Signs of Asthma in babies

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“My baby is breathing fast. He is wheezing. I brought him to the emergency department as soon as possible. Now the doctor is nebulizing my baby. I’m worried! Is my baby having asthma?”

This is a common worry of most parents if their baby gets a wheeze.


What is asthma?

Asthma is a common, chronic respiratory condition in children. It is a long term lung disease that makes your baby’s airways to become sensitive to certain triggers. In babies with asthma, the lungs and air ways can get inflamed easily when exposed to these trigger factors like pollen inhalation or when develop a respiratory infection such as a cold. Asthma in babies can lead to troublesome symptoms which can interfere with their sleep, feeding and play. In older children asthma can affect their daily routines like school, exercise and sports.

If asthma in babies are not managed properly, there may be sudden dangerous asthma attacks. Seeing your baby suffer from asthma is not easy. You may have to face various challenges. Asthma in babies have become a leading cause of emergency department visits and hospitalization. Unfortunately, asthma cannot be cured. The symptoms in your baby can continue in to adulthood. But the good news is with right management, you and your baby will be able to keep the symptoms under control and prevent further damage to the growing lungs.

 

What are the signs and symptoms of Asthma in babies?

The signs and symptoms of asthma in your baby will depend on the severity of the attack. The common signs and symptoms include:

  • Frequent cough – Cough can be seen while your baby is up and sometimes the frequency increases while your baby is asleep. Cough can be triggered by cold air or exercise. Coughing will be worse when your baby has an associated viral infection such as a common cold. Cough is either constant or it will come and go intermittently. Nocturnal cough (coughing at night) is a common symptom in asthmatic babies. Sometimes it is so disheartening to see frequent cough making your baby vomit all the milk and other foods which was consumed earlier.
  • Wheezing – Wheezing is a high pitched whistling sound that is heard while breathing. It is heard very clearly when your baby exhales (breathes out). When the asthma attack is severe, wheezing can be heard even when your baby inhales (breathing in). Wheezing may be a symptom of serious breathing problems in your baby.
  • Shortness of breath or troubled breathing – You may notice rapid breathing in your baby. Sometimes the breathing is labored that you will see the chest drawing in. Shortness of breath is medically known as dyspnea. It is often described as an intense tightening in chest, difficulty breathing, air hunger, breathlessness or feeling of suffocation. Asthma may give rise to all these described features. However, in a healthy person shortness of breath can be caused by high altitudes, very strenuous exercise, extreme temperatures and obesity. You will notice that your baby is working harder than usual to breathe. There may be flaring of the nostrils, skin sucking in between and around ribs or above the sternum and exaggerated belly movements.
  • Chest congestion and tightness – If your baby is old enough to communicate, he or she will indicate a discomfort or heaviness in the chest.
  • Noisy breathing – breathing is noisy in asthmatic babies. You will notice this especially while they are asleep.

Other less common signs and symptoms are:

  • Bouts of coughing that may worsen with a flu or a cold. Cough can be intermittent or constant. Crying, yelling, laughing and other strong emotional reactions can trigger wheezing and coughing in your baby.

Cough may be productive because of increased production of mucus. Your baby will cough out or vomit clear, yellow or greenish mucus.

  • Wheezing that worsen when your baby has a respiratory infection.
  • Your baby may have trouble sleeping due to frequent coughing, wheezing and shortness of breath.
  • Crying without any reason – The babies who cannot express themselves will cry often because of their discomfort. Crying will further increase the nose block and congestion, which in turn will worsen the troubled breathing and breathlessness.
  • If your baby gets a respiratory infection, it will take time to recover, when compared with the babies who do not have asthma. Sometimes delayed recovery may be due to bronchitis, which can occur with worsening respiratory infections.
  • Your baby will be tired or fatigued due to poor sleep and frequent coughing.
  • Poor feeding – It will be difficult to feed babies who are chronically ill. If your baby gets frequent asthma attacks, your baby will show features of failure to thrive as feeding patterns will be interfered with the sickness.
  • Poor sucking – breast fed babies will not suck satisfactorily while having asthma attacks. Since they often breathe with their mouths open, sucking will disturb their breathing. Therefore, they refuse to suck milk from breasts.
  • Loss of appetite – not even breast milk, even formula and other foods will be refused by your sick baby most of the time. Asthma symptoms as well as the medications can reduce the appetite in your baby.
  • Because of their labored and troubled breathing, these babies will be less active. Asthma attacks can hamper their play and exercise.

