Referral criteria from primary care - bronchiolitis

• Immediately refer children with bronchiolitis for emergency hospital care (usually by 999 ambulance) if they have any of the following:
  • apnoea (observed or reported)
  • child looks seriously unwell to a healthcare professional
  • severe respiratory distress, for example grunting, marked chest recession, or
  • a respiratory rate of over 70 breaths/minute
  • central cyanosis
    
    
• consideration of referral for a child with bronchiolitis to hospital if they have any of the following:
  • a respiratory rate of over 60 breaths/minute
  • difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume, taking account of risk factors and using clinical judgement)
  • clinical dehydration
  • persistent oxygen saturation of less than 92% when breathing air
    

Notes:

• when deciding whether to refer a child with bronchiolitis to secondary care, take account of the following risk factors for more severe bronchiolitis:
  • chronic lung disease (including bronchopulmonary dysplasia)
  • haemodynamically significant congenital heart disease
  • age in young infants (under 3 months)
  • premature birth, particularly under 32 weeks
  • neuromuscular disorders
  • immunodeficiency
    
    
• When deciding whether to refer a child to secondary care, take into account factors that might affect a carer's ability to look after a child with bronchiolitis, for example:
  • social circumstances
  • the skill and confidence of the carer in looking after a child with bronchiolitis at home
  • confidence in being able to spot red flag symptoms
  • distance to healthcare in case of deterioration

Provide key safety information for parents to take away for reference for children who will be looked after at home. This should cover:

• how to recognise developing 'red flag' symptoms:
  • worsening work of breathing (for example grunting, nasal flaring, marked chest recession)
  • fluid intake is 50-75% of normal or
  • no wet nappy for 12 hours

Reference:

• NICE (August 2021). Bronchiolitis in children