Coughing, fast breathing and wheezing … These symptoms characterize bronchiolitis. This small bronchial infection affects 480,000 infants each winter, nearly one in three (30%) children under two years of age.
In the presence of this disease, for decades, doctors prescribe respiratory physiotherapy. It consists in helping the baby to evacuate the mucus towards the throat and the mouth by manual pressure on the ribs, the belly.
Parents who have used it always remember it. And it's rarely a good memory. This technique is now discouraged by the High Health Authority (HAS), in its new recommendations.
A counterproductive method
"We have no level of evidence of this method.In hospitalized children with the most severe forms, respiratory physiotherapy is not only useless but surely counterproductive.This will worsen the condition of the child, who is already tired and has trouble breathing, "said Professor Pierre-Louis Druais, general practitioner and vice-chairman of the recommendations commission of the HAS.
In detail, the respiratory physio is therefore "contraindicated" in the hospital, and "not recommended" in city medicine.
"We are the only country with Belgium to prescribe the respiratory kin.In other countries, we see that the evolution is not more pejorative: children heal in the same way," adds Pierre-Louis Druais.
Three stages of gravity
For the first time, the Haute Autorite de Sante and the National Professional Council of Pediatrics (CNPP) have defined three stages of severity for this pathology.
The light forms, in which the baby continues to take more than half of his usual diet, do not require hospitalization: the primary care physician (general practitioner, pediatrician, PMI …) explains the technique of washing the nose to parents and gives them advice to monitor the progress of their child's health.
As for moderate forms, with a food intake less than half of the usual quantities, the institution considers that they should be evaluated for an orientation towards care in the city or, on a case-by-case basis. , to the hospital".
Finally, severe forms, like babies under 6 months of age, are systematically directed to the hospital and if necessary to an intensive care unit.
The nose wash "will help the child breathe better"
It is estimated that only 2-3% of infants under one year of age would be hospitalized each winter. For the overwhelming majority of cases, management is based on nose washing.
This action consists of instilling serum in the nostrils to evacuate nasal secretions. But he often repels parents who fear to make their baby cry:
"The nasal wash is experienced as something unpleasant for the parents, but it will help the child to breathe better by unclogging his airways.It must be taught this gesture, do it with them, then make them do", we explains Druais.
Drugs against indicated
This is where the role of the physiotherapist is essential:
"The bronchiolite networks of the physiotherapists have their relevance because they allow to follow the child at home, to reevaluate his condition, and to recall clear advice to give to the parents, especially on the nasal wash", continues the specialist of the HAS.
As for drugs, such as bronchodilators, adrenaline, hypertonic saline, they have "no indication in this disease," according to the health authority. Antibiotics should be reserved for the rare cases of bacterial superinfection. Antitussive syrups and bronchial fluidifiers are contraindicated.