Signs and symptoms will also vary from child to child. Your baby can get better or worse with time. Some babies will only have one or two symptoms such as a long term cough or chest congestion, which may be the only indication that they have asthma. Sometimes it will be difficult to tell that your child’s symptoms are due to having asthma. Periodic wheezing, long term wheeze and other asthma like symptoms can be due to infectious bronchitis, bronchiolitis or other respiratory problems in babies.

If there is a family history of asthma or atopy in the family, having these symptoms may point towards asthma.

What is atopy?

Atopy is the genetic tendency to develop allergic diseases like asthma, allergic rhinitis (hay fever) and atopic dermatitis (eczema). Atopy can run in families. It is typically associated with heightened immune response to common allergens, especially inhaled and food allergens.

When should you seek help?

Take your baby to see a doctor, if you suspect that he or she has asthma. Even though you are not 100% sure of asthma, if there are such symptoms it is best to visit your baby’s health care provider or a pediatrician. Early treatment will help to control symptoms in your baby and preventing your baby from developing asthma attacks which may be life threatening.

Seek help if:

  • Your baby has intermittent or constant cough – which may be linked with activities
  • Rapid breathing or shortness of breath
  • Wheezing or whistling sounds heard when your baby breathes out
  • Features of chest congestion or if your baby indicates a chest discomfort
  • If your baby develops repeated episodes of suspected pneumonia or bronchitis.

Seek emergency treatment if your baby seems very ill with cough and struggled breathing. You will notice that your baby’s chest and sides of the neck pulling inwards while he or she struggles to breathe. Your baby will have a rapid heartbeat, rapid breathing and sweating. Non stoppable crying while attempting to breathe is also a feature of an emergency.

Seek emergency care if:

  • Your baby uses his or her abdominal muscles to breathe
  • When breathing in, nostrils are widened
  • If your baby tries so hard to breathe, you may notice that your baby’s abdomen is sucked in under the ribs when he or she breathes in.

If there are such symptoms, seek help without delay.

Sometimes you may not know that your baby is having asthma. A diagnosis may not have been made previously. But if your baby has such symptoms seek medical attention immediately.

Episodes of asthma can vary in severity. An asthma attack can start with a cough, but later progress to wheezing and labored breathing.

What are the causes and trigger factors of asthma?

Causes of childhood asthma are not completely understood. Sometimes your baby may develop asthma due to following reasons.

  • Family history of atopy – genetic tendency to develop allergies
  • If there is a family history of asthma in parents, siblings etc.
  • Exposure of your baby to various environment factors like polluted air, cigarette smoke, etc.
  • If your baby developed air way infections early in life

When your baby is exposed to certain trigger factors, the sensitivity of your baby’s immune system will increase. This can lead to swelling of air ways and lungs and increased production of mucus.

Trigger factors, just like the symptoms may also vary from child to child. What triggers an asthma attack in your baby may differ from those of other babies with asthma. Sometimes the reaction to a certain trigger may be delayed. Therefore, it will be difficult to identify the trigger. Sometimes there is no apparent trigger to develop asthma symptoms.

Common triggers of asthma are:

  • Allergies to pet dander, pollen, dust mite or mold
  • Exposure to pollutants in the air – Ex: Cigarette smoke
  • Viral infections like common cold and flu
  • Cold air and changes of weather
  • Physical activities and playing

What are the risk factors that may increase your baby’s likelihood of developing asthma?

