Bronchiolitis is primarily a clinical diagnosis, and routine labs and imaging have a limited role in most cases.

The mainstays of management supported by the AAP are supportive care—including suctioning, hydration, and supplemental oxygen only when there is hypoxemia.

We should be clear about what not to use: systemic corticosteroids, inhaled epinephrine, and albuterol are not recommended.

If oxygen saturation is 90% or higher, supplemental oxygen is generally not needed.

And in children with severe respiratory distress, starting or escalation to high-flow nasal cannula is appropriate.

1.Assessment of severity of bronchiolitis based on the RR (adopted from CHOP)

Age

Mild

Moderate

Severe

<3 months

30-60

61-80

>80

3-12 months

25-50

51-70

>70

12-24 months

20-40

41-60

>60