assessment and clinical diagnosis
Last edited 08/2021 and last reviewed 08/2021
When diagnosing bronchiolitis, take into account that it occurs in children under 2 years of age and most commonly in the first year of life, peaking between 3 and 6 months
- symptoms usually peak between 3 and 5 days, and that cough resolves in 90% of infants within 3 weeks
NICE state that a diagnosis of bronchiolitis can be made if the child has a coryzal prodrome lasting 1 to 3 days, followed by:
- persistent cough and either tachypnoea or chest recession (or both)
- and either wheeze or crackles on chest auscultation (or both)
Following symptoms are common in children with this disease:
- fever (in around 30% of cases, usually of less than 39°C)
- poor feeding (typically after 3 to 5 days of illness)
Young infants with this disease (in particular those under 6 weeks of age) may present with apnoea without other clinical signs
A diagnosis of pneumonia should be considered if the child has:
- high fever (over 39°C)
- and/or persistently focal crackles
Consider a diagnosis of viral-induced wheeze or early-onset asthma rather than bronchiolitis in older infants and young children if they have:
- persistent wheeze without crackles or
- recurrent episodic wheeze or a personal or
- family history of atopy
- these conditions are unusual in children under 1 year of age
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