Baby bronchiolitis (2023): treatment, symptoms, what to do?

SUMMARY :

Where is the bronchiolitis epidemic in France?

In week 04, the trend is towards stabilization for the monitoring indicators of bronchiolitis in children under two years of age, indicates Public Health France in its epidemiological bulletin of February 1, 2023.bronchiolitis outbreak is declining in the majority of regions in metropolitan France and no department is in the epidemic phase except Mayotte: the end of the epidemic has been decreed in Île-de-France and Brittany, and Burgundy-Franche-Comté, Nouvelle-Aquitaine and Provence-Alpes-Côte d’Azur have entered the post-epidemic phase.

Cases of bronchiolitis represent 22% of hospitalizations following a visit to the emergency room in children under 2 years of age, a decrease of 4% compared to S03.

Bronchiolitis almost exclusively affects babies under 1 year old. Public Health France specifies that among the 1,540 children under 2 years old seen in the emergency room for bronchiolitis in week 04 (from January 23 to 29, 2023), 93% (1,433) were under 1 year old and 39% (596 ) were hospitalized. Of the 596 children hospitalized, 568 (95%) were under 1 year old.

[#Bronchiolite]
➡️ Stabilization at a moderate level of emergency room visits and hospitalizations
↘️ Reduction of medical acts @SOSMEDECINSFRAN
To view the February 1 bulletin https://t.co/qpmPPpnaTipic.twitter.com/Qn3HNFYsUX

– SantépubliqueFrance (@SantePublicFr) February 1, 2023

What is bronchiolitis?

Bronchiolitis (or “acute bronchiolitis in infants” in medical language) is a viral infection that mainly affects children under the age of 2. Far from being rare, it affects 3 out of 10 babies every year in France, with an average of 480,000 annual cases recorded.

If bronchiolitis preferentially affects infants not older children and adultsit is due to the presence of antibodies only present in babies, explained researchers from the Institut Pasteur, in a study published in 2017.

To know. The “epidemic peak” of the disease usually extends from November to February : this is where you have to be vigilant!

What are the symptoms in infants?

THE infant bronchiolitis symptoms are easily recognizable:

• A cold with a low fever (above 37.5°C),
• A dry cough,
• wheezing,
• Feeding difficulties.

“At the very beginning, baby has a runny nose and a small fever” explains Dr Sydney Sebban, pediatrician and medical coordinator of the Bronchiolitis Île-de-France network. But very quickly, the virus, having entered the bronchioles, these fine bronchi which bring air to the lungs, creates inflammation. The latter in turn causes hypersecretion of mucus which will clog the bronchioles. Your baby has trouble breathing. He coughs, his breathing is rapid and sometimes wheezing.

It’s serious ? Despite sometimes impressive symptoms, bronchiolitis is a benign disease. The symptoms subside (without treatment) within a few days, and the child recovers within 8 to 10 days, although the cough may persist for a fortnight.

Read also: Baby bronchiolitis: when to go (imperatively) to the emergency room?

Be careful, go to the emergency room if:

• The fever lasts more than 48 hours;
• The baby is very sleepy;
• He takes less than 50% of his bottles;
• He is less than two months old;
• her crying is excessive;
• He was born prematurely;
• He has a chronic illness;
• He is having more and more trouble breathing.

How to avoid bronchiolitis?

The pediatricians of the French Association of Ambulatory Pediatrics recall that to protect the smallest and most vulnerable, it is urgent to strengthen barrier measures which have shown their effectiveness during the covid-19 pandemic: ventilation of premises, hand hygiene, wearing a mask to limit the transmission of the virus, distancing.

To prevent bronchiolitisparents of infants can also:

• Limit visits to the circle of very close and not sick adults, no kisses or passage from arm to arm, no visit from young children before the age of 3 months;
• Wash your hands before and after contact with the baby (especially when changing, breastfeeding, bottle or meal);
• Regularly wash toys and comforters;
• Wear a mask yourself in case of a cold, cough or fever;
• If the rest of the siblings show symptoms of viral infection, keep them away from the baby in the acute phase of the infection;
• Avoid family reunions, crowded and closed places such as supermarkets, restaurants or public transport as much as possible, especially if the child is less than three months old;
• Ventilate the child’s living space daily, especially the bedroom where he sleeps;
• Avoid entering the community (nurseries, nurseries, etc.) before 3 months, do not entrust your child to the community on the days when he shows symptoms of viral infection;
• Plan his first vaccinations without delay so that he is protected as quickly as possible from severe infections in early childhood;
• Be up to date with your whooping cough vaccinations yourself, get vaccinated against the flu (ideally during pregnancy in the epidemic season);

Christèle Gras-Le Guen, president of the French Society of Pediatrics, and head of the pediatric emergency department of the Nantes University Hospital invited in October 2021 on France Info, to protect babies from bronchiolitis by limiting “visits to the circle of very close, non-sick adults”. She also advises “as far as possible”, not to take public transport, not to go to the supermarket or restaurant with babies. “These are indeed places where viruses circulate a lot, and which have absolutely no interest for a young child under two months. As far as possible, you must organize yourself to avoid places where there are a lot of of people, and of course also the big family celebrations.

