• An infant with bronchiolitis and high risk features requires immediate admission.
• For an infant with bronchiolitis and any intermediate risk features the need for hospital assessment will depend on clinical judgement, but the threshold for arranging this should be low. Arrange hospital assessment if:
• The infant was born prematurely, or has any significant health problems such as chronic respiratory disease or congenital heart disease.
• The carers are not able to cope with the child.
• There is any deterioration in the child's condition.
• An infant with bronchiolitis at low risk can be managed at home.
• For children who are managed at home advise carers to:
• Control fever and maintain hydration with self-care measures.
• Check on the child regularly, including through the night, and seek medical advice if the child deteriorates or they are unable to cope.

• Advise carers about particular features of deterioration that should prompt reconsultation:
• An increase in breathing rate, or any episodes of apnoea or signs of increased effort of breathing.
• A baby takes less than 50% of its normal feeds.
• Signs of dehydration such as dry mouth or infrequent passage of urine.
• A baby becomes less responsive or difficult to rouse.
• Persistent worsening in fever.

Basis for recommendations when to reconsult:

• The criteria for when to reconsult are adapted from admission criteria in the Scottish Intercollegiate Guidelines Network guidance on bronchiolitis, and the National Institute for Health and Clinical Excellence guideline on management of feverish illness in children [SIGN, 2006; NICE, 2007].