Bronchiolitis / Wheezing – 3-24 Months

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Wheezing is a common complaint on radio traffic. In infants, wheezing is most likely due to bronchiolitis or asthma. Listen carefully for a history of recurrent wheezing in the past as a clue toward asthma. For infants presenting for the first time or with associated stridor, think foreign body. Wheezing in older children should not be diagnosed as “bronchitis” as this is not a disease seen in children. Older wheezing children have asthma, a viral process or pneumonia. Be tuned in to a reported past history that points to undiagnosed bronchiectasis (productive cough greater than 3 months). These children should be seen in Pediatric Clinic for an evaluation.


Diagnosis: based on history and clinical presentation
Demographics: hospitalization rate for Alaska Native children 3x general population in some studies
Signs/Symptoms: cough, rhinorrhea, wheezing, respiratory distress, poor feeding
Risk Factors for Severe Disease:

  • less than 12 weeks old
  • prematurity <34 weeks
  • history of cardiopulmonary disease
  • anatomic airway defects
  • neuromuscular disease
  • immunodeficiency
  • tobacco smoke exposure

Risk for Apnea:

  • postconception age <48 weeks
  • low birth weight
  • tachypnea or respiratory depression
  • low room air oxygen saturations

Management: see Bronchiolitis/Wheezing YKHC Clinical Guideline
Prevention:

  • Good Hand Hygiene
  • Encourage breastfeeding for at least 6 months
  • discuss Tobacco Cessation when appropriate
  • Synagis for infants who qualify

Resources/References


YKHC Clinical Guidelines
Common/Unique Medical Diagnoses