Some important information from an expert on baby asthma.
Mom holding baby
Credit: Alexandra Grablewski

What Is Asthma?

Asthma is on the rise in children -- rates have increased by 160 percent in kids 4 and younger since 1980, and by 75 percent in the general population. It's the most common chronic condition among children, affecting about 5 million kids in the U.S., almost half of whom have symptoms before age 1. No one is exactly sure why asthma rates are increasing, but it may be a combination of more pollutants in the environment, earlier exposure to a wide range of allergy triggers (called allergens) in foods and in the environment, and better methods of diagnosis.

Asthma is a chronic disease in which the airways to the lungs become inflamed, leading to episodes of breathing difficulty. The condition is caused by an immune reaction to a variety of irritants (allergens such as dust, pollen, and mold), and environmental pollutants (such as tobacco smoke). In fact, there's a strong connection between allergies and asthma. Sixty percent of asthmatics suffer from allergies, usually hay fever. And babies with allergies -- experienced in infancy as eczema or a food allergy -- are at a greater risk for asthma. Asthma attacks can also be brought on by upper respiratory infections and even cold air.

An asthmatic episode occurs when the airways are exposed to irritants, setting off an allergic response that causes them to swell, spasm, and produce excess mucus. This causes the airways to constrict, resulting in a high-pitched whistling sound as the person exhales, known as wheezing.

In infants, whose airways are already very small, it takes only a little bit of swelling to make it harder for them to breathe. As a result, wheezing is common before age 1 and can be caused by simple cold viruses as well as asthma. For example, respiratory syncytial virus (RSV) often causes a type of pneumonia called bronchiolitis in young children. RSV usually begins as a regular cold, with coughing and congestion, but it can progress to difficulty breathing, a worsening cough, and wheezing.

Other conditions that can cause wheezing in infants include:

  • "Floppy" airways that narrow easily (a condition children usually outgrow by age 2)
  • A bit of food or a small object lodged in the airway
  • Bronchitis
  • Croup (a cold virus that causes a barking cough)
  • Stomach acids that get into the lungs as a result of chronic reflux

If your infant is wheezing, you should always call your doctor, even if the baby seems alert and comfortable. Your baby requires immediate attention if you notice any of the following:

  • Breathing that's faster than normal
  • Flaring of the nostrils
  • Sucking in of the stomach or pulling in between the ribs
  • Bluish color around the lips

How Is It Diagnosed?

Since wheezing isn't a sure sign of asthma, babies who have recurrent wheezing are often initially said to have reactive airway disease. Unfortunately, there are no definitive tests that can easily diagnose asthma in babies and toddlers. It's not possible to measure lung function (the volume of air in the lungs and how quickly it's exhaled) in such small children. Physicians and families simply have to monitor the baby over time and see what brings on the wheezing; if it occurs after exposure to dusty areas or spontaneously without an upper respiratory infection, that's a clue that it may be caused by asthma. If a child responds best to asthma treatments, that's another hint.

Since there's a strong link between asthma and allergies, if a child has a history of other types of allergic reactions, such as eczema, I'm more likely to suspect asthma. In addition, a family history of allergies and asthma is a risk factor. Over time, both the parents and the physician will learn what's causing the baby's wheezing and whether those patterns fit with asthma. In my own practice, if a child continues to have bouts of wheezing after the age of 12 months, I'm more inclined to attribute his wheezing to asthma.

At the same time, not every child with asthma will wheeze. Some have milder forms of the disease that give them a chronic cough, which is usually worse at night, or they may develop a chronic cough whenever they get a cold. If there is still uncertainty by age 5, children can then be given a lung function test for a definitive asthma diagnosis.

How Is It Treated?

Managing asthma requires a lot of discussion with your doctor to learn how to use your child's medications and monitor his breathing, and to know when your child needs to be seen by a doctor. Asthma severity can change a lot over the course of a year, as the seasons change. It can also change as a child grows older. I see my patients with asthma at least every three months so we can go over all of these topics and make adjustments to medications as needed.

Children are typically given two types of medication for asthma:

For quick relief of an asthma attack: The most common medication for immediate relief from asthma symptoms is albuterol. It can be given as a liquid, but the most effective way to administer it to babies is through a machine called a nebulizer, or with a handheld inhaler. The nebulizer turns the medication into a mist so it can be inhaled directly into the lungs via a mask. Albuterol opens up the lungs and relieves the constriction of the airways so your child can take in more air. The medicine works very quickly, usually within a few minutes of inhalation. But be aware that it makes infants hyper, and perhaps jittery.

If an asthma attack is especially severe, your child may also be given another medication -- corticosteroids -- in a liquid or pill form, or intravenously, for three to five days, in addition to the albuterol.

For long-term prevention of the irritation and inflammation of the airways: If your baby is experiencing wheezing that requires albuterol treatments more than two or three times a week, your doctor will want to add a preventive medication to his regimen. Besides preventing the wheezing that can escalate to severe breathing problems, preventative medications are important to avoid long-term scarring of the lungs from continual swelling and inflammation. Two kinds of anti-inflammatory medications are used for prevention in young children: cromolyn sodium and inhaled corticosteroids. To work, both have to be taken every day, whether or not your child has symptoms. Cromolyn sodium takes effect after four weeks of use; corticosteroids, after two weeks.

Cromolyn sodium is very safe, with few side effects. If your child has more severe asthma, he may need corticosteroids in an inhaled mist form. They go directly to the lungs and have fewer side effects on the body than the pill or liquid steroids sometimes given during an asthma attack.

The goal of treatment is for your child not to experience any symptoms or breathing limitations, so he can be involved in all physical activities, just like any other child.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

American Baby