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Should Your Child See a Doctor?

Wheezing

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Definition

  • A high-pitched purring or whistling sound produced during breathing out
  • Use this guideline only if the child has never been treated for asthma

Causes 

  • Main cause in the first 2 years of life: bronchiolitis (peaks at 6-12 months). This is a viral infection (usually RSV) of the small airways (bronchioles).
  • Main cause after age 2: may be the first attack of asthma.

Return to Day Care 

  • Your child can return to child care after the wheezing and fever are gone.

When to Call Your Doctor for Wheezing (Other Than Asthma)

Call 911 If…

 
  • Your child's wheezing started suddenly after medicine, an allergic food or bee sting
  • Your child has severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing)
  • Your child recently choked on small object or food
  • Your child passed out or has bluish lips
 

Call Your Doctor Now (night or day) If

  • Wheezing but none of the symptoms described above
 

Home Care Advice for Mild Wheezing (If Your Doctor Doesn't Need to See Your Child)

  1. Warm Fluids for Coughing Spasms: For any bouts of severe coughing, offer warm apple juice or lemonade if over 4 months old. (Reason: These can relax the airway and loosen up sticky secretions). Do not give any cough medicine.
  2. Nasal Washes to Open a Blocked Nose:
    • Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water.
      STEP 1: Instill 3 drops per nostril. (Age under 1 year, use 1 drop and do one side at a time)
    • STEP 2: Blow (or suction) each nostril separately, while closing off the other nostril. Then do other side.
    • STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
    • Frequency: Do nasal washes whenever your child can't breathe through the nose.
    • Saline nasal sprays can be purchased without a prescription.
    • Saline nose drops can also be made: Add 1/2 teaspoon (2 ml) of table salt to 1 cup (8 ounces or 240 ml) of warm water.
    • Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
    • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
    • For young children, can also use a wet cotton swab to remove sticky mucus.
    • Importance for a young infant: can't nurse or drink from a bottle unless the nose is open.
     
  3. Humidifier: If the air is dry in your home, run a humidifier.
  4. Smaller Feedings: Encourage small, frequent feedings whenever your child has the energy to drink. (Reason: Child with wheezing doesn't have enough energy for long feedings).
  5. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse.
  6. Contagiousness: Your child can return to child care after the wheezing and fever are gone.
  7. Call Your Doctor If:
    • Breathing becomes difficult, tight or loud
    • Wheezing becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Darville T and Yamauchi T. Respiratory syncytial virus. Pediatr Rev. 1998, 19(2):55-61.
  2. Gadomski A. Bronchiolitis dilemma: A happy wheezer and his unhappy parent. Contemp Pediatr. 2002;19(11):40-59.
  3. Gentile DA. Considering the differential diagnosis of wheezing in infants. J Respir Dis Pediatrician. 2003;5(2):84-88.
  4. Shaw KN, et al. Outpatient assessment of infants with bronchiolitis. Amer Jour Dis Child. 1991;145(2):151-5.
  5. Weinberger M, Abu-Hansan M. Pseudo-asthma: When cough, wheezing and dyspnea are not asthma. Pediatrics. 2007;120(4):855-864.
  6. Welliver JR and Welliver RC. Bronchiolitis. Pediatr Rev. 1993, 14:134-139.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 10/1/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.

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