Diagnosing Bronchiolitis

Clinical Presentation

The diagnosis of bronchiolitis requires identifying a constellation of findings in children under 2 years of age, including viral upper respiratory prodrome, lower respiratory signs, and increased respiratory effort, as recommended by the American Academy of Pediatrics 3, 4
Children with bronchiolitis typically present with lower respiratory signs such as tachypnea, wheezing, rales, and cough, according to the American Academy of Pediatrics 3, 4
Increased respiratory effort, including grunting, nasal flaring, and intercostal/subcostal retractions, is a key finding in children with bronchiolitis, as noted by the American Academy of Pediatrics 3, 4

The American Academy of Pediatrics recommends assessing the effects of bronchiolitis on feeding and hydration status in children under 2 years of age 3, 4
Mental status changes, such as lethargy or irritability, should be evaluated in children with bronchiolitis, as advised by the American Academy of Pediatrics 3, 4
The American Academy of Pediatrics identifies risk factors for severe disease, including age <12 weeks, prematurity, hemodynamically significant congenital heart disease, chronic lung disease, immunodeficiency, and in utero smoke exposure 1, 3, 4

Serial observations over time are necessary to assess the varying disease state of bronchiolitis in children, as recommended by the American Academy of Pediatrics 3, 4
The American Academy of Pediatrics advises counting the respiratory rate for a full 60 seconds to ensure accuracy in children with bronchiolitis 3, 4
Tachypnea ≥70 breaths/minute suggests an increased risk of severe disease in children with bronchiolitis, according to the American Academy of Pediatrics 5, 6

The American Academy of Pediatrics recommends against routinely obtaining chest radiographs, laboratory studies, or RSV testing in children with typical bronchiolitis, as these tests do not alter management 1, 2, 3, 4, 6
The American Academy of Pediatrics emphasizes that routine diagnostic testing increases costs without improving outcomes and may lead to inappropriate antibiotic prescribing 1, 6