Identifying and Treating Asthma in Babies

The first signs of asthma in your baby may be triggered by a respiratory infection. If your child ever develops a viral respiratory infection, be sure to look for signs of asthma. A baby has much smaller airways than an adult, so even minor inflammation can cause breathing troubles. The main symptoms of asthma in babies include:

• Labored breathing. You may notice your baby’s belly moving more than normal while breathing, and their nostrils may flare.
• Panting or heavy breathing during normal activities that usually don’t get your baby winded.
• Wheezing, which may sound like whistling. Note that other kinds of “noisy breathing” may sound like wheezing and wheezing can only be accurately diagnosed with a stethoscope.
• Frequent coughing.
• Fast, shallow breathing.
• Fatigue. Your baby may not be interested in some of their favorite activities.
• Difficulty eating or sucking.
• Face and lips may turn pale or blue. Your baby’s fingernails may also turn blue.

Several other medical conditions share some of those same symptoms, including:

• croup
• bronchiolitis
• upper respiratory infection
• acid reflux
• pneumonia
• inhaling food or other objects

Not all wheezing and coughing are caused by asthma. In fact, so many babies wheeze and have other frequent respiratory symptoms, that it’s difficult to know if a child will have asthma until they’re at least two to three years old. If your baby has asthma, don’t assume that all coughing spells are asthma attacks. This can lead to the improper use of asthma medications to treat a condition that isn’t asthma. However, if your baby’s been diagnosed with asthma, any persistent coughing episodes are probably asthma flare-ups.

Scientists still don’t know why some babies develop asthma. There are some known risk factors. A family history of allergies or asthma puts your baby at a higher risk for asthma. A mother who smoked during pregnancy is also more likely to have a baby who develops asthma. A viral infection is often the cause of asthma symptoms, especially among babies under the age of six months.

If your child ever has difficulty breathing, or experiences a change in the color of their face and lips, seek immediate medical attention. A severe asthma attack can be a medical emergency.

Diagnosing asthma in an infant or toddler can be difficult. Older children and adults can perform lung function tests to check the health of their airways. This test can’t usually be done with a baby. A baby can’t describe their symptoms, so it’s up to the doctor to review the symptoms and perform an exam. Usually the exam is done when your baby has symptoms, such as wheezing or coughing. It’s also important that you provide your doctor with a full medical history of your baby. Let them know about any patterns you’ve noticed in symptoms related to breathing, such as changes in response to activity or rest, or during different times of the day. Also tell your child’s doctor about possible triggers, such as responses to food, certain environments, or potential allergens. They’ll also want to know if there’s a family history of allergies or asthma. If your pediatrician suspects that your baby has asthma, they may want to see how your child responds to asthma medication to relieve breathing problems. If breathing becomes easier after administering the medication, that will help confirm a diagnosis of asthma. A chest X-ray or blood test may also be ordered. If you’re not confident your pediatrician will make an accurate diagnosis, you should consider seeing a doctor who specializes in pediatric asthma. This may be a pediatric allergist or pulmonologist. But again, it’s often difficult to make a definitive diagnosis of asthma in a very young child.

Most medications to treat asthma in babies are given in inhaled forms. The medications that are appropriate for older children are usually okay for babies, just sometimes at lower doses. Asthma medications are often poured into a nebulizer, which is a machine that turns liquid medications into mist form. The misty medication travels through a tube to a facemask worn by the child. Your baby may not like wearing the mask, even though it just covers the nose and mouth. With some reassurance or a distraction like a favorite toy, you should be able to get enough medication to your child to see some symptom relief. Medications may also be given via an inhaler using an extra device called an aerochamber, along with an appropriately sized mask. Several different types of medications are available. A common quick-relief drug is albuterol (Proventil, Proair HFA, Respirol, Ventolin). It’s one of a class of drugs known as bronchodilators. They help relax the airways to make breathing easier. Long-term medications include corticosteroids (Pulmicort) and leukotriene modifiers (Singulair). These drugs help reduce inflammation to ease symptoms. A mix of medications is often used. Your doctor will develop a treatment plan based on the severity and frequency of the asthma attacks. In addition to providing your baby helpful medications, you can take other steps to help manage your child’s symptoms. The two main goals are to learn your child’s triggers so you can avoid them, and to learn your child’s breathing patterns so you’ll know if an attack is pending. You can also help your baby by reducing exposure to:

• dust
• mold
• pollen
• cigarette smoke

Asthma attacks that aren’t well controlled could eventually lead to a thickening of the airways. This can lead to long-term breathing difficulties. In the short term, an asthma attack means your baby will be fussy, uncomfortable, and tired. In a serious asthma attack that can’t be stopped with quick-relief medication, you should get immediate medical attention. Your baby may need to visit the emergency room and a hospital stay may be required, too.

If you suspect your baby has asthma, seek a diagnosis. If you don’t feel you’re getting good advice from your doctor, you may consider seeking a second opinion, possibly from a specialist. Many children who wheeze or have other symptoms of asthma in infancy and early childhood don’t go on to have asthma when they’re older. But you shouldn’t change their treatment plan without first talking to their doctor.