Clinical update

Clinical update: Bronchiolitis

Child bronchiolitis

In England last year, nearly 40,000 babies and young children with bronchiolitis were admitted to hospital. This infection is usually caused by the respiratory syncytial virus, and in most cases symptoms are mild and last only a few days.

However, a quality standard published in the summer by the National Institute for Health and Care Excellence (NICE) states that admissions for bronchiolitis are rising. NICE quality standards describe high-priority areas for improvement in a defined field of care.

Bronchiolitis is now the third most common reason why babies and young children are admitted to hospital, the quality standard states. But the treatment given is not always in line with recommendations.

Antibiotics

The standard quotes from studies undertaken in UK hospitals that show children with bronchiolitis are being given antibiotics even though these are often ineffective and have side effects. Reducing unnecessary antibiotics will prevent the

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In England last year, nearly 40,000 babies and young children with bronchiolitis were admitted to hospital. This infection is usually caused by the respiratory syncytial virus, and in most cases symptoms are mild and last only a few days.

However, a quality standard published in the summer by the National Institute for Health and Care Excellence (NICE) states that admissions for bronchiolitis are rising. NICE quality standards describe high-priority areas for improvement in a defined field of care.

Bronchiolitis is now the third most common reason why babies and young children are admitted to hospital, the quality standard states. But the treatment given is not always in line with recommendations.

Antibiotics

The standard quotes from studies undertaken in UK hospitals that show children with bronchiolitis are being given antibiotics even though these are often ineffective and have side effects. ‘Reducing unnecessary antibiotics will prevent the development of bacterial resistance and will also reduce costs,’ the standard says.

Although bronchiolitis normally settles without treatment, and breathing and feeding will usually improve within five days, NICE states that parents and carers must be given safety information.

It should be explained that the condition is, in most cases, self-limiting and that medication is unnecessary. This can increase the confidence of parents and carers in their ability to look after the child at home.

Signs and symptoms

Some children can deteriorate rapidly, however, so parents and carers must also be able to identify the relevant signs and symptoms, including disrupted breathing, exhaustion, and cyanosis inside the child’s lips or under the tongue, that indicate urgent help is required from healthcare professionals.

According to NICE, more evidence-based guidance on how to avoid hospital admissions and on early supported discharge of children with bronchiolitis are needed. Carers of children at home can adopt flexible and personalised approaches that meet the needs of children and their families.

The quality standard follows the publication last year of NICE guidelines on the diagnosis and management of bronchiolitis in children. It recommends that decisions about whether to admit or discharge children should depend on the social circumstances of their carers, as well as clinical risk factors. It also warns that people smoking in the home of a child with bronchiolitis increased the risk of more severe symptoms.

Expert view

Clare_van_Miert Clare van Miert, Clinical research fellow in child health, Alder Hey Children’s NHS Trust, and a member of the NICE bronchiolitis quality standard committee

‘Bronchiolitis is a seasonal condition, from October to March. Most babies can be managed at home, but about 3% develop symptoms that worsen, and they need to be brought into hospital for help with feeding and breathing. Those more at risk of becoming sicker are those aged under three months, premature babies, and children with other conditions, such as cardiac problems or chronic lung disease. Admission is usually just for a few days. For parents it is a frightening experience. Part of the nurse’s role is to provide more information on bronchiolitis and its management, including how to help parents recognise red-flag symptoms. The standard is applicable to children’s nurses who work in either a community or hospital setting.’

Implications for nurses

This is generally a condition of short duration that puts only a few children at serious risk. For parents, however, it is distressing, especially if their children must be admitted to hospital. As well as caring for children, therefore, nursing staff involved in cases of bronchiolitis must provide appropriate information and support.

The quality standard is clear that treating bronchiolitis with antibiotics risks adverse reactions, and nurses may be required to explain to parents and carers the reasons why antibiotics have not been prescribed.

When a child has been diagnosed with bronchiolitis, community children’s nursing teams should be involved to reduce the need for hospital admission. Early discharge supported by community teams may also lessen the risk of readmission to hospital.

The wide seasonal variation in the numbers of cases of bronchiolitis means that, as winter approaches, healthcare staff must be more vigilant and should be aware that some groups of babies and children are at increased risk.


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Information for parents

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