What supportive care measures are effective in managing bronchiolitis

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Supportive care measures effective in managing symptoms of bronchiolitis in infants include:

Monitoring the infant’s oxygen saturation using pulse oximetry and providing controlled supplementary oxygen if saturation is persistently below 92% (or below 90% for children over 6 weeks) to maintain adequate oxygenation ,.
Assessing and supporting hydration status by encouraging regular fluid intake; if oral intake is inadequate (less than 50–75% of usual volume) or if clinical dehydration is present, consider nasogastric or intravenous fluid administration ,.
Using antipyretics such as paracetamol or ibuprofen to relieve distress caused by fever, but not solely to reduce temperature; avoid tepid sponging or under-dressing to reduce fever .
Encouraging continued breastfeeding for infants who are breastfed .
Avoiding routine use of chest physiotherapy, antibiotics, bronchodilators (e.g., salbutamol), corticosteroids, adrenaline nebulisation, or hypertonic saline, as these are not recommended for bronchiolitis without comorbidities .
Considering upper airway suctioning only if there is respiratory distress or feeding difficulty due to secretions, or in cases of apnoea, but not routinely .
Providing parents and carers with clear safety netting advice, including signs of deterioration such as increased work of breathing, apnoea, cyanosis, reduced fluid intake, or lethargy, and advising them to seek medical help if these occur ,.
Advising carers not to smoke in the home environment, as exposure to tobacco smoke increases severity of symptoms .

What supportive care measures are effective in managing bronchiolitis symptoms in infants?