How to Tell if Your Baby Has Asthma

What to Do When Your Baby Wheezes

Baby and doctor
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Asthma is extremely common, but how can you tell if your baby has infant asthma when he/she can't even talk?

Most of the six million children with asthma develop symptoms before the age of six, and many begin wheezing before one year. It is important to diagnose infant asthma early because, if left untreated, inflammation can cause permanent damage to the lungs.

Diagnosing infant asthma is difficult because symptoms can be so subtle that you might not suspect it.

Because your infant can't describe the symptoms of how he/she is feeling and what they are experiencing to you or your doctor, your doctor relies on your description of the symptoms as well as how your baby acts.

If you are worried about infant asthma, you will want to go to the doctor with a clear description of what concerns you and why. Additionally, your doctor will also consider a family history of asthma or allergies in deciding whether your baby has infant asthma.

Symptoms of Infant Asthma

Just as in adults, infant asthma symptoms can vary from child to child. In infant asthma, babies may have all of the classic adult asthma symptoms described below ​or just one of those symptoms.

Additionally, poor feeding, sweating, or appearing uncomfortable may be symptoms of infant asthma. Common adult asthma symptoms include:

Your doctor may also ask about the following when considering an infant asthma diagnosis:

  • Has your child wheezed more than once? Many infants will experience some wheezing after an upper respiratory tract infection. However, if your infant does this frequently, it increases the chance your child has infant asthma. During early life, viruses such as the respiratory syncytial virus, or RSV, are known to cause a disease called bronchiolitis. This can closely mimic the symptoms of asthma. However, RSV does not respond to traditional asthma treatments.
  • Does your child cough at night? Nighttime cough is one of the symptoms used to monitor asthma control and will make your doctor suspicious of infant asthma.
  • Does your child wheeze after exposure to allergens? If wheezing occurs after exposure to allergens, then your child could have infant asthma. These allergens include:
  • Does your child experience other allergy symptoms, such as atopic dermatitis or eczema, and do the parents have these conditions? There is a relationship between allergic disease and the development of asthma. Similarly, if one or both parents have asthma or an allergic disease, risk of asthma increases in offspring.
  • Does your child wheeze when exposed to tobacco smoke? Smoke is a lung irritant that can lead to asthma symptoms.
  • Does crying or laughing cause wheezing?
  • Does your child breathe so fast that they have difficulty finishing a bottle? Not being able to finish a bottle can be a sign of difficulty breathing.

Not All That Wheezes Is Infant Asthma

Wheezing can be caused by a number of other conditions and infections. Bronchiolitis, or inflammation of the small airways of the lungs, is the most common condition besides asthma that causes wheezing in young children.

Caused by the RSV virus, as noted above, and other viruses, such as influenza and parainfluenza, this condition can mimic asthma in infants. It causes recurrent wheezing or reactive airway disease. Other conditions that may cause wheezing include:

  • Congenital heart disease
  • Cystic fibrosis
  • Foreign object stuck in the respiratory tract
  • Tracheoesophageal fistula
  • Upper respiratory tract infection

Infant Asthma Treatment

Infant asthma is treated with many of the same medications as adult asthma. Your doctor may elect to start treatment if they are unsure whether your child has a diagnosis of infant asthma or they may monitor symptoms for a period of time.

While you may be worried about side effects of treatment, asthma medications are generally well tolerated.

Few studies have been performed that look at how well the typical asthma medications work in infants. Most of the current recommendations are derived from expert opinion and many of the asthma medications are not FDA-approved for infant use—although your doctor may still use them. Importantly, there is not good evidence for the use of inhaled steroids in infant asthma, so these medications are used infrequently.

When to Call the Doctor

One of the most important skills as a parent of a child with asthma-like symptoms is to know when you need to call the doctor or head to the emergency department. If you suspect wheezing and your child has never wheezed before, it is important to promptly see a healthcare provider to identify the cause.

All of the following symptoms in your infant are indications that he/she needs immediate medical attention: 

  • Wheezing that occurs while breathing both in and out
  • Coughing that has become continuous
  • Very fast breathing
  • Retractions (infant's skin is pulled into their chest as they inhale)
  • Shortness of breath
  • Becoming pale
  • Blue lips or fingernails (cyanosis)

Remember, just because your infant wheezes does not mean they have asthma. However, you do want to be sure, so have your child evaluated.

Sources:

National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma

Asthma. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. Editors: Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. 5th edition.

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