Wheezing is common in small children — around a third of all children will have an episode of wheezing before they are three years old. Although it’s common, we still don’t quite know the best thing to do about it. The problem is that wheezing, like fever, is a symptom of a disease, not a disease itself. It’s not one thing. Every physician who treats small children in the office, the emergency department, or the pediatric intensive care unit is often faced by the dilemma of what to do with a wheezing small child.
In such children wheezing is often triggered by a viral illness. When it happens in infants it is often caused by a virus we call RSV (short for respiratory syncytial virus) and causes a disorder called bronchiolitis. For those children, we know that not much of anything helps the symptoms — all we can do is provide supportive care and wait for the illness to run its course. What about wheezing children who don’t have bronchiolitis? Can anything help them?
The problem facing the doctor is that all the treatments we’ve tried over the years for small children who wheeze are taken from how we handle older children who have chronic, frequent wheezing — what we call asthma. These treatments work for asthma, yet they often don’t for wheezing that isn’t. A certain number of children who have their first spell of wheezing will go on, over years, to develop true asthma. But most wheezing toddlers won’t progress to asthma — they will have an episode or two (or three) of wheezing and then “grow out of it.” If you bring your infant or toddler to the doctor for a first (or second) episode of wheezing, the doctor has no way of knowing which of these two things will happen. There are a few clues, such as a family history of asthma, which will increase the chances of future asthma, but there’s no good way to tell.
How do most doctors handle this problem? Most will try a dose or two of asthma medications (inhaled albuterol and/or budesonide, or oral prednisolone are commonly used) just to see if it helps. If the child gets better, they can be continued.
My point is that you should understand that for this problem — wheezing in an infant or toddler — your doctor is handicapped by not being able to predict the future. Only time will tell. It’s a frustrating, but common medical scenario.
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- Wheezing in infants and toddlers: we still don’t know what’s best to do | Christopher Johnson M.D. PICU Author
- Just what is wheezing, anyway? | Christopher Johnson M.D. PICU Author
Thank you very much for this very informative post. As a mom of a 13 month old who had two wheezing episodes (both coincided with viral fevers/cold) in less than a month which required over night hospital stay for observation…I arrived at your post looking for answers. Your post gave me a lot of clarity and much needed assurance that we are doing everything we could for our little one. Thank you!
I’m glad you found it helpful
My 15mo son has always been a “loud breather.” At first, the docs and nurses said it was because he was a section baby and didn’t get that final squeeze.
With each visit to the pediatrician, the first thing out of my mouth is “he’s still a loud breather.” I’ve had several docs listen to him, and they all say the noise isn’t in his lungs.
Then at 10mo we had an attack of croup. I hoped the steroids would cure the problem.
No such luck. Now that it’s turned cold outside, my son seems to be breathing even louder. It’s similar to the croupy sound, but not the same.
Do I become that crazy mom? Or do I see if he grows out of it?
Hi Natasha:
I can’t give you specific advice, of course, but it sounds to me as if your son just has an airway smaller than average. Another possibility is that he has what we call a “floppy” airway (it has a fancy name — laryngal or-tracheomalacia). Kids with that tend to be noisy breathers. The problem generally does solve itself when the child grows bigger. The experts on this sort of thing are either pediatric allergists or pediatric pulmonologists (lung specialists). If you are really concerned about it I’d suggest finding one of those two specialists.
Hi Dr. Johnson
I found your blog very interesting, I am a student of medicine at the Catholic University of Maule in Chile, and I’m very interested in the area of pediatrics. As you said there are many blogs that talk about caring for children, but only his focus on an important topic as critical care of children. I also really like his vision of treating children as a whole and not piecemeal, as was done earlier with general medicine. I commend him for his work and I hope your next post.
Carefully
Constanza Bustos.
Dr.Johnson, thank you for your article! My son has wheezing this winter with almost every cold. The doctor has prescribed Flovent and it helps. My concern is that we have to use this medication for very long periods of time. What could be the possible side effects?
