Can bronchitis be diagnosed in a 28‑month‑old child?

Bronchiolitis Can Be Diagnosed at 28 Months, Though It Is Less Common at This Age

Bronchiolitis is a valid diagnosis in a 28-month-old child, as the American Academy of Pediatrics guidelines apply to infants aged 1 month to 2 years, and this child falls just outside but near this typical age range. 1

Age-Related Considerations

• The peak incidence of bronchiolitis occurs in infants under 2 years of age, with approximately 90% of children infected with RSV (the most common cause) within the first 2 years of life 2
• While bronchiolitis is most common in younger infants, it remains a frequent disorder in preschool children 3
• Age less than 12 weeks is specifically identified as a risk factor for severe disease, but this does not exclude older toddlers from the diagnosis 4, 1

Clinical Diagnosis at 28 Months

The diagnosis should be made exclusively on clinical history and physical examination, regardless of age. 1 Look for:

• Initial rhinitis and cough progressing to lower respiratory symptoms 5
• Tachypnea, wheezing, and crackles on auscultation 1, 2
• Use of accessory respiratory muscles and/or nasal flaring 4, 2
• Signs of increased respiratory effort 1

Important Differential Diagnosis at This Age

At 28 months, you must carefully distinguish bronchiolitis from other conditions:

• Asthma/wheezy bronchitis becomes more likely in this age group and may present similarly with wheezing and respiratory distress 3, 6
• Bacterial pneumonia with consolidation must be excluded, as it requires antibacterial therapy while bronchiolitis does not 5
• Persistent bacterial bronchitis (PBB) should be considered if chronic wet cough persists beyond 4 weeks 7

Common Pitfall to Avoid

Do not confuse bronchiolitis with asthma in this age group. 3 In general practice, significant confusion surrounds the clinical diagnosis of acute bronchitis when distinguishing it from asthma 6. At 28 months, recurrent wheezing episodes are more likely to represent asthma or wheezy bronchitis rather than typical viral bronchiolitis 3, 8.

Management Remains the Same

If bronchiolitis is diagnosed at 28 months, management follows standard guidelines:

• Supportive care with oxygen supplementation to maintain SpO₂ ≥ 90% and adequate hydration 1
• Do not use bronchodilators, corticosteroids, or antibiotics routinely 1
• Reserve antibiotics only for documented bacterial co-infection 1, 5