Intended for healthcare professionals

Practice Guidelines

Bronchiolitis in children: summary of NICE guidance

BMJ 2015; 350 doi: (Published 02 June 2015) Cite this as: BMJ 2015;350:h2305
  1. Valentina Ricci, research fellow1,
  2. Vanessa Delgado Nunes, senior research fellow and guideline lead1,
  3. M Stephen Murphy, clinical director for children’s guidelines1,
  4. Steve Cunningham, consultant and honorary reader in paediatric respiratory medicine 2
  5. on behalf of the guideline development group and technical team
  1. 1Royal College of Obstetricians and Gynaecologists, London NW1 4RG, UK
  2. 2Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
  1. Correspondence to: V Ricci vricci{at}

The bottom line

  • A diagnosis of bronchiolitis helps parents understand that cough may persist for six weeks or more after acute illness

  • Because acute bronchiolitis may become more severe, provide parents with red flag symptoms that should prompt clinical review

  • Admission to hospital is for infants who cannot maintain adequate oral hydration or who have severe respiratory distress, apnoea, or hypoxia

  • There are no effective treatments and minimal handling with adequate hydration is most important, with supplemental oxygen if needed

How patients were involved in the creation of this article

Committee members involved in the development of this guideline included two lay members who actively contributed to the formulation of the recommendations summarised here.

Bronchiolitis is the most common lower respiratory tract infection in the first year of life: one in five infants is affected and 2-3% are admitted to hospital.1 The diagnosis is made on clinical evidence and clinicians need to be confident with their decision. An initial coryzal illness progresses over three to five days to troublesome cough, increased work of breathing, and difficulty feeding. Mild cases can be managed at home, but infants with severe respiratory distress, difficulty taking adequate oral fluids, or with apnoea require secondary care. There are no effective treatments and hospitals provide supportive care with oxygen and hydration. Parents should be told about red flag symptoms that need prompt clinical review and should be aware that symptoms (mostly cough) may persist for weeks after the acute illness.2

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on how to diagnose and manage infants and children with bronchiolitis.3


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. …

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