Hi Anna:
Inhaled steroids like Flovent have been extensively studied in children and, although no medicine is totally without risk, they are extremely safe, even for prolonged periods of time. In your son’s situation, doctors often recommend using them through the winter cold season. If he is doing well in the spring, you could discuss with your doctor stopping them to see how he does
Dear Dr.Johnson, thank you very much for your reply! My son is doing well for a month and a half now. The doctor said we should use Flovent 125 mg once a day till the end of February. We are supposed to see our doctor in March. I would like to ask you what would be the right way to wean my son off this dose of Flovent? Should we switch to a smaller dose or just stop it (we are using it once a day)?
At that dose, and for inhaled steroids like Flovent, usually we just stop the medication. But I’d do as your doctor suggests because I can’t really give specific medical advice over the Internet.
My 15 month old has been battling with wheezing, coughing, congestion and ear infections. We have been doing breathing treatments of albuteral and budesonide for 7 months along with antibiotics and steroids; in the last 3 months, he has been on antibiotics 4 times. He seems to get a little better when he’s on antibiotics, but never completely better- he still wheezes when he is really active. The doctor recommended ear tubes, but my concern is that tubes will not solve our problem. What do you recommend for chronic wheezing/coughing? If that and the congestion are under control, would we even need the tubes?
Hi Katie:
I can’t give you specific medical advice over the internet without seeing your child in person. However, I can say that you’re correct that ear tubes generally aren’t used to treat wheezing problems — they’re for ear problems, most commonly recurrent ear infections.
my son is 2 years old – he has had 2 episodes of wheezing due to cough – doctor had first given him 2 ml per time /4 times a day to inhale ventalin through a nebuliser – he was very uncomfortable and we found that doctor has wrongly given him an overdose – so we consulted another doctor and they said yes surely its overdose as right dose shld be 0.25 ml – and doctor advisd us better to use the ventalin puff with a spacer and take 2 times a day as its only mild wheezing – we are worried about our son that by taking 4 days of overdose of inhaled ventalin -4 times each day – could it cause any major side effect to him – after his first episode of wheezing -after one week he had another episode due to viral cough – plz advice if it will cause any harm to him of taking overdose – also kindly let us know will he grow out of wheezing and what we should do to make his lungs stronger – in our family we dont have any history of asthama – plz help doctor – we are our worried about our 2 year old son
Generally speaking, albuterol is a very safe drug. We sometimes use it very high doses in severe asthmatic cases (much higher than your son received), so we have some experience with high levels of it. There are no aftereffects once the drug is stopped, so I wouldn’t worry at all about that for your son.
Regarding the wheezing your son had with a virus infection, that is very common. Although there is no way to be sure, most children grow out of that as they get older. The fact that there is no history of asthma in your family is no guarantee he will not have asthma later, but it does make it less likely.
I was wondering about not only the effects of the medicine but what it means for my son as a thriving three year old. He had RSV when he was six months old and it was a struggle to get the doctors to confirm it.We have been taking breathing treatments off and on for almost his whole life. Now he had what they think was Bronchitis but he was had severe wheezing since October and it is January. The doctor has given him 4 rounds of anitbiotics and 3 rounds of steroids. It has gotten to the point that I feel horrible about giving him his breathing treatments and I am worried that he will have to have them for even longer. Is there anything that could be recommended that might be a different approach for us to take?
Hi Alicia:
It’s not appropriate for me to give specific medical advice over the internet (I hope you’ll understand), but I can say that the sort of thing your son is experiencing as not that rare. It’s common for children who have had RSV to have wheezing problems long after the RSV is gone, and to have a higher risk of developing asthma. Sometimes this continuing wheezing problem can be pretty severe. One thing I could suggest is that you might consider taking your child to see a pediatric pulmonologist — a lung expert — if you haven’t already. They’re expert in handling things like that.
The good news is that problems such as your son has tend to get better as they grow older. So statistics are on your side.
Good luck.