Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Diagnosis
Treatment
Coping
You may expect the signs ofasthmato be obvious in infants—classic sudden attacks of wheezing, coughing, and shortness of breath. But they often can be subtle and easily mistaken for arespiratory infection. Because of this, and the fact that little ones can’t describe how they are feeling, many parents have no idea their infant has asthma until the attacks are more severe or overt.
Ellen Lindner / Verywell
Types of Infant Asthma
There are many different types of asthma, each with different triggers and outcomes. From a broad perspective, asthma can be classified as either:
The distinction is especially important in infants, the vast majority of whom will develop allergic asthma.As an atopic disorder (meaning one with a genetic tendency toward allergy), allergic asthma is often part of a progression of disorders referred to as the “atopic march.”
The atopic march classically begins with the development ofatopic dermatitis (eczema), often in the first six months of life.This initial atopy triggers changes in an immature immune system that opens the door tofood allergies, which in turn opens the door toallergic rhinitis (hay fever)and, finally, asthma.
The progression can either happen slowly over the course of years or rapidly during the first months of life.
With infant asthma, the early onset of symptoms is concerning as it is often predictive of more severe disease later in life. This is especially true whenwheezingdevelops before the age of 3.
It’s important, to remember, however, that not every infant with eczema will develop asthma, and not every infant with asthma will have had eczema. Asthma is a complex disease for which many factors contribute to both the onset and severity of symptoms.
Infant Asthma Symptoms
The symptoms ofasthma in childrenand adults are more or less the same but can vary from person to person in terms of severity and frequency.
Even so, there are a few characteristic differences inasthma symptomsin infants, babies, and toddlers compared to older toddlers and young children.This is due, in part, to differences in airway sizes as well as the overall strength and capacity of the lungs.
In general, though, it is difficult to diagnosis asthma in children under age 5. This is due to a lack of accurate diagnostic tools for this age group. Also, while children in this age group have similar asthma symptoms as older children, they in general have more frequent respiratory infections that cause inflammation of the airways and wheezing. This is said to make wheezing alone in children under 3 a poor indicator of asthma development later on.
Infants, Babies, and ToddlersCoughWheezingShortness of breathFrequent coughingNasal flaringExaggerated belly movements while breathingSucking in of the ribs while inhalingInterruption in crying or laughing due to breathing difficultyFatigue and lethargyReduced activityToddlers and Young ChildrenCoughWheezeShortness of breathChest tightnessFrequent coughingAttacks (and intensity of attacks) can varyDaytime fatigue and sleepiness due to poor sleepDelayed recovery from colds and other respiratory infectionsInterruption in play due to breathing problems
Infants, Babies, and ToddlersCoughWheezingShortness of breathFrequent coughingNasal flaringExaggerated belly movements while breathingSucking in of the ribs while inhalingInterruption in crying or laughing due to breathing difficultyFatigue and lethargyReduced activity
Cough
Wheezing
Shortness of breath
Frequent coughing
Nasal flaring
Exaggerated belly movements while breathing
Sucking in of the ribs while inhaling
Interruption in crying or laughing due to breathing difficulty
Fatigue and lethargy
Reduced activity
Toddlers and Young ChildrenCoughWheezeShortness of breathChest tightnessFrequent coughingAttacks (and intensity of attacks) can varyDaytime fatigue and sleepiness due to poor sleepDelayed recovery from colds and other respiratory infectionsInterruption in play due to breathing problems
Wheeze
Chest tightness
Attacks (and intensity of attacks) can vary
Daytime fatigue and sleepiness due to poor sleep
Delayed recovery from colds and other respiratory infections
Interruption in play due to breathing problems
Signs of an Emergency
Call 911 or seek emergency care if your child experiences signs of asevere attack, including:
Complications
When this occurs, the smooth muscles of the airways begin to thicken and lose their flexibility, while the goblet cells that produce mucus will grow in size. This can increase the risk ofchronic obstructive pulmonary disease (COPD)later in life.
According to the Centers for Disease Control and Prevention (CDC), more than six million children in the United States haveasthma, most of whom develop symptoms before age 6.
It is unknown what causes asthma in children and adults. The current evidence suggests a genetic predisposition paired with environmental factors alters the body’s immune response, increasingairway hyperresponsivenesstoenvironmental and physiologic triggers.
As far as infants are concerned, there is evidence certain factors can increase a child’s risk of developing asthma.
Diagnosing asthma in infants and babies is difficult because the central tools used for diagnosis—pulmonary function tests (PFTs)—do not return useful results in most cases. Even a simple exhaled nitric oxide test, which measures the amount of the gas present when one breathes out, is of little use in children under 5.
To this end, doctors rely heavily on an infant’s symptoms, a parent or guardian’s observations, and other information to make anasthma diagnosis. The process involves an extensive interview to assess the child’s history of breathing problems.
Questions may include:
Even though asthma tends to be more obvious in older babies than infants, share whatever information you have to help the doctor better understand the nature of your child’s symptoms—even if it seems unrelated or inconsequential.
Examination and Testing
The doctor will also perform a physical exam to check for breathing sounds (some of which may suggest an infection or airway obstruction) or atopic skin conditions like eczema.
If a cause is not readily found, achest X-raymay be ordered; this common imaging study is safe for newborns and infants. However, it is better at excluding other causes of wheezing and shortness of breath than confirming asthma.
If allergic asthma is suspected, the doctor may recommendallergy skin testinginvolving the insertion of tiny amounts of common allergens (such as pet dander) under the skin to see if a reaction occurs. Even so, allergy skin testing is rarely performed in children under 6 months old.
Differential Diagnoses
If asthma is diagnosed in a child under 2 and their symptoms are mild, a doctor may take a wait-and-see approach. This is partly because there’s been little research into the safety ofasthma drugsfor children this young.
Iftreatmentis needed, many of the same medications used for adults can be considered. The selection would be based on the risk of side effects, the frequency and severity of attacks, the impact of asthma on the child’s quality of life, and whether the drug is approved for use in children.
Among the treatments available to children under 4:
Inhaled corticosteroids also may be given to children under 4 who have mild asthma but who experience wheezing when they get a respiratory tract infection. In such cases, the National Institutes of Health recommends starting a short course of ICS daily at the onset of symptoms and a short-acting beta agonist (SABA) as needed for quick relief.
There are no FDA-approved asthmamedications for children under 1, but the Global Initiative for Asthma (GINA) recommends nebulizedalbuterol(a rescue medication) every 20 minutes for the first hour to treat acute symptoms in infants.
Among the additional treatments available to children over 4:
Children diagnosed with severe allergic asthma may be referred to an allergist for subcutaneous immunotherapy (SCIT)—a.k.a.,allergy shots. The NIH advises SCIT for kids over 5 along with standard medication if their asthma is controlled at the initiation, build-up, and maintenance phases of immunotherapy.
Summary
Diagnosing asthma in infants can be difficult even for medical professionals, as many diagnostic tests are not accurate for children under 5 and asthma is often mistaken for other common respiratory illnesses. It is important, though, to treat asthma (which is often linked to eczema and allergies) early in order to prevent ongoing injury to still-developing lungs.
Caregivers should know what symptoms to look for in an infant and they should promptly relay these symptoms to a pediatrician and/or pediatric pulmonologist. Many of these are similar to characteristic signs of asthma—like wheezing and coughing—in older children. Infants might also experience nasal flaring and retraction of the muscles between the ribs while breathing—which are signs that emergency medical attention is needed.
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