More than 6 million children under the age of 18 have asthma.
The majority of kids with asthma develop symptoms by age 6, and
many even develop symptoms by age 3. If your infant has a cold and
is
wheezing
, you may be wondering if the problem is asthma. But it's not
always clear if an infant has asthma. More important than getting a
firm diagnosis is making sure your child gets treated for any
breathing problems that occur.
Asthma is becoming more common in developed countries, though no
one knows exactly why. But researchers are sure of one thing: A
child is most likely to develop asthma if there's a family
history of allergies and asthma. This is especially true if the
child's parents have asthma and certain allergies. (Some
allergies, such as to penicillin or insect stings, don't affect
the risk of asthma.)
My Baby Is Wheezing. Is It Asthma?
Asthma is a chronic disease of the lungs that causes the airways
to swell, tighten, and produce excess mucus. It can be difficult to
diagnose in children under the age of 5, especially in infants,
because other conditions have similar symptoms.
It's also difficult to accurately measure babies' lung
function (how well they breathe). Older kids and adults are better
able to cooperate with
lung function tests
, which often involve taking a deep breath and blowing out as fast
as the person can. This type of testing may show asthmatic changes
in the lungs.
The mechanics of a baby's lungs also complicate the
diagnosis of asthma. Infants' airways are small. When a baby
gets a respiratory tract infection, these already small passages
get swollen and filled with mucus much more easily than an older
child's or an adult's. This can lead to coughing, wheezing,
and other symptoms of asthma (even if it is not asthma, but just a
viral infection).
Bronchiolitis and RSV
One common condition that mimics asthma in infants is
bronchiolitis
, which is usually caused by a viral infection, most commonly
respiratory syncytial virus (RSV)
. The infection affects the tiny airways called bronchioles. The
airways swell, making it difficult for a child to breathe. Infants
are often affected because their airways are so small that they
become blocked more easily than those of older kids or adults.
Symptoms of bronchiolitis include rapid breathing, a cough,
wheezing, and fever. Infants who develop bronchiolitis may be more
likely to develop asthma later in life. But it's unclear if
that's because RSV infection causes asthma or because the child
was born with a tendency to wheeze and was therefore more prone to
both bronchiolitis and asthma. Studies are being done to clarify
the relationship between bronchiolitis and the later development of
asthma.
There are also less common reasons for wheezing in infants. A
foreign object or piece of food inhaled into the lungs may cause
wheezing.
Premature infants
who have insufficiently developed airways may wheeze.
Cystic fibrosis
can cause a child to wheeze, too, but it usually involves
additional symptoms such as delayed growth.
Delaying Asthma Diagnosis
It's important to remember that just one instance of
wheezing isn't enough to diagnose asthma. It must happen more
than once. But even when wheezing happens on a recurring basis, a
doctor may still not be certain the cause is asthma, especially in
young children. More time, and sometimes more tests, may be needed
to confirm the diagnosis and decide on the best long-term
management plan for the child.
Doctors want to avoid an incorrect diagnosis, which might
unnecessarily disrupt the lives of the entire family or label a
child with a chronic condition he or she may not have. Fewer than
one third of all infants who wheeze on a recurring basis during
their first 3 years continue to wheeze into later childhood. In
other words, most kids who wheeze as infants outgrow it and
don't have asthma when they get older.
However, doctors know that uncontrolled and persistent asthma
can damage the lungs over time. The early use of anti-inflammatory
medications may help prevent this from happening.
For these reasons, doctors might choose to treat the symptoms as
if the child has asthma, even if the diagnosis is uncertain. They
may prescribe asthma medications, but probably won't officially
diagnose a child with asthma unless he or she continues to have
symptoms.
Diagnosing Asthma in Older Babies
You should talk to your doctor about possible asthma if your
child has:
- wheezing that has happened more than once (with or without
illness)
- constant or bouts of coughing that get worse at night or
after active playing
- any other breathing problem that concerns you
The doctor also may ask you whether your child has breathing
problems in different circumstances, such as during a cold, or when
exposed to:
- cold air
-
allergens
, such as pets or dust
- smoke
It's important to tell the doctor about any family history
of allergies, asthma, and sinus problems. This information and
careful observation of your child over time will help the doctor
decide if the symptoms are due to asthma or some other problem.
Treating the Symptoms
Just because the doctor doesn't diagnose asthma doesn't
mean your child can't be treated for wheezing. The doctor may
prescribe inhaled asthma medications to see if the symptoms
improve.
Because these medicines are generally safe, even for use in
infants and young children, the possible benefits of a trial of
asthma medications usually outweigh the risks of side effects.
The severity of the breathing problems, as well as how often
symptoms occur, will help determine which kind of medicine you have
to give your child. The doctor also will consider whether your
child needs continuous treatment or if medicine should be given
only when he or she is having symptoms. Asthma medicines are often
delivered using an
inhaler
with a
spacer
or through a
nebulizer
.
You should also review the treatment plan with anyone who takes
care of your child. Ensure that caregivers understand the plan,
and, if your child needs asthma medicine, teach them and family
members how to use the inhaler or nebulizer.
Reviewed by:
Elana Pearl Ben-Joseph, MD
Date reviewed: June 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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