Is It Asthma?
The rate is rising, and there are many possible causes -- yet asthma is not the only reason for wheezing. "Some kids are transient wheezers -- they'll wheeze until age 2 or 3 and then stop," says Omaha osteopathic physician and allergist James M. Tracy, DO, president of the Nebraska Allergy Society. Otherwise healthy young children may be prone to occasional wheezing or coughing, often set off by illness or a condition such as gastro-esophageal reflux (recurrent spitting up), but two-thirds eventually outgrow it. Until then, their wheezing could be treated the same way as an asthma attack, with a "rescue medication" such as albuterol (sold under the brand names Proventil and Ventolin), a bronchodilator that quickly relaxes the airway muscles. These drugs can cause restlessness, irritability, and nervousness. Xopenex, a new drug (levalbuterol), may cause fewer side effects.
For the one-third who may go on to develop full-blown asthma, a definitive diagnosis may not come until the child is at least 5 and can reliably follow directions to fully inhale and then fully exhale for four seconds into a spirometer, an instrument that measures airflow. Still, many pediatricians will diagnose asthma in preschoolers and toddlers. "For a younger child, we base a diagnosis on the pattern of wheezing, the possibility of other conditions, and whether asthma medication helps, but it's still a gray area," says Dr. Liu.
Another gray area: the apparent but still unexplained link between asthma and respiratory syncytial virus (RSV), an extremely common childhood illness that can cause wheezing. "Virtually all children get RSV by age 2, and for most, the virus causes coldlike symptoms," says J.J. LaBella, MD, assistant clinical professor of pediatrics at the University of Pittsburgh. "But it can also be serious, especially for infants born before 35 weeks' gestation, as well as in those with chronic lung or neuromuscular diseases, such as muscular dystrophy, cerebral palsy, and spinal muscular atrophy." Premature babies' underdeveloped, fragile airways are prone to complications, such as bronchiolitis -- an infection of the small breathing tubes -- and pneumonia.
Respiratory Syncytial Virus (RSV)
Each year, more than 125,000 babies are hospitalized for RSV, the top cause of hospitalization for kids under age 1. Experts agree that parents should take steps to protect babies from the highly contagious virus -- scrupulous hand-washing as well as avoiding crowds and sick people help. If your baby is among the most vulnerable, ask his doctor about Synagis, a preventive drug injected monthly during RSV season, from October through March. "It's been shown to cut hospitalization risk in half for high-risk babies," says Dr. LaBella.
If your baby does develop RSV, you'll know it. "The symptoms aren't subtle," notes Dr. LaBella. "If your baby starts to wheeze -- you can hear the breathing and see the muscles working on the chest -- you need to call the doctor." Listen for a characteristic high-pitched sound as your child exhales.