Asthma in Infants
It is very difficult to make a definite diagnosis of asthma in infants. There are many things that contribute to asthma-like symptoms within this age group. The number one misconception is that wheezing in infants is an automatic sign of asthma. Not true. Wheezing in infants does not automatically mean the child has asthma.
Almost 50% of all infants will have a wheezing episode sometime during their first year of life, and the majority of these instances are caused by simple airway obstructions or inflammation. Less than one-third of infants who wheeze on a recurring basis during the first three years of their life continue wheezing later in life. Because of this, some doctors want to delay an asthma diagnosis until the child is over the age of six.
When children, especially infants, have a cold or upper respiratory infection, their airways can become very narrow and inflamed, resulting in a distinct, wheezing sound. Sometimes the sound is extremely noisy, while other times it’s only audible with a stethoscope.
Because infants already have tiny airways, if inflammation or an obstruction occurs, it presents a huge problem by decreasing the width of the airways even more. Another cause of wheezing in infants is their chest wall structure. The walls of the chest are flexible at that age, and when babies forcefully exhale, the walls compress and can put pressure on the airways, narrowing them, as well.
If your child is wheezing, you may be able to pinpoint where the airway obstruction or inflammation lies by listening to the tone of the wheeze. Breathing will be noisy and coarse if the problem is stemming from upper airways, whereas it will sound pitchy with a musical tone if the sound originates from the lower airways.
If your infant is diagnosed with asthma, it is critical to pay close attention to signs that indicate difficulty breathing, such as:
- Sitting up and refusing to lie down
- Stops feeding
- Pale, blue skin
- Rapid breathing
- Using accessory muscles of breathing or drawing muscles in at the neck (may look like the skin is being pulled)
Infant wheezing can also be induced by a common infant condition that mimics asthma, called bronchiolitis. Bronchiolitis is a small airway inflammation caused by a viral infection, such as Respiratory Syncytial Virus, or RSV. RSV symptoms include rapid breathing, coughing, wheezing, and fever. Instead of labeling children with bronchiolitis as asthmatics, doctors will diagnose them with “reactive airway disease,” because most kids lose the asthma-like symptoms by six years of age.
Other, less common factors that may contribute to wheezing during infancy include food or liquid from the stomach leaking into the esophagus, weak windpipe walls, premature birth, cystic fibrosis, and foreign objects in the air path, among other things.
“Wheezing is common, but not normal, and can get very severe, so it’s important to have it checked out, especially if it interferes with eating or with play,” said Dr. Robert Strunk, professor of pediatrics at Washington University School of Medicine.
If all the above scenarios have been ruled out, and you still suspect your infant of having asthma, the following risk factors are the strongest indicators of having the disease:
- At least 3 episodes of wheezing within 12 months
- Frequent respiratory infections
- One or both parents with asthma
- Reactions to airborne allergens, such as pollen, dust, mold, etc.
- Allergic skin reactions, like eczema
- Wheezing without a cold or infection
- Nasal allergies, such as hay fever
- Coughing fits at night or after play
Between the child’s medical history, signs and symptoms, and physical exam and results, your doctor may suggest several options to alleviate your child’s symptoms. Asthma medications may be prescribed for a four- to six-week trial period to see if your child’s condition improves. If your little one’s health improves, your child most likely has asthma.