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NICE has issued draft recommendations to provide best practice advice on the care of babies and young children with the lung infection – bronchiolitis. 

Bronchiolitis is the most common disease that affects the lower respiratory tract and around 1 in 3 babies will develop the condition in their first year of life.

It is caused by a viral infection where small airways in the lungs, known as bronchioles, become inflamed. This reduces the amount of air entering the lungs and causes breathing difficulties. Symptoms usually start as a cough with forced breathing.  It often results in difficulty feeding.

Professor Mark Baker, director of clinical practice at NICE said: “Bronchiolitis may often be confused with a common cold in infants who present to primary care. In the majority of cases, symptoms are mild and will only last a few days, but in some cases the disease can lead to serious illness. It is very important that children with bronchiolitis are correctly diagnosed and their symptoms closely monitored. So parents and carers, as well as doctors, nurses and health visitors need  to know when to seek help from specialist care.”  

Most children with bronchiolitis can be managed at home and the draft guideline has key safety information for parents and carers. This includes red flag symptoms to look out for such as increasing difficulty breathing or exhaustion, and when to arrange a follow up or get immediate help.

A small proportion (2-3%) of infants with bronchiolitis will require hospitalisation. The guideline sets out recommendations for people working in primary care on when to consider referral to specialist care, such as if a child has rapid breathing (a respiratory rate of over 60 breaths/minute), difficulty breastfeeding or clinical dehydration.

It also sets out the symptoms which require immediate referral to emergency care, usually by calling 999. Urgent symptoms include stopping breathing, looking seriously unwell or beginning to turn blue.

The draft guideline recommends treatment with supportive therapies such as oxygen, airway suctioning or tube feeding for some children with bronchiolitis. It does not recommend the use of a range of other therapies such as antibiotics, bronchodilators or corticosteroids.

Professor Mark Baker added: “With this new draft guideline our aim is to assist clinicians, alongside parents and carers, in making decisions about how to thoroughly assess babies and young children with bronchiolitis and what the most appropriate treatments are to use, to ensure they are well looked after.”

The draft guideline will be open for public consultation until Monday 5 January 2015. Although only registered stakeholders (such as professional and government organisations, patient and carer groups and companies) can formally comment on NICE consultations, organisations can register as a stakeholder at any time during the development of a guideline. Individuals are advised to pass comments through the registered stakeholder organisation that most closely represents them.

The final guideline is due to be published in May 2015. 

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

Facts and figures

• Approximately 1 in 5 infants will develop clinical bronchiolitis in the first year of life and 2-3% of all infants require hospitalization.
• In 2011/12, there were 30,451 secondary care admissions for bronchiolitis, in England.
• In 2009/10, there were 72 recorded deaths of children within 90 days of hospital admission for bronchiolitis, in England

About the guidance

1. The draft guidance for bronchiolitis in children is available athttp://www.nice.org.uk/guidance/indevelopment/GID-CGWAVER136.  

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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