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Asthma (Baby and infant)
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Asthma (Baby and infant)

 

Condition
Asthma (Baby and infant)
Class
Respiratory system
Description
Asthma is a common condition that affects the small airways or tubes in the lungs called bronchioles, making it difficult to breathe.

Babies and infants often develop coughs and wheezes but, although these are symptoms of asthma, it does not mean that the child has asthma as many other illnesses affecting the airways have similar symptoms. It is estimated that only about one third of children who had a wheeze when they were a baby will have asthma later in life.

Doctors will usually delay making a diagnosis of asthma until the baby is at least 12 months old when the baby's lungs are better developed and a more complete pattern of symptoms has emerged.
Causes
One of the commonest causes of wheeze in babies and infants that can be confused with asthma is a condition called bronchiolitis that usually occurs as a result of a viral infection. To understand why asthma and bronchiolitis can be confused, it is important to know something about the structure of the airways in the lungs.

The airways or bronchioles have an outer muscular wall and a soft inner lining. The outer muscular wall controls the size of the opening of the airway. When the muscles relax the opening of the airways gets bigger, making it easier to breathe and allowing more air into the lungs. When the muscles contract the opening of the airways gets smaller, making it harder to breathe and allowing less air into the lungs. The cells of the soft inner lining produce mucus which helps trap dust and other small particles in the air.

Babies have very narrow bronchioles. When babies get a respiratory infection such as bronchiolitis, the lining of the bronchioles becomes swollen and produces more mucus. This makes the baby's bronchioles even narrower, obstructing the flow of air in the lungs and causing a wheeze when the baby breathes. Also, the presence of mucus in the lungs makes the baby cough in an attempt to clear it.

When an infant has asthma, the cells in the bronchioles become overly sensitive and are easily irritated by substances such as dust, pollen, cigarette smoke, animal fur, even cold air. The muscles in the walls of the airway contract making it difficult to breathe. At the same time, the inner lining of the airway becomes swollen or inflamed and produces lots of mucus. The swelling of the lining and the increased amount of mucus make the narrowed airway even narrower and breathing even more difficult, causing wheeze and cough.

No one knows exactly why some babies develop asthma and others do not. It is probably a combination of genetic and environmental factors. Babies are more likely to develop asthma if there is a history of asthma, allergy or eczema in the family. Environmental factors such as house dust mite, pollution, passive smoking (including the mother smoking during pregnancy), or a viral infection probably combine with genetic factors to increase the chances of getting asthma.

There are also numerous other causes that are thought to increase the risk of babies developing asthma. For example, babies who are born by caesarean section, who are born prematurely, who are born overweight, who are bottle-fed instead of breast fed, even if born in the autumn. However, while there does appear to be an association between asthma and some of these factors, not all are universally accepted by doctors.
Symptoms
Symptoms of respiratory infections such as bronchiolitis, colds and influenza are very similar to the symptoms of asthma. Both cause wheezing and cough and the baby will show signs of having difficulty in breathing. If a baby has a wheeze due to a virus, the wheeze will only occur infrequently during times of infection and the baby's temperature will also be raised. However, if a baby or infant has asthma they will develop a wheeze or dry cough without showing other signs of infection such a runny nose or high temperature. Wheeze caused by asthma may also occur frequently, on several occasions, often getting worse at night, or after the baby has been out in the cold air or near animals.
Treatment
If treatment is required, many doctors will use the same medicines to make breathing easier for babies with a wheeze, whether its cause is viral or asthma. Treatment falls into two main categories - relievers and preventers.

Relievers
Relievers work quickly to ease the symptoms and help the baby or infant breathe more easily. They should be used at the first signs of wheeze beginning. Relievers include drugs such as salbutamol that relax the muscles in the airways, widening the airways and so making breathing easier.

Sometimes, very young babies do not respond well to drugs such as salbutamol. In such circumstances, another reliever called ipratropium bromide may be used.

Preventers
Preventers include drugs known as inhaled steroids such as beclometasone or budesonide. These drugs act to reduce the sensitivity of the airways to irritant substances. When used regularly they reduce inflammation of the airways. However, because there is a risk that steroids may inhibit growth in young children, many doctors are against the use of inhaled steroids for long periods and do not recommend their use in viral wheeze.

