Red flags & when to go in person for Bronchiolitis (Infant) - Triage

Audience: pediatric

Bronchiolitis is a common lung infection in infants that causes swelling and mucus buildup in the small airways of the lungs. It often starts with cold-like symptoms such as a runny nose and cough, and may lead to difficulty breathing. Most cases improve with home care, but some infants need in-person medical attention. This guide helps parents and caregivers recognize warning signs or "red flags" that mean it's important to see a healthcare provider in person. Telemedicine can help assess mild cases and provide advice, but cannot replace physical exams or emergency care. Knowing when to seek urgent care can keep your infant safe and ensure they get the right treatment quickly. Always trust your instincts and seek help if you are worried about your child's breathing or overall condition.

Red flags — go in person / ER

• Infant has difficulty breathing with chest retractions, grunting, or very fast breathing — seek emergency care immediately.
• Blue or gray color around lips, face, or nails — call emergency services or go to the emergency room.
• Infant is very sleepy, hard to wake, or not feeding at all — get urgent medical evaluation promptly.

What telemedicine can do

• Initial symptom assessment and guidance for mild bronchiolitis symptoms.
• Advice on home care and monitoring.
• Determining if red flags are present and if in-person care is needed.

What telemedicine cannot do

• Physical examination to assess breathing effort and oxygen levels.
• Emergency treatment for severe breathing difficulties.
• Diagnostic tests like oxygen saturation measurement or chest x-rays.

What is Bronchiolitis in Infants?

Bronchiolitis is an infection that affects the smallest airways in a baby's lungs. It usually happens in babies under 2 years old, especially during cold seasons. The infection causes swelling and mucus, making it hard for the baby to breathe well. Common signs include coughing, wheezing, and sometimes a fever.

Common Symptoms to Watch For

Most infants with bronchiolitis have mild symptoms like a runny nose, cough, and slight fever. They may also breathe faster than usual or have noisy breathing. Babies might be fussier, feed less, or sleep more than normal.

Red Flags: When to Seek In-Person Care

Some signs mean your baby needs urgent medical attention. These include:

If you see any of these, go to the nearest healthcare facility or emergency room.

How Telemedicine Can Help

Telemedicine can be useful for initial advice and checking mild symptoms. A healthcare provider can ask about your baby's symptoms, watch breathing through video, and help decide if in-person care is needed. It is a convenient way to get guidance without leaving home.

Limitations of Telemedicine for Bronchiolitis

Telemedicine cannot replace a physical exam or tests that may be needed to check oxygen levels or lung function. If your baby shows red flags or worsens, an in-person visit is essential for proper treatment and monitoring.

Preparing for a Telemedicine Visit

Before your tele-visit, have the following ready:

This helps the provider make the best assessment.

How to prepare for your tele-visit

• Have a list of your infant's symptoms and their duration.
• Ensure you have a thermometer to measure temperature.
• Prepare to show your infant's breathing on video if possible.
• List any medications or treatments already given.
• Be ready to describe feeding patterns and diaper output.

After your tele-visit

• Follow the healthcare provider's advice on home care and symptom monitoring.
• Watch closely for any new or worsening red flags.
• Keep your infant hydrated and comfortable.
• Schedule an in-person visit if symptoms do not improve or worsen.
• Seek emergency care immediately if red flags develop after the tele-visit.

FAQs

What causes bronchiolitis in infants?

Bronchiolitis is usually caused by a viral infection, most commonly the respiratory syncytial virus (RSV). It leads to swelling and mucus in the small airways of the lungs, making breathing harder for infants.

Can bronchiolitis be treated at home?

Many infants with mild bronchiolitis improve with home care, such as keeping them hydrated, using a humidifier, and managing fever. However, close monitoring is important to catch any warning signs that need medical attention.

When should I take my baby to the hospital?

If your baby shows signs like difficulty breathing, blue lips or face, is very sleepy or hard to wake, or is not feeding at all, you should seek emergency medical care immediately.

Is bronchiolitis contagious?

Yes, bronchiolitis is contagious. It spreads through droplets from coughs or sneezes and by touching contaminated surfaces. Good hand hygiene and keeping sick people away from infants can help prevent it.

Can telemedicine replace in-person visits for bronchiolitis?

Telemedicine can help assess mild symptoms and provide advice but cannot replace physical exams or emergency care. If your infant has severe symptoms or red flags, an in-person visit is necessary.

Sources

1. Bronchiolitis — MedlinePlus, U.S. National Library of Medicine.
2. Respiratory Syncytial Virus Infection (RSV) — Centers for Disease Control and Prevention (CDC).
3. Bronchiolitis in Children — Mayo Clinic.
4. Bronchiolitis — American Academy of Pediatrics (AAP).

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If your infant has severe symptoms or red flags, seek immediate medical attention.