Return of bronchiolitis in babies: duration, up to what age?

Bronchiolitis is back in Octoberconfirms Public Health France. “Activity linked to bronchiolitis in children under two years of age is increasing in France.” Four regions have moved to the pre-epidemic phase (Grand-Est, Normandy, New Aquitaine and Pays-de-la-Loire). The increase in activity linked to bronchiolitis continues for medical procedures SOS doctorsfor the emergency visits as well as for hospitalizations after visits to the emergency room. “The increases are comparable to those observed in the two years prior to the same period, reflecting a early start again of activity linked to bronchiolitis” specifies the health agency. Bronchiolitis is an infectious disease due to respiratory syncytial virus (RSV) which affects the small bronchi And hinders breathing. She touches each year around 500,000 children aged 0 to 2 years.

Is bronchiolitis contagious?

Yes, bronchiolitis is a highly contagious viral disease. The bronchiolitis virus is transmitted very easily by direct contact, via respiratory secretions, or indirectly by hands, toys, clothes… Adults and older children who carry respiratory syncytial virus usually have no signs or have a simple cold. So many people carry the virus and are contagious without knowing it. Colds in children and adults can cause bronchiolitis in infants.

When to go to the Emergency Department in case of bronchiolitis?

You must call Samu at 15 or go to the Emergency Department if the baby:

• is less than six weeks old OR a former premature baby less than three months old.
• already has an identified respiratory or heart disease.
• refuses his bottles or taking the breast
• vomits systematically.
• turns blue, around the mouth.
• makes you feel unwell.
• pauses breathing
• His breathing becomes slow while remaining very difficult to breathe.
• no longer reacts, is very tired, sleeps all the time, whines.

What are the symptoms of bronchiolitis?

“The first signs of viral infection are a runny nose and mild cough. Then a difficulty breathing more or less important, and this Quite characteristic whistling noise“, explains the practitioner. Then comes a wet and productive coughand an reduction in diet caused by difficulty breathing. In addition to these digestive signs, the child may present irritability, fatigue and moderate fever. A isolated mild cough may be observed for up to 4 weeks.

What to do if a baby has bronchiolitis?

To avoid saturating pediatric emergency services and on the advice of Public Health France :

• Clean his nose at least 6 times a day with physiological serumespecially before giving him something to drink or eat
• Give him water to drink regularly to avoid dehydration.
• Good ventilation of the environment (room at less than 19°C at night), do not hesitate to get some fresh air with your baby during the day
• Don’t cover it too much
• Splitting meals (small amounts frequently) to ensure sufficient hydration.
• Never smoke near him
• Exclude all smoking in places where the child is: transporting the infant…
• Lay the infant on his back flat.

How long does bronchiolitis last?

According to Public Health Francein the majority of cases, the bronchiolitis heals spontaneously after 5 to 10 days but the cough may persist for 2 to 4 weeks.

Until what age can you get bronchiolitis?

Especially up to 2 years old. Bronchiolitis is a viral pathology that mainly affects children aged 0 to 2 yearswith a peak between 3 and 6 months. It specifically affects young children because their immune system is still under development. We think that almost all children under the age of two will contract this virusAnd that a third of them will develop bronchiolitis. “RSV alone represents half of bronchiolitis. The other half will be attributable to RSV associated with another virus, or to another virus alone“, he explains. Adults and older children who carry respiratory syncytial virus usually have no signs or have a simple cold.

What are the causes of bronchiolitis?

The term “bronchiolitis” includes all obstructive bronchiolitis due to different viruses but the respiratory syncytial virus (RSV) is the most common and the one that causes bronchiolitis in infants: before the age of 2, more than 9 out of 10 children have been in contact with this pneumovirus. “THE The caliber of an infant’s bronchioles is very small. The viral infection will affect the wall of these bronchioles, and will cause an inflammatory reaction, edema of the wall and hyper-secretion which will lead to obstruction of these bronchioles. This obstruction is all the easier as the caliber of these bronchioles is naturally small.“, explains Professor Delacourt. Furthermore, the infant boy has bronchi slightly narrower than those of a girl, which explains why it is more regularly affected. “From the moment the bronchioles are blocked, the distribution of air in the lung is heterogeneous, which causes whistling.“, he adds.

What are the treatments for bronchiolitis?

