Clinical Reference Systems: Pediatric Advisor 10.0
Admission and Discharge Instructions
- Your child is wheezing. This means that when your child
breathes out he or she makes a high-pitched whistling
- Your child is breathing rapidly at a rate of over 40
breaths per minute.
- Your child has to push the air out (tight breathing).
- Your child has a cough and may cough up a very sticky
- Often a fever and a runny nose precede the breathing
problems and cough.
The symptoms are similar to asthma.
The average age of children who get bronchiolitis is
6 months. They are never older than 2 years.
The wheezing is caused by a narrowing of the smallest
airways in the lung (bronchioles). This narrowing results
from inflammation (swelling) caused by a virus, usually the
respiratory syncytial virus (RSV). RSV occurs in epidemics
almost every winter. While infants with RSV develop
bronchiolitis, children over age 2 years and adults just
develop cold symptoms.
The virus is in nasal secretions of infected people. It is
spread by an infected person who sneezes or coughs less than
6 feet away from someone else or by his or her hands after
touching the nose or eyes.
People do not develop permanent immunity to the virus, which
means that they can be infected by it many times.
Reasons for Admission to the Hospital
___ Needs IV fluids.
___ Needs antibiotic or other medicine.
___ Needs oxygen.
___ Other reasons: ______________________________________________.
Wheezing and tight breathing (difficulty breathing out)
become worse for 2 or 3 days and then begin to improve.
Overall, the wheezing lasts approximately 7 days and the
cough about 14 days.
The most common complication of bronchiolitis is an ear
infection, which occurs in some 20% of infants. Bacterial
pneumonia is an uncommon complication. Only 1% or 2% of
children with bronchiolitis are hospitalized.
Requirements for Discharge
Discharge Instructions for Home Treatment
- Wheezing medicines
Some children with bronchiolitis respond to asthma-type
medicines for wheezing, but others do not.
Your child's medicine is __________________. Give _____
every ____ hours. Continue the medicine until your
child's wheezing is gone for 24 hours.
- Other medicines
- For pain or fever over 102ƒF (39ƒC)
- Warm fluids for coughing spasms
Coughing spasms are often caused by sticky secretions in
the back of the throat. Warm liquids usually relax the
airway and loosen the secretions. Offer warm lemonade
or apple juice if your child is over 4 months old.
In addition, breathing warm moist air helps to loosen up
the sticky mucus that may be choking your child. You
can provide warm mist by placing a warm wet washcloth
loosely over your child's nose and mouth. Or you can
fill a humidifier with warm water and have your child
breathe in the warm mist it produces. Avoid steam
vaporizers because they can cause burns.
Dry air tends to make coughs worse. Use a humidifier in
your child's bedroom. Buy one with a heating element or
a filter system that removes molds and bacteria that
might be in the water.
- Suction of a blocked nose
If the nose is blocked up, your child will not be able
to drink from a bottle or to breast-feed. Most stuffy
noses are blocked by dry or sticky mucus. Suction alone
cannot remove dry secretions. Warm tap-water or saline
nosedrops are better than any medicine you can buy for
loosening up mucus. Place three drops of warm water or
saline in each nostril. After about one minute, use a
soft rubber suction bulb to suck out the mucus. You can
repeat this procedure several times until your child's
breathing through the nose becomes quiet and easy.
Encourage your child to drink enough fluids.
Eating is often tiring, so offer your child formula,
breast milk, or regular milk (if he is over 1 year old)
in smaller amounts at more frequent intervals. If your
child vomits during a coughing spasm, feed him or her
- No smoking
Tobacco smoke aggravates coughing. Children who have an
RSV infection are much more likely to wheeze if they are
exposed to tobacco smoke. Don't let anyone smoke around
your child. In fact, try not to let anybody smoke
inside your home.
- Additional instructions
Follow-Up Appointment after Discharge
___ Your child needs to be rechecked and has an appointment
on _____________ at _______ with
___ Your child needs to be rechecked in ________ days. Call
your child's doctor to make an appointment.
___ A follow-up appointment is not necessary. Call the
doctor if you have any concerns.
Call Your Child's Physician Immediately If:
- Breathing becomes labored or difficult.
- The wheezing becomes severe (tight).
- Breathing becomes faster than 60 breaths per minute (when
your child is not crying).
Call Your Child's Physician Within 24 Hours If:
- Any fever lasts more than 3 days.
- The cough lasts more than 3 weeks.
- You have other questions or concerns.