PV Card: Algorithm for acute bronchiolitis management


baby-cough-canstockphoto5283520Bronchiolitis is a common lower respiratory tract infection in children less than 2 years old, and especially in those 3-6 months old. In a collaboration with the American Academy of Pediatrics’ (AAP) Section on Emergency Medicine Committee on Quality Transformation, we present a PV card summarizing the Section’s “Clinical Algorithm for Bronchiolitis in the Emergency Department Setting” (reproduced with permission).1 Dr. Shabnam Jain sums it up best in her expert peer review below: “In bronchiolitis, less is more.”

How to use the Bronchiolitis Algorithm


  • Does not apply if severe or atypical presentation

Inclusion Criteria

  • Children, 1‐12 months of age, presenting with symptoms and signs suggestive of a clinical diagnosis of bronchiolitis, such as upper respiratory tract infection such as rhinitis and coughing, progressing to lower respiratory symptoms including wheezing, crackles, and/or tachypnea that may result in difficulty breathing and/or difficulty feeding

Exclusion Criteria

  • Full‐term infants that are <28 days old
  • Premature infants that are <48 weeks post‐conception
  • Patients with hemodynamically significant cardiac or significant pulmonary disease (such as bronchopulmonary dysplasia or asthma) or other major chronic conditions (such as immunodeficiency and neuromuscular disease)



[Download the PV card]


(AAP) Section on Emergency Medicine Committee on Quality Transformation: Bronchiolitis Content Expert Team

  • Shabnam Jain, MD | Champion (Children’s Healthcare of Atlanta)
  • Anne Stack, MD | Co‐Champion (Boston Children’s Hospital)
  • Marc Baskin, MD (Boston Children’s Hospital)
  • Laura Chapman, MD (Hasbro Children’s Hospital)
  • Peter Dayan, MD (Morgan Stanley Children’s Hospital)
  • Mark Meredith, MD (Le Bonheur Children’s Hospital)
  • Graham Thompson, MD (Alberta Children’s Hospital)
  • Joseph Zorc, MD (Children’s Hospital of Philadelphia)

Note: This algorithm does not represent AAP policy and was not reviewed or approved by the AAP Board of Directors.

(c) Can Stock Photo / 800

Ralston S, Lieberthal A, Meissner H, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-502. [PubMed]

Michelle Lin, MD
ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

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