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Wheezing in Infants and Young Children

By John T. McBride, MD

Wheezing is a relatively high-pitched whistling sound that occurs during breathing when the airways are partially blocked.

  • Wheezing is caused by a narrowing of the airways.

  • Symptoms may include cough, fever, and runny nose.

  • The diagnosis is based on chest x-rays and sometimes other tests.

  • Treatment can include bronchodilators and corticosteroids.

Wheezing is caused by a narrowing or blockage (obstruction) of the airways. The narrowing can be caused by

  • Swelling of the tissues in the airways

  • Spasm of the tiny muscles in the walls of the airways (bronchospasm)

  • Accumulation of mucus in the airways

Recurring episodes of wheezing (see Wheezing) are common in the first few years of life. Until recently, doctors diagnosed these episodes as asthma (see Asthma in Children) because, like asthma, episodes could be relieved by inhaling drugs that open the airways (bronchodilators) and because most adults who have asthma first developed symptoms in childhood. Now, however, doctors know that only some infants and young children who have such episodes of wheezing have asthma in later childhood or adolescence.

Did You Know...

  • Not all wheezing is caused by asthma.

Children who are more likely to be eventually diagnosed with asthma include children who have one or more of the following risk factors:

  • Certain rashes

  • More severe wheezing episodes

  • Family members with asthma

  • A family tendency to have many allergies

However, in most children, wheezing episodes stop by 6 to 10 years of age, and doctors do not diagnose these episodes as asthma. Such children have other causes for their recurring episodes of wheezing.

Causes

A single, sudden episode of wheezing in infants and young children is usually caused by a viral respiratory infection.

The most common causes of recurring episodes are most likely to be caused by

  • Frequent viral lung infections

  • Allergies

  • Asthma

Less common causes of recurring wheezing include chronic difficulty swallowing that causes recurring inhalation of objects into the lungs, gastroesophageal reflux, a foreign object in the lungs, or heart failure. Often, the cause of recurring wheezing is unclear.

Whatever the initial cause of the wheezing, symptoms are often worsened by allergies or inhaled irritants (such as tobacco smoke).

Symptoms

Wheezing is often accompanied by a recurring cough that is dry or brings up sputum (also called phlegm). Other symptoms depend on the cause and may include fever, runny nose, and feeding difficulties (caused by heart failure or difficulty swallowing).

A high-pitched wheezing sound is heard when the child breathes out. If airway narrowing is severe, the wheezing sound can be heard when the child breathes in. Very ill children may also breathe rapidly, use a lot of their chest muscles to breathe, and have flaring of the nostrils and a bluish discoloration of the skin. Fever may be present in children with a lung infection.

Diagnosis

  • Chest x-rays

  • Rarely, swallowing studies, CT scanning, bronchoscopy

For a first episode of severe wheezing, most doctors do a chest x-ray to look for signs of a foreign object in the lungs, pneumonia, or heart failure. Doctors measure oxygen levels in the blood by placing a sensor on a finger (pulse oximetry).

For children with recurring episodes of wheezing, flare-ups typically do not require testing unless there are signs of severe breathing problems. Children who have frequent or severe flare-ups or symptoms that are not relieved by bronchodilators or other asthma drugs may need other tests such as swallowing studies (see X-Ray Studies), computed tomography (CT—see Computed Tomography (CT)), or bronchoscopy (see Bronchoscopy).

Treatment

  • For flare-ups, bronchodilators and sometimes corticosteroids

  • For severe wheezing, daily use of bronchodilators and anti-inflammatory drugs used for asthma

Infants and young children who have flare-ups of wheezing are given an inhaled bronchodilator (such as albuterol) and, if the wheezing is severe, corticosteroids (such as prednisone) given by mouth or vein.

Children who are unlikely to develop persistent asthma, such as children who do not have signs of allergies or a family history of allergies or asthma and whose episodes of wheezing are relatively mild and infrequent, usually require only inhaled bronchodilators used as needed to control their symptoms.

Most young children with more frequent and/or severe episodes of wheezing are helped by daily use of bronchodilators and anti-inflammatory drugs that are used for asthma (see Chronic asthma). Although daily use of a leukotriene modifier (such as montelukast or zafirlukast) or a low-dose inhaled corticosteroid (such as beclomethasone) decreases the severity and frequency of episodes of wheezing, these drugs do not change the way the disorder naturally progresses.

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • RAYOS
  • PROVENTIL-HFA, VENTOLIN-HFA
  • SINGULAIR
  • ACCOLATE
  • BECONASE

* This is the Consumer Version. *