Scenario 1:

Logan is a chubby 5 month old who goes to day care. One evening,his mother was told by the day care assistant that he has mild fever and runny nose. The next day his mother found him to have wheeze and questionable troubled breathing. What could be the cause for his wheeze?

Scenario 2:

Max is a skinny 5 year old, who has been having repeated episodes of cough, cold and wheeze since toddler-hood. Lately his mother feels that his symptoms are getting worse and he is increasingly woken up from sleep by breathing difficulty and wheeze. Is his wheeze due to asthma?

What is wheezing?

Wheezing is a high pitched whistling sound that occurs while breathing and it is caused by the flow of air through constricted breathing tubes. It is usually heard while exhaling, but also can be heard while inhaling. It is usually caused by the constriction of smaller airways deep in the chest but also can be due to larger airway constriction. There are many causes for wheeze and the mechanism by which they cause wheeze are the following.

1.spasm or constriction of airways.

2. blockage by a foreign object.

3. excessive secretion.

4.swelling of the mucous lining of the airways.

Wheezing is a very common symptom of childhood and infancy. It is rare in the newborn period, though.

Common causes of wheeze:

1. Asthma:

Not all asthmatics wheeze and not all wheezers are asthmatics. However asthma usually presents with recurrent episodes of wheeze and breathing difficulty.Other common symptoms that must clue you are

recurrent attacks of cold,

coughing, wheeze and difficulty in breathing during activities like running, jumping etc

prolonged coughing that worsens at night,

a general feeling of being unwell.

Asthma is exacerbated during exposure to cold, pollutants, certain food like egg or milk, allergens like pollen, pet fur etc. With modern treatment asthma can be controlled very well. It is important to visit your doctor if you think that your child has asthma.

2.Bronchiolitis:

It presents as low grade fever,cough, breathing difficulty, reduced feeding with or without audible wheeze. It is common during winter or late spring. Majority of cases are caused by 'Respiratory syncitial virus', rest are caused by adeno viru, parainfluenza virus or mycoplasma. Infants usually recover in 2 weeks but may have prolonged wheeze or cough. Occasionally a child with severe breathing difficulty may need hospitalisation.

3. Transient wheezing in infancy:

It is characterised by recurrent wheeze in non atopic infants and toddlers which usually disappears when child turns three. If the symptoms are severe and the child has allergic manifestations, he can go on to have asthma.

4.Choking on a foreign object:

If the onset of wheeze is abrupt on a previously healthy child, it may be due to choking on a foreign object. The choking can be observed or unobserved, may or may not present as an emergency but always deserves prompt medical examination and treatment.

5.Allergy:

Allergic reaction to cold, pollen, animal fur, insect bite, certain food can present with wheeze. The child may have red, itchy watery eyes, runny nose, sneezing and coughing. In food allergy, following ingestion of a particular food ,the child may get a rash, watery eyes, runny nose, vomiting, diarrhoea,itching and swelling of mouth, face and neck, wheeze and a worsening breathing difficulty (which is an emergency).

6.Gastroesophageal reflux disease:

This condition begins to present at 4 weeks, peaks at 4 months and subsides by one year as the child starts to walk around and starts taking solid food. It is due to the immaturity of the sphincter which lead to reflux of stomach content back. This will present as irritability, wheeze, noisy breathing, choking and hoarseness of voice.

7.Pneumonia:

Starts with symptoms similar to common cold but progressively worsens with high fever, cough, wheezing, grunting, difficulty in breathing and chest pain. The child looks sick, feeding declines and breathing difficulty worsens. Significant distress requires hospitalisation.

8.Cystic fibrosis:

Presents with frequent cold, long standing cough, recurrent sinusitis, bulky greasy stool with offensive odour, loss of weight and nasal polyps. An observant mother notices that the baby's skin is salty to kiss.

9.Other causes:

Most cases of wheeze in infants and toddlers are associated with viral infection.Wheezing also occurs in many other conditions like heart diseases, congenital malformation of airways, dysfunction of vocal cords, chronic lung diseases etc

Croup is characterised by stridor (which is a high pitched noise while breathing), breathing difficulty , barky cough and it may also present with wheeze.

When should I vist my doctor?

The importance of wheezing is that it indicates difficulty in breathing. You must visit the doctor if

1. Any child with significant , prolonged or worsening breathing difficulty. Declining feeding, confusion, inability to talk, bluish tinge of lips and tongue,disappearance of wheeze (which indicates no air flow) ,exhaustion are ominous signs(Go to the emergency room immediately)
2. choking requires immediate medical attention. High fever( may provoke seizure ) also needs prompt medical management.
3. if there is history of ingestion of a food product that the child is/not known to be allergic to and the child develops symptoms like swelling of face and neck, itching and breathing difficulty, call emergency)
4. a wheeze that wont go away or keep coming back
5. other symptoms like fever, itchy watery eyes, chest pain, general unwellness.
6. if the child is not thriving well
7. if there is family history of allergy
8. if you are concerned as a parent and getting stressed out by your child's wheeze.

 

 

What will the doctor do?

In case of emergencies the priority will be to stabilise the child and maintain his respiration. A detailed history of the present episode, if there had been previous episodes, other symptoms, family history and a thorough medical examination including child's height and weight parameters, presence of clubbing (nails appearing to be bent over the finger tip) , auscultation of child's chest will allow the doctor to pinpoint the diagnosis. The doctor will also ask for a chest x ray, airflow measurements (like peak expiratory flow and spirometry, if your child is old enough) and other tests to confirm his diagnosis.

The treatment depends on the diagnosis, the priority being to make the child breathe easily and maintain his oxygenation. The child may be given medication inhalers, antibiotics, steroids etc accordng to the diagnosis. In case of chronic illness like cystic fibrosis or asthma, self help groups can make a world of difference.

What can I do at home?

1. Be forewarned about the danger signs. Do not hesitate to call the doctor (even if it is in the middle of night) if danger signs appear.
2. Make the child sit up, loosen clothing, ventilate the room.
3. Take medication promptly (reliever inhalers , in case of asthma).
4. Give plenty of fluids and keep the child hydrated.
5. Comfort the child and keep him calm. Sitting in a room full of moist heated air (as in a closed bathroom with running hot shower or a room with vaporizer) may help.
6. Do not use over the counter cough medicine without physician's approval.
7. Avoid smoking.

Remember

1. All wheezers are not asthmatics.
2. Seek medical care when necessary
3. Coughing and wheezing means lot of worrying and sleepless nights but in most cases, symptoms can be releived at home and the children recover fairly soon.