Bronchiolitis vs Bronchitis in Children: Key Differences in Management
Bronchiolitis and bronchitis in children are fundamentally different diseases requiring distinct management approaches, with bronchiolitis being a viral lower respiratory tract infection in infants requiring only supportive care, while the term "bronchitis" in children requires immediate clarification as it often represents either bronchiolitis or protracted bacterial bronchitis. 1
Disease Definition and Age Distinction
Bronchiolitis is a viral lower respiratory tract infection characterized by inflammation, edema, and mucus production in the small airways, most commonly caused by respiratory syncytial virus (RSV), primarily affecting infants under 12 months of age. 2
Acute bronchitis in older children is typically a different clinical entity, and the term requires clarification to distinguish it from bronchiolitis, as management paradigms differ completely. 1
Bronchiolitis Management: Supportive Care Only
What TO Do for Bronchiolitis:
Oxygen supplementation only if SpO2 falls persistently below 90%, maintaining SpO2 ≥90% with standard oxygen delivery. 2, 1, 3
Hydration support by assessing oral intake ability, with IV or nasogastric fluids reserved for infants who cannot maintain adequate oral intake. Use isotonic fluids if IV hydration is needed, as infants may develop SIADH and are at risk for hyponatremia with hypotonic fluids. 2, 3
Gentle nasal suctioning only as needed for symptomatic relief, avoiding deep suctioning which is associated with longer hospital stays in infants 2-12 months of age. 2, 3
Continue breastfeeding if possible, as breastfed infants have shorter hospital stays and 72% reduction in hospitalization risk. 2
Monitor feeding carefully, as aspiration risk increases significantly when respiratory rate exceeds 60-70 breaths/minute. 2, 1
What NOT To Do for Bronchiolitis:
Do not use bronchodilators routinely, as they lack evidence of benefit. 2, 3, 4, 5
Do not use corticosteroids routinely, as they lack evidence of benefit. 2, 3, 4, 5
Do not prescribe antibiotics unless there are specific indications of bacterial coinfection (such as acute otitis media or documented bacterial pneumonia), as the risk of serious bacterial infection is <1%. 2, 1, 5
Do not order routine chest radiographs, viral testing, or laboratory studies, as bronchiolitis is a clinical diagnosis. 2, 1, 4
Do not use continuous pulse oximetry in stable infants, as it may lead to less careful clinical monitoring. 2, 1
Do not treat based solely on pulse oximetry readings without clinical correlation, as transient desaturations can occur in healthy infants. 2, 1
High-Risk Infants Requiring Closer Monitoring
Infants with the following characteristics require closer monitoring and may have abnormal baseline oxygenation: 2, 1, 3
- Age <12 weeks
- History of prematurity
- Hemodynamically significant congenital heart disease
- Chronic lung disease
- Immunodeficiency
Post-Bronchiolitis Chronic Cough Management
For children with chronic wet/productive cough following bronchiolitis without specific cough pointers, use 2 weeks of antibiotics targeted to common respiratory bacteria according to pediatric chronic cough guidelines. 1
Critical Clinical Pitfalls to Avoid
Fever alone does not justify antibiotics in bronchiolitis, as serious bacterial infection risk is <1%. 2, 1
Do not overlook feeding difficulties, as respiratory rate >60-70 breaths/minute significantly increases aspiration risk. 2, 1
Do not apply pediatric bronchiolitis treatment paradigms to adults, as adult bronchiolitis is fundamentally different and requires cause-specific treatment. 1
Expected Clinical Course
Symptoms of bronchiolitis (cough, congestion, wheezing) are expected to last 2-3 weeks, which is normal and does not indicate treatment failure. 2