1. Bronchiolitis Dr M Tariq Consultant Paediatrician with Respiratory Interest.

2. Call associate specialist on: 07*** *** ***

4. Observed or reported apnoea Child looks seriously unwell Respiratory distress with RR>70, nasal flaring, grunting, severe chest wall recession Central cyanosis Persistent oxygen sats less than 92% If feeding <50% of feeds and /or clinical dehydration-ask for wet nappies Always check for an ability to re attend if the child deteriorates REFER TO SECONDARY CARE

5. Chronic lung disease Congenital heart disease Prematurity Neuromuscular disorders Immunodeficiency Male sex Not breast feeding Smokers at home RISK FACTORS

7. Treatment in primary care: 0.9% saline nasal drops Advise on small and frequent feeds Reassurance –self limiting nature of illness In secondary care: Oxygen and respiratory support if sats <94% and severe respiratory distress Trial of bronchodilators-controversial Hypertonic saline nebulisers CXR and antibiotics are not indicated in bronchiolitis unless atypical presentation TREATMENT

8. NHS 111 (Available 24/7) Walsall Manor Hospital Paediatric Assessment Unit (Available 24/7): 07*** *** ***