Best way to treat bronchiolitis: simple care that works

TL;DR:

• Most cases need supportive care at home, not medicines.
  
• Saline drops, gentle suction, fluids, and fever control help.
  
• Seek care if breathing worsens or feeding falls below half.
  
• Oxygen is used if saturations stay below guideline cutoffs.
  
• Bronchodilators, steroids, antibiotics, and chest physio are not routine.
  

What bronchiolitis is and how it usually runs

Bronchiolitis is a viral infection of the small airways in babies and toddlers. It causes cough, fast breathing, and wheeze, often after a runny nose. Symptoms peak around day 3 to 5, and most children improve over 1 to 2 weeks. Cough can last up to 3 weeks. This pattern is described in national guidance.

Most children can be cared for at home with simple measures. A small share will need hospital care for oxygen or feeding support. Decisions are based on breathing effort, oxygen levels, age, and intake.

The core treatment: supportive care

At home

• Clear the nose. Use saline drops or spray. Do brief, gentle suction if the nose is blocked.
  
• Keep fluids going. Offer small, frequent feeds. Breast milk or formula if an infant, water for older toddlers.
  
• Treat fever if needed. Paracetamol or ibuprofen in age-appropriate doses.
  
• Let them rest. Hold upright for comfort. Avoid smoke exposure.
  

These steps improve comfort while the illness runs its course. National guidance also advises giving families clear safety advice before sending a child home.

In hospital

Support still focuses on breathing and hydration. Teams give supplemental oxygen if oxygen saturation stays below target thresholds. They use nasogastric or orogastric feeds or intravenous fluids if the child cannot drink enough. Some children need noninvasive respiratory support.

When oxygen is needed

Guidelines advise oxygen if saturations are persistently below 90 percent in most infants 6 weeks and older. For babies under 6 weeks or children with certain conditions, the threshold is 92 percent. Discharge targets mirror these levels once the child is feeding and stable.

High-flow nasal cannula

Many hospitals use high-flow nasal cannula for infants who remain distressed on low-flow oxygen. A 2024 Cochrane review found high-flow may modestly shorten hospital stay, reduce oxygen days, and lower treatment escalation compared with low-flow, with similar adverse events. Evidence versus CPAP is less certain.

What not to use

Evidence does not support routine use of several drugs and procedures in bronchiolitis.

• No routine bronchodilators like salbutamol or albuterol. They do not improve oxygen saturation, do not cut admissions, and do not shorten illness. This is based on a Cochrane review.
  
• No routine steroids inhaled or systemic.
  
• No nebulized adrenaline in routine care.
  
• No hypertonic saline as standard treatment.
  
• No antibiotics unless there is clear bacterial infection.
  
• No chest physiotherapy in otherwise typical cases.
  

These recommendations are set out in guideline summaries for everyday practice.

When to seek urgent care

Go to emergency care now if any of these happen:

• Pauses in breathing or blue lips or tongue.
  
• Severe breathing effort, grunting, marked chest in-drawing, or breathing rate over 70.
  
• Looks very unwell, unusually sleepy, or not responding.
  

Consider hospital review if:

• Breathing is persistently fast, over about 60 per minute.
  
• Drinking drops to half to three-quarters of normal.
  
• Signs of dehydration or no wet nappy for 12 hours.
  
• Oxygen saturation at home reads below low-90s, if you have a reliable pediatric pulse oximeter.
  

These thresholds reflect referral and admission criteria used in practice.

Feeding and hydration tips

Offer small, frequent feeds. If breastfeeding, offer more often for shorter periods. Watch for fewer wet nappies, dry mouth, or lethargy. In hospital, teams may place a feeding tube or give IV fluids if oral intake is not safe.

Common mistakes to avoid

• Starting inhalers without benefit. If a medically supervised trial of a bronchodilator shows no clear improvement, stop it. Evidence does not support routine use.
  
• Using leftover antibiotics. Bronchiolitis is viral, and antibiotics do not help unless another infection is proven.
  
• Deep suctioning at home. Gentle nasal suction is fine. Avoid aggressive suction that can irritate the airway.
  
• Ignoring feeding. Hydration can drop fast in infants. Seek help early if intake falls.
  

Simple home-care checklist

Special groups

Babies under 3 months, premature infants, and children with heart, lung, or neuromuscular conditions have higher risk. Clinicians lower oxygen thresholds for very young or high-risk infants and admit sooner for observation and support.

What to expect after discharge

Most children go home when they are breathing comfortably on room air and drinking well. Caregivers receive safety advice and know when to return. A lingering cough can be normal for up to 3 weeks.

Why it matters

Clear, simple care avoids unnecessary drugs and procedures. Families learn to spot trouble early. Hospitals reserve oxygen and high-flow support for the children who truly need it, guided by evidence from large systematic reviews and national guidelines.

Sources:

• NICE, “Bronchiolitis in children: diagnosis and management (NG9),” https://www.nice.org.uk/guidance/ng9, last updated 2021-08-09.
  
• Cochrane, “High-flow nasal cannula oxygen therapy for infants with bronchiolitis,” https://www.cochrane.org/evidence/CD009609_high-flow-nasal-cannula-tube-oxygen-therapy-infants-bronchiolitis, published 2024-03-20.
  
• Gadomski AM, Scribani MB, “Bronchodilators for bronchiolitis,” Cochrane Database Syst Rev 2014, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001266.pub4/full, published 2014-06-17.