The National Institute for Health and Care Excellence has issued advice to parents, carers and clinicians on spotting and managing bronchiolitis – a chest infection – in babies and young children.
Last year more than 39,300 babies and young children were admitted to hospital with bronchiolitis in England. The infection is caused by a virus – usually the respiratory syncytial virus (RSV) – and cannot be treated with antibiotics. In the majority of cases, symptoms are mild, lasting only a few days and most children with bronchiolitis can be managed at home. The quality standard recognises the importance of arming parents and carers with key safety information so they know how to keep their child comfortable at home and when to seek help.
The standard states that breathing and feeding will usually get better within five days although a cough may take up to three weeks to go. It lists red flag symptoms parents and carers should look out for such as disrupted breathing, exhaustion or the skin inside the child’s lips turning blue.
The standard says that parents and carers should be advised that bronchiolitis usually settles without the need for treatment. Normal medicines that would be given for a cold can be used to help ease symptoms. Studies in UK hospitals have shown that antibiotics are being given to young children for bronchiolitis even though they are not recommended. The standard stresses that healthcare professionals should not prescribe antibiotics as they do not work and can cause side effects.
Professor Gillian Leng, deputy chief executive at NICE, said: “Hospital admissions for bronchiolitis have risen steadily over the past two decades and it is now the third most common reason that babies and young children are admitted to hospital. Although a small number of cases become serious, the large majority are mild and children can be looked after comfortably in their own homes. We want to make sure parents and carers feel safe and confident monitoring their child’s symptoms so that they only have to go to hospital if it is absolutely necessary.
“Bronchiolitis is a viral infection which means that antibiotics do not work, yet we are still hearing of cases where they are being prescribed. This needs to stop. We want to remind healthcare professionals that reducing unnecessary use of antibiotics will help fight the threat of bacterial resistance and will also reduce costs.”
Bronchiolitis is caused by a viral infection where small airways in the lungs, known as bronchioles, become inflamed. This reduces the amount of air entering the lungs and causes breathing difficulties. Symptoms usually start as a cough with forced breathing. It often results in difficulty feeding. Approximately 1 in 3 infants will develop clinical bronchiolitis in the first year of life, and 2%–3% of these will need hospitalisation.
The quality standard was developed following consultation with key organisations in child health to provide their views on current practice and what needs to be done to provide better quality care. The standard includes three statements that set out priorities for delivering high-quality care to babies and young children with bronchiolitis, as well as their families.
Dr Maureen Baker, chair of the Royal College of General Practitioners, said: “Bronchiolitis can be a very nasty illness for babies and young children, and very distressing and alarming for their parents. But most babies and young children with bronchiolitis do not require antibiotics and this guidance will help reassure parents that in the majority of cases the condition can be effectively managed at home. It will also support GPs and their teams who are working hard to reduce antibiotic prescribing so that they are only given to our younger patients when they really need them.”
