Wheezing

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 Your Doctor Now (night or day) If

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.