Nursing the infant with bronchiolitis: nasal suction, feeding, oxygen and when to escalate
- Safe practice
Bronchiolitis care is supportive: clear the nose, keep the baby fed and hydrated, give oxygen when saturation is low and spot the baby who is tiring.
What it is
Bronchiolitis is a viral infection of the small airways in children under two. No medicine shortens it, so nursing care is the treatment: gentle nasal suction, help with feeding, oxygen when saturation falls, close observation and family teaching. The illness often gets worse over the first three days before it improves. The nurse looks for the infant at higher risk, the one who cannot feed safely, and the one who is tiring or having apnoeas.
What it requires
- Regular clinical assessment: respiratory rate, work of breathing, colour, feeding and hydration.
- Spot-check oximetry for lower-risk or improving infants; continuous monitoring may be used for high-risk infants in the acute phase.
- Electronic monitoring never replaces looking at the baby.
- Isotonic IV fluids, when used, need regular sodium checks (per order).
How it is applied (and why)
- Count respiratory rate for a full minute and look for indrawing, grunting and nasal flaring — they measure the work of breathing.
- Measure SpO2 and give oxygen per order and protocol — low saturation, not noise, decides the need for oxygen.
- Put saline drops in the nose, then suction gently and superficially before feeds — a clear nose helps the baby feed and breathe.
- Offer breast milk or formula in small, frequent feeds — AIEPI advises small, frequent feeds in respiratory illness.
- If breathing is too fast to feed safely, stop oral feeds and ask for a tube or IV plan — this prevents aspiration.
- Record intake, wet nappies and weight — poor intake and dehydration are reasons for admission.
- Watch for apnoea, cyanosis and a tired, floppy baby — these signal exhaustion and need help now.
- Keep smoke away from the baby and teach hand washing and respiratory hygiene — this protects the baby and siblings.
- Before discharge, check breathing has improved, saturation stays up without oxygen and feeding is adequate — these are the usual criteria.
In nursing practice
- Expect the illness to worsen over the first 72 hours; warn the family that this is common.
- Admission is usual with severe distress, oxygen need, dehydration or poor intake, cyanosis or apnoea, high risk, or a family that cannot cope.
- Infants normally desaturate briefly during sleep: interpret a single low reading together with the clinical picture.
- Home care: plenty of fluids, saline drops and bulb suction, rest, and no smoking near the child.
Common mistakes
- Deep or infrequent suctioning, which has been linked to longer stays.
- Pushing oral feeds in an infant who is breathing very fast.
- Relying on the monitor and not looking at the baby.
- Sending the family home without teaching the warning signs: blue lips, very fast or hard breathing, indrawing or flaring, extreme tiredness.
Test yourself
Think of the answer, then tap the question to see it.
Which infants with bronchiolitis are at higher risk of severe disease?
Those born before 35 weeks, younger than 3 months, with significant heart or lung disease, or with immunodeficiency.
How should nasal suction be done in bronchiolitis?
Gently and superficially, reasonably often (for example before feeds), after saline drops; deep suctioning is avoided.
Why may oral feeding be unsafe in an infant breathing more than 60 times per minute?
The infant may aspirate, especially with a blocked nose; feeding by tube or IV fluids is then considered, per order.
Which treatments are not recommended routinely in bronchiolitis?
Bronchodilators, corticosteroids, chest physiotherapy and antibiotics (unless a bacterial infection is suspected).
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age (Canadian Paediatric Society, 2021); Bronchiolitis (MedlinePlus, U.S. National Library of Medicine, 2024); Cuadro de procedimientos AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia) (Ministerio de Salud y Protección Social de Colombia, 2016).
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Representative model, for educational purposes only.