Spacers
The relievers and preventers are available as inhalers which are small aerosols designed to deliver a measured dose of the medicine to the lungs. As babies and infants are unable to use inhalers properly, a doctor may also prescribe a spacer and a face mask to be used with the inhalers. A spacer is just a large plastic cylinder that allows the inhaler to be attached at one end, and the face mask at the other. The inhaler is puffed into the spacer, allowing the baby to breathe normally through the face mask. As the baby breathes through the face mask it inhales the active medicine from the spacer.
When to consult your pharmacist
If your child has been prescribed an inhaler and you want help and advice on how to use it with a spacer and face mask, talk to your pharmacist.

If your child is under 2 years of age and the wheeze or cough is due to a viral infection, do not give your child medicines that have been prescribed for others in the family as they may not be suitable. Talk to your pharmacist for advice.

Preparations containing paracetamol and ibuprofen are helpful if your baby has a high temperature, but check with your pharmacist first. Glycerol, honey and lemon mixtures help relieve coughs. If your baby is over 3 months of age, vapour rubs or sodium chloride nose drops may clear nasal congestion and help feeding.
When to consult your doctor
Always see your doctor if your baby develops a wheeze or a persistent cough, and seek advice urgently if your baby or infant shows signs of difficulty breathing.

If your baby develops an occasional wheeze, then its cause is very likely to be viral. Your doctor will listen to your baby's chest and look for signs of an infection.

If your baby frequently wheezes, your doctor may suspect asthma. You will be asked whether there is any history of allergies in the family and to describe your baby's symptoms and when they occur. When your baby is a little older, your doctor may perform skin, blood and lung function tests to confirm asthma.
Caring for a baby with asthma
If you think that your baby has asthma it will help your doctor if you keep a diary of your baby's symptoms, describing as fully as you can how your baby was affected and when the symptoms occurred. However, even if your doctor suspects that your baby may have asthma, it may not be until your baby is at least 1 year old when your baby's lungs are better developed that a firm diagnosis can be made. Later, when your baby has reached at least 3 years of age and is able to follow instructions, the doctor may test your baby's lung function with a simple device called a peak flow meter to confirm the diagnosis.

Whether the cause of wheeze in your baby is a respiratory infection or asthma there are a number of things that you can do to reduce the chance of it occurring. For example, never smoke or allow others to smoke in the vicinity of your baby. If animal fur causes your baby to wheeze, try to keep the animal away from rooms occupied by the baby such as the living room and the baby's bedroom. Vacuum carpets and curtains regularly and wash baby's bed linen to reduce levels of dust.

If medicines are prescribed for your baby or infant and you find that you have to use them more frequently or they do not seem be as effective, it may be as sign that your child's wheeze or asthma is getting worse. Also, if your baby or infant is coughing or wheezing regularly, waking up at night or just not able to do things such as run around without getting breathless and tired, these too can be a sign that the wheeze or asthma is getting worse. Always see your doctor or nurse in these circumstances.

As babies and infants are unable to use inhalers properly, a doctor may also prescribe a spacer and a face mask to be used with the inhalers. The large size of the spacer can be intimidating, but do not worry, as your doctor or nurse will show you how to use the spacer and how to put the face mask on your baby. As your baby gets older, she or he will be able to use the spacer without a face mask and will eventually learn to use the inhaler without the spacer.
Useful Tips
  • Get to know the things that trigger your child's wheeze and avoid them
  • Special anti-allergy bed linen and vacuum cleaners can help reduce house dust mite droppings, a common cause of wheeze
  • Never smoke or allow anyone to smoke near your child
  • Speak to your doctor or nurse if your child's wheeze gets worse or is not relieved by the medicines prescribed
  • Seek urgent medical help if your child shows signs of breathing difficulties
Further information
Asthma UK is the charity dedicated to improving the health and well-being of people in the UK whose lives are affected by asthma. Asthma UK runs an advice line operated by asthma specialist nurses. Its website provides comprehensive information about asthma and gives practical advice on Nursery and Child care for parents.
Asthma UK Adviceline
Asthma UK
Summit House
70 Wilson Street
London
EC2A 2DB
Helpline: 0800 121 62 44
www.asthma.org.uk

Reviewed on 6 December 2010


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