Baby bronchiolitis 2022: symptoms, consult or not?

BRONCHIOLITIS EPIDEMIC. The bronchiolitis epidemic is early this year with emergency services already saturated. Symptoms, duration, when to go to the ER (or not), when to see a doctor (or not): practical info.

[Updated October 24, 2022 at 11:12 a.m.] Bronchiolitis is an infectious disease caused by respiratory syncytial virus (VRS) that affects small bronchi and interfere with breathing. L' 2022-2023 epidemic has already started . After the Hauts-de-France, Ile-de-France, New Aquitaine and Occitanie , ' the regions Auvergne-Rhône-Alpes, Burgundy-Franche-Comté, Brittany, Centre-Val de Loire, Grand Est, Guyana, Normandy and Pays de la Loire are passed into epidemic phase ' indicate Public Health France October 19. The cases in children under 2 years are increasing. 'The outpatient and hospital pediatrics is under great strain due to an earlier outbreak of bronchiolitis, more brutal and more intense than previous years ' warns the French Association of Ambulatory Pediatrics (AFPA) in a communicated of October 23. In open letter to the President of the Republic Emmanuel Macron , more than 4,000 caregivers denounce the saturation of pediatric services, particularly linked to the bronchiolitis epidemic. The AFPA pediatricians encourage parents to be better informed , to adopt a responsible attitude going to the emergency room only if the child requires hospital care and avoiding unjustified consultations in town. What are the warning signs bronchiolitis? What to do ? When to worry? What risks of 'hospitalisation ? How long does it last ?

Where is the 2022 bronchiolitis epidemic?

'The bronchiolitis virus arises through winter epidemic . It usually starts beginning of November and ending at the end of January. The epidemic peak is reached in the first half of december ', recalls Professor Christophe Delacourt, pneumo-pediatrician at Necker Hospital. the practitioner. The bronchiolitis epidemic is early this year with already saturated Emergency services and a ten regions in the epidemic phase. According to surveillance point published by Santé Publique France on October 19, bronchiolitis continues to increase in France in children under 2 years of age. 'Of the 2,959 children under 2 seen in the emergency room for bronchiolitis in week 41, 93% were under 1 year old and 33% were hospitalized. Of the 973 children hospitalized, 96% were under 1 year old “, specifies the health organization. Surveillance of infant bronchiolitis for the 2022-23 winter season helps to monitoring the transmission of respiratory syncytial virus (RSV), main responsible des bronchiolites du nourrisson. A typical season of bronchiolitis is the source, each week, of 5 to 6,000 visits to pediatric emergencies and approximately 2,000 hospitalizations in France , recalled the Scientific Council of Covid in an Opinion of October 2021.

When to go to the emergency room in case of bronchiolitis?

Call Samu on 15 or go to Emergency if the baby:

  • is less than six weeks old OR a former preemie less than three months old.
  • already has an identified respiratory or cardiac disease.
  • refuses her bottles or to breastfeed
  • regularly vomits.
  • turns blue, around the mouth.
  • makes you feel unwell.
  • takes breathing pauses
  • His breathing becomes slow while remaining very embarrassed to breathe.
  • unresponsive, very tired, sleeps all the time, moans.
  emergency bronchiolitis afpa recommendations october 2022
Recommendations from Afpa-Bronchiolitis and Emergencies

What are the symptoms of bronchiolitis?

' The first signs of infection virale are a runny nose and mild cough . Then will gradually settle a difficulty breathing more or less important, and rather characteristic hissing noise ' , details the practitioner. Then comes a cough fat and productive , and an decrease in food caused by difficulty breathing. In addition to these digestive signs, the child may show irritability, fatigue and moderate fever. A isolated mild cough may be observed for up to 4 weeks .

What if the child has symptoms of bronchiolitis?

To avoid overloading pediatric emergency services:

  • Frequent nasal washing (nasopharyngeal clearing) using saline, especially before meals.
  • Good ventilation of the environment (bedroom less than 19°C at night), do not hesitate to get some air with your baby during the day
  • Splitting meals (small amounts frequently) to ensure sufficient hydration.
  • Exclude all smoking in places where infants live and are transported.
  • Lay the infant flat on his back.
  Respiratory system
Respiratory system

How to wash the nose of the baby who has bronchiolitis?

This is a painless gesture which consists of instilling serum into the nostrils to evacuate nasal secretions and relieve the infant.

  • Wash your hands and take single-use saline pods.
  • Lay your baby on his back or on his side and imperatively keep his head on the side (to avoid the risk of 'wrong route' or the passage of serum in the respiratory tract).
  • Gently place the tip of the pod at the entrance to the highest nostril, relative to your baby's position.
  • Press the pod to fully insert its contents into the nostril. At the same time, close your child's mouth so that the serum comes out the other nostril along with the nasal secretions.
  • Wait until your baby has swallowed properly.
  • Wipe his nose with a disposable tissue.
  • Repeat this for the other nostril using another pod, laying your baby down and turning their head to the other side.

Is bronchiolitis contagious?

Bronchiolitis is a highly contagious viral disease . RSV is transmitted very easily, either by direct contact, via the respiratory secretions, either by indirect transmission: mains , toys , clothes … The common cold in children and adults can cause bronchiolitis in infants. Hand washing is essential.

What is bronchiolitis?

