EPIDEMIC The bronchiolitis epidemic continues in France against a backdrop of saturation of pediatric emergency services

Bronchiolitis: Physiotherapists, a relay in the medical care of infants?

In case of bronchiolitis, washing the baby's nose is a gesture to facilitate breathing. — SIPA

  • The bronchiolitis epidemic currently raging in France is causing very high numbers of emergency room visits and hospitalizations.
  • Figures higher than those observed for more than ten years, according to Public Health France.
  • In this context of strong epidemic and saturation of the pediatric emergency services, the physiotherapists want to pose as relay of monitoring of the children.

A virulent return. Putting to sleep at the winter of 2020-2021 by the Covid-19 pandemic and scrupulously observed barrier gestures, bronchiolitis is this year at risk. the origin of a record number of hospitalizations. Health public France thus notes in its last bulletin of “passages to the emergency room and hospitalizations for bronchiolitis very high and at a high level. levels above those observed at epidemic peaks for more than ten years.

Direct consequence: the early epidemic – “still rising,” government spokesman Olivier Véran – clogs pediatric emergency services already in to out of breath and fills the waiting rooms of pediatric practices a little more. To limit this congestion, the National Council of the Order of Masseurs Physiotherapists and the College of Masso Physiotherapy have indicated to be “always mobilized”, recalling their “primary role in the care of young patients in town”. And this, even though the use of respiratory physiotherapy is no longer recommended; for this childhood disease.

Physiotherapy respiratory, a prescription not automatic

Common and highly contagious, bronchiolitis, most commonly caused by respiratory syncytial virus (RSV), causes babies to cough and have difficult, rapid, wheezy breathing. Distressing for the parents, it is nevertheless most of the time benign. Only the most serious cases may require a visit to the emergency room, or even hospitalization.

Intermediate stage up to in recent years: many parents were given a prescription for respiratory physiotherapy, for decluttering sessions. Often impressive manipulations, supposed to help the baby to breathe better by evacuating secretions. But since an opinion issued in November 2019, the High Authority of health (HAS) no longer recommends this technique, considering that its effectiveness has not been demonstrated.

“Decluttering physiotherapy as it’s been widely prescribed by general practitioners to an era has not been done for a while, confirms Dr. Sylvie Hubinois, pediatrician and president of the French Association of Ambulatory Pediatrics (AFPA). On the medical level, in the majority trivial cases of bronchiolitis, it is not necessary: ​​when infants wheeze, it does not help. nothing because they are not cluttered, and when they are cluttered, the efficiency is reduced. is very relative since very quickly, they secrete again, explains the pediatrician. In addition, these were quite unpleasant sessions for the children”.

Provide “outpatient follow-up” to “unclog pediatric emergencies”

“The HAS opinion is technical, it says that decluttering is not necessary in children under the age of one with bronchiolitis, which is true in most cases , indicates to 20 MinutesYvan Tourjansky, President of the Regional Union of Liberal Physiotherapists of Ile de France. But our skills go well beyond; kiné decluttering. Our capacities for diagnosis, auscultation and management of children with respiratory problems allow us to ensure their care and avoid unnecessary visits to the emergency room”.


Thus, since “the epidemic situation and hospital tensions only accentuate the difficulties [weighing on pediatric services], the territorial network of physiotherapists allows to respond present and to ensure outpatient monitoring of these respiratory conditions, assure the National Council of the Order of Masseurs Physiotherapists and the College of Masso Physiotherapy. It is not a question of prescribing physiotherapy but a physiotherapist who will be present to reassure and inform the parents, to learn the techniques of decluttering the airways. superior health and monitoring the state of health; of these infants.”

Today, “in Hauts-de-Seine, the emergency services tell us that 60% of the children who are there should not end up in the emergency room. Many parents take their children there because they have not been able to obtain a quick consultation with their pediatrician or general practitioner, continues Yvan Tourjansky. It’s unfortunate for the families who shouldn’t have going to the emergency room, and for those whose children really need to be hospitalized but have a longer wait as a result.

“ A relay ” in child supervision

In this context, “we are a relay, assures the physiotherapist. We already have been asked to ensure this relay in the past, both to take care of the children and reassure the parents as well as to make the buffer between the city medicine and the hospital emergencies. We are able to to explain to the parents all the preventive measures, but above all to ensure monitoring, since the condition of a child who has bronchiolitis can evolve very quickly”.


“It’s true, physiotherapists know how to measure saturation, take a respiratory rate and assess the extent of a child’s respiratory distress, confirms Dr Hubinois. They also know how to show parents how to wash the baby's nose. to prevent the nose from being congested, since this is the most effective thing to do. to do in case of bronchiolitis. I speak only in my name, but to As such, we could consider a pediatrician-physiotherapist collaboration protocol for monitoring children. But, of course, only with physiotherapists who are used to seeing babies.”

On the other hand, “going to the physio The therapist cannot replace going to the doctor. If most cases of bronchiolitis are mild, in case of fever, digestive or ENT disorders, the doctor must do a complete clinical examination,” adds the pediatrician.

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