Page 70 - Learnwell EVS
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2. Respiratory diseases
In all oth er cases, th e ch ild m ay be treated at h om e, prov id ed th e parents are taug h t
h ow to carry out treatm ent, and w h at sig ns of sev erity sh ould lead to re-consultation.
Outpatient treatment
– N asal irrig ation w ith 0 .9 % N aC l before each feed ing (d em onstrate th e tech nique
toth e m oth er) . 2
1
– Sm all, frequent feed ing s to red uce v om iting trig g ered by bouts of coug h ing .
– Increased fluid s if fev er and / or sig nificant secretions are present.
– T reat fev er (see pag e 2 6 ).
– H and le th e patient th e patient as little as possible and av oid unnecessary proced ures.
Hospitalisation
– In all cases:
• P lace th e infant in a sem i-reclining position (± 3 0 °).
• N asal irrig ation, sm all, frequent feed s, treatm ent of fev er: as for outpatient
treatm ent.
• G entle oro-ph aryng eal suction if need ed .
• M onitor fluid intake: norm al requirem ents are 8 0 to 1 0 0 m l/ kg / d ay + 2 0 to
2 5 m l/ kg / d ay w ith h ig h fev er or v ery profuse secretions.
– A ccord ing to sym ptom s:
• H um id ified nasal oxyg en (1 to 2 litres/ m in).
• W h en th ere is v om iting or sig nificant fatig ue w h en sucking , fluid requirem ents
m ay be ad m inistered by nasog astric tube (sm all v olum es on a frequent basis) or th e
I V route, for th e sh ortest possible tim e. A v oid breastfeed ing or oral feed s in
ch ild ren w ith sev ere tach ypnoea, but d o not prolong N G feed s ( respiratory
com prom ise) or I V infusions any long er th an necessary.
• B ronch od ilator th erapy: th is th erapy m ay be consid ered after a trial treatm ent h as
been g iv en ( salbutamol inh aler, 1 0 0 m icrog ram s/ puff: 2 to 3 puffs w ith spacer,
repeated tw ice at an interv al of 3 0 m inutes). I f inh aled salbutam ol appears effectiv e
in reliev ing sym ptom s, th e treatm ent is continued (2 to 3 puffs ev ery 6 h ours in th e
acute ph ase, th en g rad ual red uction as recov ery takes place) . I f th e trial is
ineffectiv e, th e treatm ent is d iscontinued .
• A ntibiotics are not ind icated unless th ere is concern about com plications such as
second ary bacterial pneum onia.
Prevention and control
T h e risk of transm ission of th e v irus is increased in h ospital setting s:
– C h ild ren w ith bronch iolitis sh ould be g rouped tog eth er, aw ay from oth er ch ild ren
(coh orting ).
– A s infection is m ost com m only transm itted by th e h and s, th e m ost im portant
prev ention m easure is h and -w ash ing after any contact w ith patients, and objects or
surfaces in contact w ith patients on w h ich th e v irus m ay surv iv e for sev eral h ours.
– I n ad d ition, staff sh ould w ear g ow ns, g lov es and surg ical m asks w h en in contact
w ith patients.
Lie the child on his back, head turned to the side and instil 0.9% NaCl into the nose, one nostril at a time.
2
65
In all oth er cases, th e ch ild m ay be treated at h om e, prov id ed th e parents are taug h t
h ow to carry out treatm ent, and w h at sig ns of sev erity sh ould lead to re-consultation.
Outpatient treatment
– N asal irrig ation w ith 0 .9 % N aC l before each feed ing (d em onstrate th e tech nique
toth e m oth er) . 2
1
– Sm all, frequent feed ing s to red uce v om iting trig g ered by bouts of coug h ing .
– Increased fluid s if fev er and / or sig nificant secretions are present.
– T reat fev er (see pag e 2 6 ).
– H and le th e patient th e patient as little as possible and av oid unnecessary proced ures.
Hospitalisation
– In all cases:
• P lace th e infant in a sem i-reclining position (± 3 0 °).
• N asal irrig ation, sm all, frequent feed s, treatm ent of fev er: as for outpatient
treatm ent.
• G entle oro-ph aryng eal suction if need ed .
• M onitor fluid intake: norm al requirem ents are 8 0 to 1 0 0 m l/ kg / d ay + 2 0 to
2 5 m l/ kg / d ay w ith h ig h fev er or v ery profuse secretions.
– A ccord ing to sym ptom s:
• H um id ified nasal oxyg en (1 to 2 litres/ m in).
• W h en th ere is v om iting or sig nificant fatig ue w h en sucking , fluid requirem ents
m ay be ad m inistered by nasog astric tube (sm all v olum es on a frequent basis) or th e
I V route, for th e sh ortest possible tim e. A v oid breastfeed ing or oral feed s in
ch ild ren w ith sev ere tach ypnoea, but d o not prolong N G feed s ( respiratory
com prom ise) or I V infusions any long er th an necessary.
• B ronch od ilator th erapy: th is th erapy m ay be consid ered after a trial treatm ent h as
been g iv en ( salbutamol inh aler, 1 0 0 m icrog ram s/ puff: 2 to 3 puffs w ith spacer,
repeated tw ice at an interv al of 3 0 m inutes). I f inh aled salbutam ol appears effectiv e
in reliev ing sym ptom s, th e treatm ent is continued (2 to 3 puffs ev ery 6 h ours in th e
acute ph ase, th en g rad ual red uction as recov ery takes place) . I f th e trial is
ineffectiv e, th e treatm ent is d iscontinued .
• A ntibiotics are not ind icated unless th ere is concern about com plications such as
second ary bacterial pneum onia.
Prevention and control
T h e risk of transm ission of th e v irus is increased in h ospital setting s:
– C h ild ren w ith bronch iolitis sh ould be g rouped tog eth er, aw ay from oth er ch ild ren
(coh orting ).
– A s infection is m ost com m only transm itted by th e h and s, th e m ost im portant
prev ention m easure is h and -w ash ing after any contact w ith patients, and objects or
surfaces in contact w ith patients on w h ich th e v irus m ay surv iv e for sev eral h ours.
– I n ad d ition, staff sh ould w ear g ow ns, g lov es and surg ical m asks w h en in contact
w ith patients.
Lie the child on his back, head turned to the side and instil 0.9% NaCl into the nose, one nostril at a time.
2
65
