Bronchiolitis — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Severity / admit?
   Severity and whether admission is needed? (Age 1–23 months, clinical diagnosis (no routine imaging/RSV testing). Risk factors for severe disease: <12 weeks old, prematurity, cardiopulmonary disease, immunodeficiency. Admit/escalate for: respiratory distress, hypoxia SpO2 <90%, apnea, poor feeding/dehydration.)
   • Mild, no risk factors → Mild outpatient
   • Respiratory distress/hypoxia/dehydration/high-risk → Admit
2. [End] Mild outpatient
   Purely supportive care — nasal suction, ensure feeding/hydration, oxygen only if SpO2 <90%; no routine bronchodilators, epinephrine, corticosteroids, antibiotics or chest physiotherapy. Parent education, return advice and warning signs.
3. [End] Admit
   Admit for respiratory distress/hypoxia/dehydration/high-risk: still mainly supportive — nasal suction, hydration (oral/NG/IV), oxygen if SpO2 <90%, high-flow nasal cannula if needed; monitor for apnea. No routine bronchodilators/steroids/antibiotics (unless a bacterial infection coexists).

Source guidelines & references

• AAP 2014 Clinical practice guideline: diagnosis, management and prevention of bronchiolitis. Pediatrics 2014

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways