referral criteria from primary care - bronchiolitis

Last edited 08/2021 and last reviewed 08/2021

  • 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


  • 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