Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Apnoea, cyanosis or exhaustion
Apnoea, central cyanosis, reduced consciousness, poor respiratory effort or exhaustion indicates impending or established respiratory failure and may occur without prominent cough in a young infant.
Action: Call the paediatric emergency team, position and open the airway, give oxygen, support ventilation and monitor continuously. Check glucose and temperature, obtain intravenous or intraosseous access if needed and involve paediatric intensive care early. Treat alternative time-critical diagnoses including sepsis, congenital heart disease and upper-airway obstruction while stabilising.
Synopsis
Diagnose bronchiolitis clinically, grade respiratory and feeding risk by age and comorbidity, use the correct oxygen and admission thresholds, provide proportionate secretion and hydration support, and avoid ineffective medicines and investigations.
Bronchiolitis is a clinical diagnosis in a child under 2 years: 1–3 days of coryza followed by persistent cough, tachypnoea or recession and wheeze or crackles, usually peaking on days 3–5.
Young infants can present with apnoea before typical chest signs. Record gestation, chronological age, comorbidity, feeding and previous apnoea explicitly.
First-line assessment is respiratory rate, work of breathing, alertness, colour, pulse oximetry with a correctly sized probe, hydration and observed ability to feed.
Key red flags
Observed or reported apnoea, central cyanosis, poor respiratory effort, exhaustion or reduced responsiveness requires emergency hospital care.
Investigation priorities
01
First-line: clinical assessment and pulse oximetryFirst stepFirst line
Confirm the syndrome and determine respiratory, oxygen and feeding support needs.
Management branches
CommunityAssess referral risk
A child under 2 years has a typical bronchiolitis syndrome.
Measure respiratory effort, saturation where available, hydration and observed or reported intake.
Arrange emergency transfer for apnoea, cyanosis, severe distress or exhaustion; consider referral for persistent saturation below 92%, rate above 60, dehydration or reduced intake.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.