Discharge Plan for 1-Year-Old with Bronchiolitis After Ventolin Treatment
Do not continue Ventolin (albuterol) at discharge, as bronchodilators should not be used routinely in bronchiolitis management and have not been shown to improve clinical outcomes. 1
Discontinue Bronchodilator Therapy
Bronchodilators should not be prescribed for home use in bronchiolitis. The 2014 American Academy of Pediatrics guidelines removed the option for trial bronchodilator therapy that existed in the 2006 version, given stronger evidence demonstrating no benefit and no well-established method to determine objective response. 1
Studies show bronchodilators do not affect disease resolution, length of stay, or need for hospitalization in bronchiolitis, despite possible transient improvements in clinical scores. 1
The potential adverse effects (tachycardia, tremors) and cost outweigh any minimal transient benefits. 1
Discharge Criteria Assessment
Before discharge, ensure the child meets these criteria:
Oxygen saturation ≥90% on room air with infant feeding well and having minimal respiratory distress. 1
Adequate hydration and ability to take fluids orally. This is a strong recommendation for assessment before discharge. 1
Stable respiratory status without signs of severe distress (respiratory rate, work of breathing, general appearance). 1
For infants under 3 months old, consider an observation period of up to 25 hours to detect 95% of delayed desaturations; for infants ≥3 months old, an 11-hour observation period is sufficient. 2
Discharge Instructions for Parents
Provide clear guidance on:
Expected disease course: Bronchiolitis is self-limited, typically improving over 7-10 days, though cough may persist longer. 1
Supportive care measures:
- Maintain adequate hydration with frequent small feedings
- Nasal suctioning as needed for comfort
- Monitor for signs of respiratory distress 1
Return precautions - seek immediate medical attention if:
- Increased work of breathing or respiratory distress
- Poor feeding or signs of dehydration
- Oxygen saturation concerns (if home monitoring available)
- Lethargy or decreased responsiveness 1
Medications NOT to Prescribe
No bronchodilators (albuterol/salbutamol) for home use 1
No corticosteroids - these should not be used routinely in bronchiolitis management 1
No antibiotics unless specific evidence of bacterial co-infection exists 1
No chest physiotherapy - not beneficial in bronchiolitis 1
Follow-Up Arrangements
Schedule follow-up within 24-48 hours with primary care provider to reassess clinical status 1
Earlier follow-up or continued observation may be warranted for high-risk patients: age <12 weeks, history of prematurity, underlying cardiopulmonary disease, or immunodeficiency 1
Prevention Education
Emphasize hand hygiene as the most important step in preventing RSV spread to other household members 1
Avoid passive smoke exposure - this is a strong recommendation 1
Encourage continued breastfeeding to decrease risk of future lower respiratory tract disease 1
Common Pitfall to Avoid
The most critical error is continuing bronchodilators at discharge based on their use during hospitalization. Despite Ventolin being given on the ward, there is no indication for ongoing bronchodilator therapy in bronchiolitis, as it does not alter disease course or improve meaningful clinical outcomes. 1