What to do in case of bronchiolitis in a baby?

No medication in case of bronchiolitis in infants: according to the High Authority for Health (HAS), ” bronchodilators, adrenaline, hypertonic saline have no indication in this disease “. Antibiotics are only called for in rare cases of bacterial superinfection – remember that they do not work on viruses!

To avoid… The techniques of respiratory physiotherapy traditional (clapping or vibrations) are “contraindicated“. The technique of increasing expiratory flow (EFA) has “not proven effective” et “is therefore not recommended“.

To overcome this disease (which is mild in the vast majority of cases) HAS only recommends the nose wash and special monitoring of the little patient.

To know. It is necessary to go to the doctor quickly if the child has difficulty breathing and/or if he no longer drinks. You must call the emergency services (15 or 112) if the child has a bluish mouth, if he feels unwell, if he sleeps all the time or if he seems to have apnea from time to time!

Read also:Why the respiratory physiotherapist questions

In video, 3 misconceptions about the disease

Is there a vaccine for bronchiolitis?

The French laboratory Sanofi, in collaboration with the AstraZeneca laboratory, announced at the beginning of September that it was working on the development of a vaccine against bronchiolitis in infants. This vaccine, baptized “Nirsevimab”, has been tested on 2300 children, and its efficiency is estimated at 79.5%. But as phase 3 clinical trials are still in their very early stages, the vaccine should not be available before 2023. The European Medicines Agency must first decide on its marketing.

Is bronchiolitis contagious? How is it transmitted? How long?

Bronchiolitis is a disease “extremely” contagious, according to Health Insurance. The virus can be transmitted in two ways:

• The contagion can be done directly from person to person, through bronchial secretions (sneezing, sputtering, coughing, blowing your nose, etc.) or contact between people (kissing),
• Indirectly, through the hands or objects soiled by saliva (toys, towels, contaminated food or drink, etc.).

How long? Without complications, bronchiolitis heals by 7 to 10 days.

What are the treatments for bronchiolitis?

The Treatment of baby’s bronchiolitis essentially consists of treat symptoms : washing the nose with physiological serumif necessary, additional supply of oxygen. Chest physiotherapy is no longer recommended since 2020. “Bronchodilator drugs and mucolytics are also of no use in the treatment of bronchiolitis“, explains the Health Insurance. In addition, the antitussives, expectorants and thinners are contraindicated in children under 2 years old.

Finally, since bronchiolitis is caused by a virus, antibiotic treatment has no effect. Antibiotics are prescribed only in case of bacterial superinfection.

Depending on your infant’s age, medical condition, and severity of bronchiolitis, your doctor judge of the need for a possible hospitalization of your infant for monitoring.

If the bronchiolitis is not severe (therefore does not require hospitalization) your doctor will give you advice on monitoring your child, particularly during the first two days. He also explains the warning signs that you should consult again and reschedules, if necessary, a new consultation to check that the bronchiolitis is on the way to healing.

Don’t look for “natural remedies“, bronchiolitis can be severe if it is not taken care of. A consultation is essential.

To remember :

• Make sure your child is breathing properly: unclutter his nose before meals and regularly (as many times as necessary) by washing the nose; when awake, keep your child upright, this can help him breathe better; Avoid exposing your child to passive smoking. Read also: How to blow your baby’s nose?
• See to split meals so that he continues to eat despite the loss of appetite and offer him water frequently.
• In case of fever, dress him lightly and monitor his temperature. Unless contraindicated, give paracetamol if necessary. Do not overheat his room (19°C max). Read also: Baby fever, when to go to the emergency room?
• Be attentive to any change in behavior (the baby moves less, reacts less…).

When to consult the doctor again or dial 15?

During the duration of the bronchiolitis and especially the first two days, monitor your baby’s health and see your doctor again if:

• Your child has a beating of the wings of the nose, intercostal indrawing (to breathe he digs his chest) or begins to breathe more quickly;
• Its temperature rises;
• You fail to feed him or get him to drink enough to keep him well hydrated;
• Your child’s behavior changes (he cries, he is less reactive, etc.)

Contact 15 if:

• He pauses for breath;
• His breathing becomes slow and he remains very embarrassed to breathe;
• He feels unwell;
• He no longer reacts, is very tired, sleeps all the time, moans;
• It turns blue around the mouth;
• He refuses to drink bottles or breastfeed.

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