  • If there is a family history of asthma or other allergies
  • Exposure to tobacco smoke, even while in the mother’s womb
  • Living in a highly polluted environment
  • Previous allergic reactions in your baby including food allergies, skin reactions or allergic rhinitis (hay fever)
  • Gastro esophageal reflux disease (GERD) in your baby is also a risk factor which causes frequent heart burn
  • Having other respiratory conditions like rhinitis (chronic runny nose or stuffy nose), sinusitis (inflamed sinuses) or previous pneumonia
  • Being a male baby will increase the risk of developing asthma
  • Are you and your baby a Puerto Rican or black? Then the risk is more

What are the complications of uncontrolled asthma?

Asthma, especially if not managed properly, can give rise to many complications.

  • If the asthma attacks in your baby are severe, they will require emergency treatment and many hospital admissions
  • Poor sleep and fatigue
  • Your baby’s lung function may permanently decline when having uncontrolled asthma since a very young age
  • The symptoms can interfere with play, feeding and other activities in your baby
  • Failure to thrive in your baby

What is known as failure to thrive in babies?

Failure to thrive is a term used to describe inadequate growth or inability to maintain a healthy growth, usually during early childhood. It is a sign of malnutrition or under nutrition. Suffering from a chronic illness like asthma can lead to failure to thrive in babies. This is partly because of poor feeding during periods of asthma attacks.

Why do these symptoms arise in asthmatic babies?

When your baby is exposed to certain triggers, several things can happen to your baby’s air way.

  • The lining around your baby’s air ways will start to swell. This is due to inflammation of the inside lining which happens mainly due to inhaled allergens. Swelling narrows your baby’s air ways that may lead to labored breathing.
  • The muscles around the air ways may tighten. Therefore, wheezing and whistling sounds can arise when your baby is breathing out. Your baby will have to push the air out through a narrow air way, which makes the whistling sounds or the wheeze.
  • Your baby’s air ways will make thick mucus than normal. So, the cough will be phlegmy and the breathing noisy.

Babies are more at risk of wheezing because their air ways are very small. These passages which are already small, when inflamed can swell up and fill with mucus more easily than an older child’s or an adult’s air passages. These reactions will make your baby’s air ways narrow. This in turn will make it difficult for air to go in to and out of your baby’s lungs, giving rise to the symptoms of asthma.

Babies with asthma do not have symptoms all the time. Usually they have a few symptoms like cough. But sometimes symptoms can flare up when exposed to triggers.

Some other health conditions can give rise to similar signs and symptoms of asthma. Ex: heart disease in babies

Therefore if your child has one or more of these symptoms, visit your baby’s health care provider for further evaluation and diagnosis.

How is asthma diagnosed in your baby?

After taking a thorough history and doing a physical examination, your baby’s doctor will recommend the following tests.

  • Blood tests – your doctor will be able to know the levels of certain white blood cells which may be elevated in response to allergies and infection.
  • Spirometry – Lung function of your baby will be checked by using a device called the spirometer. This test can be done in adults as well as children, including infants. Spirometry is done to assess how well your baby’s lungs work by measuring how much air he or she inhales, how much air is exhaled and how quickly exhalation is done. It is used to diagnose not only asthma, but also other conditions which affect breathing such as chronic obstructive pulmonary disease.
  • Chest x ray (CXR) – Invisible energy beams are used to make images of your baby’s chest. An x ray of the chest will produce images of your baby’s lungs, airways, heart, blood vessels and the bones of the spine and rib cage. Chest X ray (radiograph) is a non- invasive diagnostic test commonly performed in health care facilities.
  • Allergy tests – These will show whether your baby is having allergies that can cause or worsen his or her asthma. Skin prick testing is a commonly used allergy test. A drop of liquid which contains a substance which your baby may be allergic to is put to the fore arm of your baby. The skin under this drop is then gently pricked. If your baby is allergic to this substance, an itchy red bump will appear at the site within 15 minutes.

