Patient handout

Pediatric bronchiolitis

PRODUCTION

1. Your condition

This handout is for pediatric bronchiolitis. Your care team identified this based on: first wheezing episode in infant <2 yr after uri prodrome (aap 2014 ralston).

Other reasons your team may use this plan: increased work of breathing in infant — retractions, nasal flaring (aap 2014 ralston; nice 2021); apneic episode in infant with uri (aap 2014 ralston); poor feeding / dehydration during uri in infant (aap 2014 ralston; nice 2021).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
oxygen titrated to SpO2 ≥90%	NC 0.5-2 L/min titrated	inhaled	continuous	AAP 2014; HFNC for moderate-severe
normal saline maintenance fluids OR NG feeds	Holliday-Segar maintenance per kg	IV/NG	continuous	AAP 2014 supportive — IV vs NG per local practice; NG safe per Oakley 2013
albuterol	2.5 mg neb (0.15 mg/kg, min 2.5 mg, max 5 mg)	inhaled	one-time trial only — continue ONLY if clear improvement	AAP 2014: do NOT routinely; only continue if documented improvement on trial; otherwise stop
epinephrine	0.5 mg neb (1:1000)	inhaled	single trial	Limited evidence; not standard; AAP 2014 against routine use
dexamethasone	0.6 mg/kg PO/IV (max 16 mg) — NOT routine	PO/IV	NOT routine for bronchiolitis	AAP 2014 recommends against routine dexamethasone — Cochrane no benefit
hypertonic saline 3% nebulised	4 mL nebulised	inhaled	q6-8 h	AAP 2014 weak recommendation in admitted only; recent meta-analyses mixed
palivizumab	15 mg/kg IM monthly Nov-Apr (5 doses)	IM	monthly during RSV season	AAP 2014 — narrow eligibility; nirsevimab supersedes for many cohorts
nirsevimab	50-100 mg IM (per weight band)	IM	single dose per RSV season	Hammitt MELODY NEJM 2022 + ACIP 2023 — universal infant prophylaxis

Plan: Supportive care (AAP 2014 Ralston) — most clinical work is non-pharmacologic

3. When to call your provider

Contact your care team if any of the following happen:

Phone-check or clinic-visit reveals worsening WOB → return to ED (AAP 2014 Ralston; NICE 2021)
Phone-check or clinic-visit reveals poor feeding / dehydration → return to ED (AAP 2014 Ralston)
New apnea event reported by caregiver → return to ED + cardiorespiratory monitoring evaluation (AAP 2014 Ralston)
New fever + age < 60 d → return to ED for febrile-infant workup (AAP 2014 Ralston; AAP 2021 Pantell)
Recurrent wheeze ≥ 3 episodes → refer to pulm.asthma.peds.v1 sibling engine (AAP 2014 Ralston)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Apneic episode during bronchiolitis in young infant (AAP 2014 Ralston)
Severe retractions / nasal flaring / grunting / oxygen level (SpO₂) <90% on RA (AAP 2014 Ralston; NICE 2021)
Fever + bronchiolitis in infant <60 d (AAP 2014 Ralston)
Ex-preemie (<29 wks GA OR chronic lung disease of prematurity) with bronchiolitis (AAP 2014 Ralston)
Hemodynamically significant CHD with bronchiolitis (AAP 2014 Ralston)
Apneic episode in young infant — age < 6 wk term OR preterm < 32 wk (ex-preemie / BPD) with apnea during bronchiolitis (AAP 2014 Ralston; Schroeder JAMA Peds 2013 cohort — apnea LR+ ~ 3-5 for < 6 wk term, ~ 8-15 for preterm < 32 wk)(life-threatening)
Severe respiratory distress — marked retractions + grunting + nasal flaring + RR ≥ 70 in infant < 12 mo (AAP 2014 Ralston; NICE 2021)
oxygen level (SpO₂) < 90% sustained on room air (AAP 2014 Ralston hospitalization threshold; some centres use < 92% per NICE 2021)
Dehydration OR feeding intolerance — reduced PO intake < 50-75% over 24 h OR < 4 wet diapers per 24 h OR tachypnea limiting PO (AAP 2014 Ralston; NICE 2021)

5. Follow-up

Pediatrician within 1-2 d post-discharge; RSV prevention plan next season (palivizumab high-risk OR nirsevimab universal — ACIP 2023; Hammitt MELODY NEJM 2022); asthma surveillance for recurrent (AAP 2014 Ralston)

6. Sources

Guideline: AAP 2014 Bronchiolitis CPG (Ralston) + PARIS HFNC NEJM 2018 + ACIP 2024 nirsevimab universal-infant + Hammitt MEDLEY NEJM 2022 + NICE NG9 2021