Bronchiolitis (baby): symptoms, treatment, duration?

"Bronchiolitis is a viral infectious disease that affects the small bronchi, the bronchioles", explains Professor Christophe Delacourt, pneumo-pediatrician at Necker Hospital. The disease is defined by an acute episode of respiratory discomfort (rhinitis sequence followed by respiratory signs: cough, wheezing and/or crackles, accompanied or not by polypnea and/or signs of respiratory struggle) at any time of the year. . In France, it affects 30% of infants under the age of 2 each winter; 2 to 3% of children under the age of one are hospitalized each year for severe bronchiolitis. What are the warning signs of bronchiolitis? What to do ? When to worry? What are the risks of hospitalization? How long does it last? Info.

What is bronchiolitis?

"Bronchiolitis is a viral infectious disease that affects the small bronchi, the bronchioles", explains Professor Christophe Delacourt, pneumo-pediatrician at Necker Hospital. The disease is defined by an acute episode of respiratory discomfort (rhinitis sequence followed by respiratory signs: cough, wheezing and/or crackles, accompanied or not by polypnea and/or signs of respiratory struggle) at any time of the year. . In France, it affects 30% of infants under the age of 2 each winter; 2 to 3% of children under the age of one are hospitalized per year for severe bronchiolitis.

What is the virus responsible for 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 age 2, more than 9 out of 10 children have been in contact with this pneumovirus. RSV bronchiolitis is particularly severe. The risk of hospitalization is higher than in other bronchiolitis.

How long does bronchiolitis last?

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

Until what age?

Bronchiolitis is a viral pathology that affects around 500,000 children between the ages of 0 and 2 every 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 under development. It is estimated 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 with another virus alone", he explains. Adults and older children who carry respiratory syncytial virus usually have no signs or just a cold.

What are the causes ?

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 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 the obstruction of these bronchioles. This obstruction is all the easier since 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 he 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 are the symptoms of bronchiolitis?

“The first signs of viral infection are a runny nose and a slight cough. Then more or less significant respiratory discomfort will gradually set in, and this fairly characteristic whistling noise”, explains the practitioner. This is followed by a fatty and productive cough, and a decrease in food intake caused by difficulty breathing. In addition to these digestive signs, the child may present with irritability, fatigue and moderate fever. An isolated mild cough may be observed for up to 4 weeks. "As soon as these symptoms appear, consult your local doctor or pediatrician" recommends the Ile-de-France Bronchiolitis network.

Is it contagious ?

Bronchiolitis is a highly contagious viral disease. RSV is transmitted very easily, either by direct contact, via respiratory secretions, or by indirect transmission: hands, toys, clothes... Colds in children and adults can cause bronchiolitis in the baby. Hand washing is essential.

How is the diagnosis made?

Bronchiolitis is usually easily diagnosed by a doctor's physical examination, without the need for additional tests. “The doctor will look for signs requiring possible hospital monitoring, to find out if bronchiolitis can be treated easily at home,” he concludes.

What are the treatments for bronchiolitis?

Infant bronchiolitis naturally evolves towards recovery 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. 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 hospitalization, reminds the High Authority of Health: the primary care physician (general practitioner, pediatrician, PMI, etc.) explains the technique of nose washing to parents and gives them advice on how to monitor the evolution 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 guide infants towards care in town or, on a case-by-case basis, in hospital.

► 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.

To relieve the little patient, it is necessary:

Traditional respiratory physiotherapy techniques such as clapping or vibration, for example, are contraindicated by HAS. "The technique of increased expiratory flow (EFA) is not effective in the management of infants hospitalized with acute bronchiolitis, adds the authority. Having not demonstrated its effectiveness for the forms of bronchiolitis treated on an outpatient basis either, so it is not recommended."

How to wash the baby's nose?

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

What medications can be given for bronchiolitis?

Bronchodilators, adrenaline, hypertonic saline, nebulization of hypertonic saline, systematic antibiotic therapy... Drug treatment is not indicated in the management of acute bronchiolitis. Antibiotic therapy should be reserved for rare cases of bacterial superinfection. Cough syrups and bronchial thinners are downright contraindicated.

Is respiratory physio recommended?

Respiratory physiotherapy is no longer recommended in the treatment of bronchiolitis in children under 12 months by the Haute Autorité de Santé since November 2019. Traditional respiratory physiotherapy techniques such as clapping or vibration for example are even contraindicated. by HAS. "The current analysis of the literature does not show a beneficial effect" she justifies. Several studies have shown that respiratory physiotherapy does not reduce the hospitalization time of infants with bronchiolitis. For the unions of physiotherapists, their care "goes much further than simple bronchial drainage". "The physiotherapist auscultates, 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 press release. 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, respiratory physiotherapy is still used in some children with bronchiolitis, but rather in those for whom the disease is less obstructive.

What are the signs of complications to watch out for?

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 you to make an appointment with a doctor to have your baby re-examined:

When to go to the emergency room?

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

What are the risks of hospitalization?

Bronchiolitis is the leading cause of hospitalization in pediatrics during the winter. "The elements of concern that will lead the doctor to recommend hospital care are: significant undernourishment, very significant respiratory discomfort, or the fact that he seems very sleepy and not very active", warns Professor Delacourt . In the most serious stages, hospitalization can be in an intensive care or resuscitation unit. Infant bronchiolitis is a pathology to be taken seriously, especially 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.

How to avoid it?

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 a preventive treatment. These are injections of antibodies (Palivizumab), to be done monthly during the first two winters, and protecting against RSV. For other children, especially children under 12 months, several bronchiolitis prevention tips should be applied.

When does bronchiolitis end?

"The bronchiolitis virus occurs by winter epidemic. It generally begins at the beginning of November and ends at the end of January. The epidemic peak is reached in the first half of December", specifies the practitioner. A typical season of bronchiolitis is at the origin, each week, of 5 to 6,000 visits to pediatric emergencies and around 2,000 hospitalizations in France, recalled the Scientific Council of Covid in an Opinion of October 2021.

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

Sources:

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

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

RSV bronchiolitis: a potentially serious disease for infants that requires increased 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. Recommendation of good practice - November 14, 2019.

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