg, localised crackles (suggesting pneumonia) tachypnoea and low oxygen saturations (<94% in air).”

The Quality Standard can be downloaded 

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