One instance or episode of wheezing is not enough to diagnose asthma. Wheezing episodes should happen more than once. Most babies who wheeze, outgrow it with time and don’t have asthma when they grow older. Therefore, doctors usually don’t make an asthma diagnosis until your baby is older, by about 4 to 5 years of age. Meantime, your baby’s health care provider will treat those asthma like symptoms without labeling your baby as asthma. Asthma will be officially diagnosed if the symptoms continue.

You can share your worries and concerns with your baby’s doctor and inquire about possible asthma in your baby. This may be likely if your baby has;

  • Prolonged coughing or coughing that gets worse at night or after active playing
  • Wheezing which has occurred more than once, even if it is without any illness
  • Any other breathing problems in your baby which concerns you

How is asthma treated?

Diagnosing and managing asthma in babies can be challenging and difficult. Some effective treatment available for adults and older children are not recommended for babies. Careful and frequent monitoring is needed when treating a baby with asthma. Your doctor will discuss with you and write down an asthma action plan. You can minimize your baby’s asthma symptoms by following these instructions. Your asthma diary will help to monitor symptoms and to adjust the treatment accordingly.

Treatment will depend on your baby’s age, symptoms, general health and how severe the condition is. Sometimes your baby may be referred to a pulmonologist or an asthma and allergy specialist.

Treatment will include looking for triggers and will teach you ways of how to avoid these triggers for your baby. It will be easy for your doctor to decide, if you maintain a diary on your baby’s symptoms and possible causes which you think that triggered these symptoms.

Your baby will be prescribed asthma medications to reduce the symptoms. Reducing the symptoms is one of the main goals of treatment.

  • Bronchodilators – They will help to open up the narrowed air ways. In asthma, the air way narrowing is reversible. Therefore, bronchodilators will relieve your baby’s coughing, shortness of breath, wheezing and difficulty in breathing, thus improving the main symptoms of asthma. Short acting bronchodilators like salbutamol and ipravent provide immediate relief of asthma symptoms. Their effects last for 4 to 6 hours. These are used to control the attack and not as long term medications.
  • Anti- inflammatory medications – The inflammation of the air ways will be decreased, which will relieve the symptoms like cough and wheeze. For long term control and maintenance these should be taken daily.

Ex: Inhaled corticosteroids (Beclomethasone, budesonide, Fluticasone, pulmicort)

An inhaler can be used with a spacer and a mask to administer the drug to your baby.

Long acting beta agonist like Salmeterol can be combined with inhaled corticosteroid treatment regimen.

 

  • Anti- Leukotrienes – these will reduce the narrowing of the air ways. Leukotriene modifiers like Montelukast comes as chewable tablets as well as in granular form. You can add it to your baby’s pureed food.
  • Oral corticosteroids are only used when asthma cannot be controlled with other treatments because of their side effects.

A nebulizer can be used to deliver the drugs when it is difficult to get the babies to use an inhaler device. Nebulizer turns the medication in to a fine mist for your baby to inhale through the face mask.

 

Asthma is treated by controlling inflammation with drugs, avoiding trigger factors when possible and by using medications to treat an asthma attack. As asthma is chronic and ongoing inflammation of lungs and air ways, treating inflammation is mandatory because the inflammation makes your baby’s air ways vulnerable to asthma attacks.

You can also make changes to your home to control the asthma triggers. This will minimize your child’s exposure to triggers.

  • Clean your house well to control pet dander and dust
  • Avoid taking your child outdoors during pollen season. You can check pollen count reports.
  • Avoid tobacco smoking at home

References:

https://www.mayoclinic.org/diseases-conditions/childhood-asthma/symptoms-causes/syc-20351507

https://www.mayoclinic.org/diseases-conditions/childhood-asthma/diagnosis-treatment/drc-20351513

https://www.hopkinsmedicine.org/health/conditions-and-diseases/asthma/asthma-in-children

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