News | Published February 25, 2013

Wheezing in small children

Infants and young children are at risk for respiratory illnesses that involve wheezing as a major symptom. Wheezing is a noise that sounds like a highly-pitched squeak usually when breathing out. It can be associated with a dry, tight, hacking cough and also nasal flaring. The muscles in a child’s neck, ribs and abdomen can also retract as they move the child’s breaths in and out.

The two most common wheezing illnesses in young children are bronchiolitis and reactive airway disease. Infants and children can also have actual asthma and wheezing from non-infectious triggers such as allergies, irritants such as cigarette smoke, and temperature (usually cold). The following is a description of these scenarios and how to respond appropriately if your child wheezes.

Bronchiolitis is an illness that only affects infants, usually under one year of age. It is most commonly triggered by RSV (Respiratory Syncitial Virus). RSV is very prevalent during the winter months in the United States and causes the common cold in adults and older children. Young infants are susceptible to a lung infection when the bronchioles (small airways) in the lungs are inflamed and filled with mucus, causing wheezing, coughing and possibly respiratory distress. This susceptibility comes from immature defenses in the young infant’s lungs compared to older children and adults. On exam, infants with bronchiolitis will have wheezing and trouble breathing that can sometimes lead to albuterol and oxygen treatment. Premature babies are even more susceptible to RSV and its breathing complications. We are fortunate to now have a vaccine (Synagis) to protect premature babies against RSV.

Reactive Airway Disease is a form of childhood asthma where kids, under the age of six, will wheeze whenever they get a cold. This is treated the same way as regular asthma is, with albuterol to relax the airways and steroids to reduce inflammation in the lungs. Fortunately, a large proportion of these kids will “grow out of it” and no longer need treatment when they get older. Adults and children can also have reactive airway disease when they have a significant lung infection like pneumonia.

Children with asthma can also wheeze from triggers other than illnesses. Wheezing and coughing can occur when there are allergies to environmental triggers (dust, pollen, molds, etc.) as well as food allergies. This is treated by removing or reducing exposure to the offending allergen. Cigarette smoke is more of an irritant than a true allergen but can also cause wheezing in kids. Reducing the exposure to smoke fixes this issue. 

The children most at risk for getting an illness that involves wheezing are the following:

  1. Children with a family history of asthma
  2. Young infants and especially premature infants who are exposed to RSV
  3. Children with food or environmental allergies
  4. Children who live in homes with exposure to second-hand smoke

The most important question for parents is when to take their wheezing child to the doctor’s office or emergency room. The first time you notice your child wheezing or having a dry, tight cough, the child should be evaluated as soon as possible within 24 hours, ideally in your pediatrician’s office. If there are any signs of breathing problems, bluish color around the lips and mouth, shortness of breath or muscle retractions, the child needs to be seen quickly, if needed through the emergency room. First-time wheezing and any wheezing with breathing distress must be checked quickly. Your pediatrician is trained and able to provide the necessary treatments to treat wheezing both during your child’s illness and also long term if wheezing is a lasting issue for your child.