A Guide for Providers:The Facts Behind Common Respiratory Virus Misconceptions
During cold, flu and RSV season, parents and providers alike often have questions about viral respiratory symptom severity and when a visit to the emergency department is recommended. Below are some common misconceptions our clinicians often hear about respiratory viruses – click on each to see the facts and tips from the pediatric healthcare experts at Valley Children’s.
The wheezing in bronchiolitis is caused by a different process than the wheezing in asthma and breathing treatments and steroids will not make a difference unless the child also has asthma.
Chest X-rays are not recommended in typical bronchiolitis as they lead to increased use of antibiotics without benefit to the patient.
Saturation > 89% is acceptable in children with bronchiolitis. Lower saturations are normal with known viral illness. Transient desaturations to < 90% are also normal and unless sustained do not warrant emergency or inpatient care.
There is no evidence to support the need for a nap test. Healthy infants with bronchiolitis experience self-resolving desaturations in sleep. This is normal and not dangerous.
Transient desaturation after administration of albuterol is a normal physiologic phenomenon. Children whose saturations do not recover to >/= 89% within 30 minutes should be evaluated as this would not be typical.
The use of home pulse oximetry has been shown to lead to increased use of healthcare without benefit to the patients. It also contributes to alarm fatigue and does not reliably detect meaningful hypoxia.
Infants who are energetic, feeding well, urinating and not irritable who are comfortably tachypneic can be managed safely at home.
Reasons to seek emergency medical attention are significant difficulty breathing (flaring of the nostrils, rapid or labored breathing, sucking in of ribs with breathing, grunting, bobbing of the head with breathing, color change), irritability, lethargy, significant decrease in oral intake or urination. Patients displaying these symptoms should be directed to seek emergency care immediately.
Learn More: Bronchiolitis Guidelines
Valley Children's pediatric specialists have developed outpatient, inpatient and emergency department bronchiolitis guidelines for providers. Click here to access the guidelines
Have questions? To contact our Provider Assistance Line, call 559-353-8800
To arrange transport or for urgent consultations with a Valley Children's specialist, call our 24/7 Access Center at 866-353-KIDS (5437)