Pediatric Respiratory Illness
Bronchiolitis, croup, epiglottitis and foreign bodies
Bronchiolitis (usually RSV, under 2 years)
- Starts like a cold, then cough, wheeze, crackles, tachypnea, retractions, nasal flaring, poor feeding.
- Apnea can be the first sign in young or preterm infants.
- Worst around days 3–5.
Care is supportive
- Nasal suctioning (saline + bulb) before feeds and sleep.
- Hydration: small frequent feeds; NG or IV fluids if needed.
- Oxygen if SpO₂ stays <90%; high-flow nasal cannula for more severe cases.
- Contact precautions; hand hygiene; cluster care.
Updated: not routinely recommended
Corticosteroids, albuterol, antibiotics (unless bacterial infection), and chest physiotherapy don't help typical bronchiolitis (AAP). Older guides that list steroids are out of date.
Prevention New
RSV vaccine in pregnancy (32–36 wk) or a long-acting antibody for the baby (nirsevimab or clesrovimab) before or during the first RSV season.
Croup (laryngotracheobronchitis)
- Usually parainfluenza virus; 6 months–3 years.
- Barking, seal-like cough, hoarse voice, inspiratory stridor; worse at night.
- Dexamethasone single dose (oral or IM) for all severities.
- Nebulized epinephrine for stridor at rest; observe 2–4 h after (symptoms can return).
- Keep the child calm, on the parent's lap. Mist therapy isn't proven.
Epiglottitis: airway emergency
- Sudden high fever, toxic look; the 4 Ds: drooling, dysphagia, dysphonia (muffled voice), distress; tripod position.
- Do not put anything in the mouth or examine the throat (no tongue blade, no throat swab): it can cause complete obstruction.
- Keep upright and calm; emergency airway equipment at the bedside; intubation in a controlled setting; IV antibiotics.
- Rare now thanks to the Hib vaccine.
Foreign-body aspiration
Sudden cough, choking or wheeze in a toddler, often one-sided decreased breath sounds. Prevent: no nuts, whole grapes, hard candy, popcorn or small toys for under 4s; cut food small.
Priority
Stridor at rest, drooling, tripod position, silent chest, or a falling SpO₂ in a tiring child → call for help now. Don't upset the child: crying worsens obstruction.