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Wheezing and Asthma in Infants

More than 6 million children under the age of 18 have asthma. An estimated 80% of kids with asthma develop symptoms by age 5, and 50% develop symptoms by age 2. If your infant wheezes when he or she has a cold, 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 he or she may be having.

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 some 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 child who hasn't turned 1 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 wheezing, one of the symptoms of asthma.

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 that lead to the lungs. 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 children 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 of the infection or because the child was more prone to breathing problems in the first place. 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 if a baby is wheezing 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 stigmatize 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 year continue to wheeze into later childhood. In other words, most children 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 a child's 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 past the first birthday.

Diagnosing Asthma in Older Babies
You should talk to your child's doctor about possible asthma if your child has:

• wheezing that happens 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. The doctor also may ask about whether the problems occur when the child is exposed to:

• cold air
• allergens, such as pets or dust
• smoke

It's important to tell your child's 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 your child's symptoms are due to asthma or some other problem.

Treating Your Child's Symptoms

Just because your child's doctor doesn't diagnose your child with asthma during the first year of life doesn't mean your child can't be treated for wheezing. A doctor may prescribe inhaled asthma medications to see if the symptoms get better with that treatment.

Because these medicines are generally safe, even for use in infants and young children, the possible benefits of a trial of asthma medications usually outweighs the risks of side effects.

The severity of your child's breathing problems, as well as how often he or she experiences symptoms, will help determine which kind of medicine you have to give him or her. 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 your child's treatment plan with anyone who takes care of him or her. Ensure that caregivers understand the plan, and, if your child needs asthma medicine, teach caregivers and family members how to use the inhaler or nebulizer.