Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: The Wheezing Infant - Causes and Treatment

Category: Child Care


This winter we will see large numbers of infants wheezing. Some of these will be as young as one month of age. In very small infants under a year of age with significant wheezing, it is important to have the child checked by a pediatrician or family doctor. The airways in small infants are extremely tiny and very small amounts of mucous or bronchial tightening can cause major obstructions and illness.

The most common cause of wheezing in infants under a year will be upper respiratory viral infections. Of these, RSV virus or respiratory syncytial virus has been a common cause of significant wheezing and respiratory distress particularly over the past ten years. A small percentage of these children will become so short of breath they will have to be hospitalized. Signs to look for requiring hospitalization will include difficulty sleeping; difficultly feeding; poor color; very rapid respirations such as greater than 50 per minute; retractions or sucking in of the skin between the ribs with every breath and head bobbing or moving the head forward with every breath to try to push the air out. These signs mean the child is having a very hard time breathing in or breathing out and are "red flags" to see your doctor right away and possibly even have the child hospitalized. In the hospital, the doctor can treat any infection as well as bronchial obstruction and dehydration by giving IV fluids, humidified oxygen, and several medicines by inhalation, IV or by mouth.

The second most common cause of wheezing in small infants is asthma. Frequently children who have a tendency to have asthma develop their first noticed attack from an upper respiratory infection. In other words, an upper respiratory virus is the trigger that sets off the first wave of asthma in that child. For that reason children should be followed closely after being in the hospital or after being seen in the doctors office for wheezing to see if they have recurrent wheezing and truly have asthma. If they do it is well established to treat them with inhalation treatments with beta adrenergic medicines such as Ventolin, Proventil or Alupent. These can be given with saline (salt water) or with Intal. Intal is a preventive anti-inflammatory medicine which is expensive but very effective in controlling allergies and asthma. Also corticosteriods by inhalation can be added in moderate to severe asthmatics who are hard to control. Finally, theophylline can be added to the therapy of wheezing infants but should be used very cautiously because of its toxicity if the blood levels get high.

Other causes of wheezes in small infants include rare things such as cystic fibrosis, immune deficiencies and bronchial obstruction from aspiration. This means a child chokes on a food particle or something they place in their mouth and it gets lodged in their bronchi causing obstruction in their lungs and wheezing. All these conditions are obviously serious and need to be checked and diagnosed by your physician.

Fortunately today, for the majority of wheezing infants, we have many good medicines available and inhalation medicines in particular. With proper therapy to minimize side effects, most of these children can be kept at home and spend much less time in the doctor's office, ER and hospital ward. They should grow up to be healthy and live full lives. A very small percentage of these children may go on to have severe asthma and require aggressive therapy throughout their childhood. A majority of them will get better each year and over 80% will totally outgrow their asthma by age 21.