Explain bronchiolitis and its home care to a worried parent — OSCE

Candidate instructions

You are the paediatric registrar. A 5-month-old girl with moderate bronchiolitis has been settled with gentle nasal suction and support for her feeding, and is now feeding better and saturating well. Her mother has ten minutes with you. She wants to understand, in plain language: (1) what bronchiolitis is; (2) why she is not being given antibiotics or an inhaler; (3) whether it will get worse; and (4) exactly what to watch for and when to come back. Explain with empathy, check understanding, and agree a clear plan. [1]

Encounter

Mother: "What actually is bronchiolitis? All that wheezing and fast breathing scared me." [2]

Registrar: "It is frightening to watch, so I understand completely. Bronchiolitis is a common chest infection caused by a cold-type virus, usually one called RSV. The virus swells and clogs the tiniest breathing tubes deep in the lungs, and that is what makes her breathe fast, wheeze and cough and find feeding harder. It is very common in babies in winter, and the good news is that it almost always gets better on its own over one to two weeks." [2] [4]

Mother: "So why no antibiotics, and why not an inhaler like my older son has?" [3]

Registrar: "Both are really reasonable questions. Antibiotics only work against bacteria, and this is a virus, so they would not help her and could cause side effects. And the inhaler your son uses relaxes tight muscles in the airways — but in bronchiolitis the tubes are blocked by swelling and mucus rather than tight muscle, so careful studies show inhalers do not help babies with this illness. What genuinely helps her is keeping her feeding, keeping her comfortable, and giving oxygen only if her levels dip." [3] [1]

Mother: "Will she get worse before she gets better?" [1]

Registrar: "She might, and it helps to know that in advance. Bronchiolitis often peaks around the third to fifth day before it turns the corner, so her cough and breathing may be a little worse over the next day or two even though nothing has gone wrong. The cough can also linger for a few weeks after she is otherwise well. What we watch for is not the cough itself but her breathing effort, her feeding and her colour." [1] [2]

Mother: "So when do I need to bring her back?" [1]

Registrar: "Here is the clear plan. Come back urgently — call an ambulance if needed — if she has any pauses in her breathing or goes pale or blue; if her breathing looks much harder, with the skin sucking in around the ribs or at the base of the neck; if she feeds less than about half or has far fewer wet nappies; or if she becomes floppy, very drowsy or hard to wake. And trust your instinct — if you are worried, bring her in. Shall I write these down for you?" [1]

Mother: "Yes, please. That makes it much clearer." [2]

Registrar: "I will give you a written bronchiolitis fact sheet with those warning signs and our number. To check I have explained it well — can you tell me the three main things that would make you bring her straight back?" [1]

Examiner debrief

A strong candidate explains bronchiolitis in plain language (a viral infection swelling the smallest airways), justifies withholding antibiotics and bronchodilators with the evidence rather than dismissing the mother's concern, warns explicitly that the illness often peaks around days three to five and that cough can linger, and gives concrete, specific return advice focused on breathing effort, feeding and colour. They check understanding with teach-back and provide written information. Pitfalls include prescribing antibiotics or an inhaler to satisfy the parent, vague safety-netting such as "come back if worse", and failing to warn about the normal mid-illness deterioration. [1] [3]