' The bronchiolitis is a viral infection that affects the small bronchi, bronchioles ', explains Professor Christophe Delacourt, pneumo-pediatrician at the Necker hospital. The disease is defined by a acute episode of difficulty breathing (rhinitis sequence followed by respiratory signs: coughing, wheezing and/or crackles , with or without polypnea and/or signs of respiratory struggle) at any time of the year. In France, it affects 30% of infants under 2 years old each winter ; 2 to 3% of children under the age of one are hospitalized per year for severe bronchiolitis.

How long does bronchiolitis last?

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

Until what age can you get bronchiolitis?

Bronchiolitis is a viral disease that affects around 500,000 children between the ages of 0 and 2 each year , with a peak between 3 and 6 months. It specifically affects young children, which can be explained by the fact that their immune system is still developing . On estimate that almost all children under the age of two will contract this virus , and that a third of them will develop bronchiolitis . ' RSV alone accounts for 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 are carriers of the 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 years, more than 9 out of 10 children have been in contact with this pneumovirus. ' 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 , an edema of the wall and a hyper-secretion which will lead to the obstruction of these bronchioles. This obstruction is all the easier as the caliber of these bronchioles is naturally small. ', explains Professor Delacourt. In addition, the infant boy has slightly narrower bronchi than those of a girl, which explains why it is more regularly affected. ' From the moment the bronchioles are obstructed, the distribution of air in the lung is heterogeneous, which causes wheezing. “, he adds.

What virus causes bronchiolitis?

The term 'bronchiolitis' includes all obstructive bronchiolitis due to different viruses, but the respiratory syncytial virus (RSV) is the most common (60 to 75% of bronchiolitis) 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 RSV bronchiolitis are particularly severe . The risk of hospitalization is higher than in other bronchiolitis.

Chest physiotherapy is no longer recommended for the treatment of bronchiolitis in children under 12 months of age.

What are the treatments for bronchiolitis?

infant bronchiolitis evolves naturally towards healing on average within 10 days . 'It's a viral infection, so you have to limit oneself to symptomatic measures, and wait for the infection to pass and the bronchi to repair. There is no specific treatment for this' , details the pediatrician. As soon as symptoms appear, you should consult your doctor or pediatrician.

Mild forms do not require hospitalization , remind the High Authority of Health : the primary care physician (general practitioner, pediatrician, PMI, etc.) explains the technique of nose wash to parents and gives them advice on how to monitor the progress of their child's state of health so that they know how to react in the event of warning signs.

Moderate forms are the subject of an assessment that can direct the infants to care in the community or, on a case-by-case basis, to the hospital.

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

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

What medications can be given for bronchiolitis?

Bronchodilators, adrenaline, hypertonic saline, hypertonic saline nebulization, 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 sirops Antitussives and bronchial thinners are downright contraindicated.

Is respiratory physio recommended?

Chest 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. traditional respiratory physiotherapy techniques such as clapping or vibration, for example, are even contraindicated by the HAS. 'L' a current analysis of the literature does not show a beneficial effect ' she justifies. Several studies have shown that respiratory physio did not reduce hospitalization time infants with bronchiolitis. For the unions of physiotherapists, their support 'goes much further than simple bronchial drainage' . 'The physiotherapist examines, assesses and redirects the baby to the emergency room or the attending physician if necessary. He reassures and accompanies the parents. He is a key player in health education' they recalled in a communicated . Without forgetting that 'the establishment of networks of physiotherapists from the 2000s has made it possible to significantly reduce the use of emergencies'. In practice, the respiratory physiotherapy is still used in some children with bronchiolitis but rather in those for whom the disease is less obstructive .

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

It is necessary to monitor a child with bronchiolitis especially the first 48 hours in relation to the onset of respiratory symptoms because this is the period during which everything is likely to get worse. Some signs, if they persist after a nose wash, require making 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 condition, or has 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 belly rises, the spaces between the ribs widen,
  • A very high fever,
  • He drinks less well over several consecutive meals (less than half the amount usually drunk in 24 hours).

What are the risks of hospitalization in case of bronchiolitis?

Bronchiolitis is the leading cause of pediatric hospitalizations during the winter. 'The elements of concern that will lead the doctor to recommend hospital treatment are: a severe undernourishment , a severe difficulty breathing , or the fact that he seems very sleepy and inactive', warns Professor Delacourt. In the most serious stages, hospitalization can be done in intensive care or resuscitation unit . Infantile bronchiolitis is a pathology to be taken seriously , especially in very young children, and particularly those under 6 weeks of age. In this case, hospital care is necessary, ' because they are more at risk of respiratory apnea “, says the doctor.

How to avoid bronchiolitis? Is there a vaccine?

Some more fragile children are particularly at risk of severe complications from bronchiolitis, such as those with other conditions and premature babies. For these there is a 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 (under 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. For it to be, it must be validated by the European Commission and by national health authorities. Finally, for all children, especially children under 12 months, several bronchiolitis prevention tips should be applied.

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

Bronchiolitis Epidemic: Overloaded Pediatric ERs? Mpedia, October 22, 2022

'A peaceful situation: when and how to alleviate?' Opinion of the COVID-19 Scientific Council October 5, 2021.

Bronchiolitis: winter surveillance report 2020-2021. French public health. Updated August 12, 2021.

RSV Bronchiolitis: A potentially serious disease for infants that requires extra vigilance now and throughout the winter. AstraZeneca press release. September 30, 2021.

Management of the 1st episode of acute bronchiolitis in infants under 12 months. Best Practice Recommendation - November 14, 2019.

Bronchiolitis: HAS recommendations misinterpreted. Physical therapy is important in the overall management of bronchiolitis in infants, November 14, 2019.