Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of asthma in children and adolescents and bronchiolitis in infants and young children
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In infants and children aged less than 2 years presenting or hospitalized with suspected bronchiolitis, routine use of chest X-ray is not suggested for the initial diagnosis and management of bronchiolitis.
Recommended against
Conditional
Certainty of evidence
Very low
Notes and Remarks
- Chest X-ray for hospitalized infants and children with suspected bronchiolitis should only be considered on a case-by-case basis; for example, in the following clinical situations:
- if there is high suspicion for other alternate diagnosis or underlying cardiac or chronic lung disease related to risk factors elicited on history or physical examination;
- if a child fails to respond to treatment or persistent symptoms for more than 2 weeks without improvement;
- if there is suspected bacterial superinfection or recurrent episodes of pneumonia;
- if there is severe respiratory distress or severe hypoxaemia requiring admission to high care or intensive care;
- where a complication, such as effusion or pneumothorax, may be suspected; for example, when there are unilateral signs of severe dullness to percussion or absent breath sounds.
- Implementation will require family engagement through effective communication regarding the diagnosis and natural course of the illness. Caregivers should be informed that most cases of bronchiolitis resolve without the need for tests or medications, and that a CXR is unlikely to change the diagnosis and could lead to unnecessary use of antibiotics and exposure to radiation.
- Targeted quality improvement strategies that include the use of clinical champions, implementation of local clinical pathways based on national guidelines, focused educational delivery, educational materials, and audit and feedback may be required to ensure adherence (192).