Physiotherapists, a relay in the medical care of infants?

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

Direct consequence: the early epidemic – “still in a rising wave”, recalled government spokesperson Olivier Véran – clutters pediatric emergency services already out of breath and fills the waiting rooms of the cabinets a little more. of pediatrics. To limit this congestion, the National Council of the Order of Masseur Physiotherapists and the College of Masso Physiotherapy have indicated that they are “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.

Respiratory physio, a prescription that is not automatic

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

Intermediate stage until 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 his secretions. But since an opinion issued in November 2019, the High Authority for Health (HAS) no longer recommends this technique, considering that its effectiveness has not been demonstrated.

“Decluttering physiotherapy as it was widely prescribed by general practitioners at one time has not been done for a while, confirms Dr. Sylvie Hubinois, pediatrician and president of the French Association of Ambulatory Pediatrics (AFPA). Medically, in the majority of trivial cases of bronchiolitis, it is unnecessary: ​​when infants wheeze, it is useless because they are not congested, and when congested, l The effectiveness is very relative since very quickly, they secrete again, explains the pediatrician. In addition, these were quite unpleasant sessions for the children”.

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

“The HAS opinion is technical, it says that decluttering is not necessary in children under one year old in the event of bronchiolitis, which is true in most cases, indicates to 20 minutes Yvan Tourjansky, president of the regional union of liberal physiotherapists in Ile de France. But our skills go well beyond decluttering physio. Our capacities for diagnosis, auscultation, 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 [pesant sur les services de pédiatrie], the territorial network of physiotherapists makes it possible to respond present and to ensure outpatient follow-up 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, learn techniques for clearing the upper airways and monitor the state of health of these infants. .

Today, “in the 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 doctor, continues Yvan Tourjansky. This is unfortunate for the families who should not have gone to the emergency room, and for those whose children really need to be hospitalized but suffer a longer wait as a result”.

“A relay” in the supervision of children

In this context, “we are a relay, assures the physiotherapist. We have already been asked to provide this relay in the past, both to take care of the children and reassure the parents and to act as a buffer between city medicine and hospital emergencies. We are able 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 importance 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 blocked, since this is the most effective thing to do in the event of bronchiolitis. I speak only in my name, but as such, we could consider a pediatrician-physiotherapist collaboration protocol for the supervision of children. But, of course, only with physiotherapists who are used to seeing babies”.

On the other hand, “going to the physiotherapist 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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