Bronchiolitis in infants evolves naturally towards healing on average within 10 days. “It’s a viral infection, so you have to limit yourself to symptomatic measures, and wait for the infection to pass and the bronchi to repair themselves. There is no specific treatment for this.”, explains the pediatrician. As soon as symptoms appear, you should consult your doctor or pediatrician.

► Mild forms do not require hospitalizationreminds her High Authority of Health : the primary care doctor (general practitioner, pediatrician, PMI, etc.) explains the technique of nose wash to parents and gives them advice on monitoring the evolution of their child’s health so that they know how to react in the event of warning signs.

► Moderate forms are subject to an assessment that can direct infants to treatment in town or, on a case-by-case basis, to hospital.

► The serious forms are immediately referred to the hospital and if necessary to an intensive care unit. Very young children under 6 weeks of age are also subject to systematic hospital monitoring.

THE traditional respiratory physiotherapy techniques such as clapping or vibration for example are contraindicated by the HAS. “There technique of increasing expiratory flow (AFE) is not effective in the management of infants hospitalized for acute bronchiolitis, adds the authority. Having not demonstrated its effectiveness for forms of bronchiolitis treated on an outpatient basis either, it is therefore not recommended.”

What medications can be given in case of bronchiolitis?

Bronchodilators, adrenaline, hypertonic saline, nebulization of hypertonic saline, systematic antibiotic therapy… The drug treatment is not indicated in the management of acute bronchiolitis. L’antibiotic therapy should be reserved for rare cases of bacterial superinfection. THE syrups cough suppressants and bronchial thinners are completely contraindicated.

Is respiratory physiotherapy recommended?

Respiratory physiotherapy is no longer recommended in the treatment of bronchiolitis of the children under 12 months, over there High Authority of Health since November 2019. “L’hascurrent analysis of the literature does not show a beneficial effect” she justifies. Several studies have shown that respiratory physiotherapy did not reduce hospitalization time of infants with bronchiolitis. For physiotherapist unions, their support “goes much further than simple bronchial drainage” . “The physiotherapist examines, evaluates and redirects the baby to the emergency room or the attending physician if necessary. He reassures and supports the parents. He is a key player in health education” they recalled in a communicated. In practice, the respiratory physiotherapy is still used in certain children with bronchiolitis but rather in those for whom the disease is less obstructive.

What are the signs of seriousness of bronchiolitis? When to consult?

A child with bronchiolitis should be monitored especially during the first 48 hours from the start of respiratory symptoms because this is the period during which everything is likely to get worse. Certain signs, if they persist after a nose wash, require you to make an appointment with a doctor for your baby to be re-examined. Consult a healthcare professional or your child’s pediatrician if your child has less than 3 months, is formerly premature, has a chronic illness or if he presents one of the following signs:

• His behavior changes and seems unusual to you (he is tired; less responsive or very agitated; whines a little).
• His breathing became faster.
• The child’s stomach rises, the spaces between the ribs widen,
• A very high fever,
• He drinks less well over several consecutive meals (less than half the quantity usually drunk in 24 hours).

What are the hospitalization conditions in case of bronchiolitis?

Bronchiolitis is the leading cause of hospitalization in pediatrics during the winter. “The elements of concern which will lead the doctor to recommend hospital treatment are: significant undernutritiona very significant respiratory discomfortor the fact that he seems very sleepy and not very active”, warns Professor Delacourt. In the most serious stages, hospitalization can be done in intensive care or resuscitation unit. Bronchiolitis in infants is a pathology to be taken seriously, particularly in very young children, and in particular those under 6 weeks of age. In this case, hospital care is necessary,”because they are more at risk of respiratory apnea“, specifies the doctor.

Some more fragile children are particularly at risk of severe complications from bronchiolitis, such as those affected by other pathologies and premature babies. For these there is preventive treatment available on the French market. It’s about antibody injections (Palivizumab), to be done monthly during the first two winters, and protecting against RSV. For other infants (less than one year old), a vaccine developed by Sanofi and AstraZeneca, called Beyfortus has been approved by the European Medicines Agency. It is not available in France at the moment. Apart from these solutions, there are good actions to prevent bronchiolitis: wash your hands regularly, avoid taking your child into crowded places, regularly wash their comforters and toys, open the window to ventilate, etc.

Thanks to Professor Christophe Delacourt, Pneumology-Allergology Department – Necker-Enfants Malades Hospital – AP-HP.