Wheezing in Infants and Young Children

The most common cause of a single, sudden episode of wheezing in infants and young children is usually a

The most common causes of recurring episodes of wheezing are

Less common causes of recurring wheezing include chronic difficulty swallowing Difficulty Swallowing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become... read more that causes recurring inhalation of food or liquids into the lungs, gastroesophageal reflux Gastroesophageal Reflux in Children Gastroesophageal reflux is the backward movement of food and acid from the stomach into the esophagus and sometimes into the mouth. Reflux may be caused by the infant’s position during feeding... read more , a foreign object in the lungs, or heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more .

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

Wheezing is often accompanied by a recurring cough Cough in Children Cough helps clear materials from the airways and prevent them from going to the lungs. The materials may be particles that have been inhaled or substances from the lungs and/or airways. Most... read more that is dry or brings up sputum (also called phlegm). Other symptoms depend on the cause and may include fever Fever in Infants and Children Normal body temperature varies from person to person and throughout the day (it is typically highest in the afternoon). Normal body temperature is higher in preschool-aged children and highest... read more , 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 (cyanosis Cyanosis Cyanosis is a bluish discoloration of the skin resulting from an inadequate amount of oxygen in the blood. Cyanosis occurs when oxygen-depleted (deoxygenated) blood, which is bluish rather than... read more ). Fever may be present in children with a lung infection.

For a first episode of severe wheezing, most doctors do a chest x-ray Chest Imaging Chest imaging studies include X-rays Computed tomography (CT) CT angiography Magnetic resonance imaging (MRI) read more 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 Pulse oximetry Both arterial blood gas testing and pulse oximetry measure the amount of oxygen in the blood, which helps determine how well the lungs are functioning. Arterial blood gas tests are invasive... read more ).

For children with recurring episodes of wheezing who have already had testing, 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 X-Ray Studies of the Digestive Tract X-rays often are used to evaluate digestive problems. Standard x-rays ( plain x-rays) can show some blockages or paralysis of the digestive tract, or abnormal air patterns in the abdominal cavity... read more , computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (CT), or bronchoscopy Bronchoscopy Bronchoscopy is a direct visual examination of the voice box (larynx) and airways through a viewing tube (a bronchoscope). A bronchoscope has a camera at the end that allows a doctor to look... read more .

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 as-needed use of bronchodilators and by daily use of anti-inflammatory drugs that are used for asthma ( see Chronic asthma Chronic asthma Asthma is a recurring inflammatory lung disorder in which certain stimuli (triggers) inflame the airways and cause them to temporarily narrow, resulting in difficulty breathing. Asthma triggers... read more ). 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.