Respiratory Disease

Asthma In Children

Asthma is a chronic condition with symptoms of cough, wheezing, chest tightness, chest pain, or difficulty breathing. These symptoms occur periodically, usually related to specific triggering events. Exacerbations in children are often precipitated by a viral infection

Asthma symptoms often develop in children before five years of age, although it is sometimes difficult to diagnose asthma in infants and toddlers. Up to a third of children under three years of age will cough and wheeze with colds, but many of them will not go on to have asthma.
Asthma symptoms that start in childhood can disappear later in their life. Sometimes, however, it goes away temporarily, only to return a couple of years later. But other children with asthma — particularly those children with severe asthma — never outgrow it.

The symptoms of asthma in a baby or toddler include:

Is It Asthma?

Asthma symptoms can look like symptoms of other respiratory diseases. The following illnesses may have symptoms like asthma:

  • Bronchiolitis
  • Croup
  • Pneumonia
  • Upper respiratory tract viral infections (URI)
  • Epiglottis
  • Acid reflux
  • Aspiration
  • Inhaled foreign body
  • Cystic fibrosis
  • Birth defects
  • Heart disease

Risk Factors

Asthma is a chronic inflammatory disease of the airways characterised by reversible airways narrowing and bronchospasm; it limits the air flow out of the lungs. This narrowing is almost always completely reversible if children receive appropriate treatment quickly. Many different genetic, infectious, and environmental factors may increase the risk of developing asthma including:

  • Viral infections
  • Exposure to tobacco smoke
  • Pollution
  • Stress
  • Family history – Children with a personal or family history of certain medical problems, such as asthma, allergies, anaphylaxis, or eczema are at increased risk of developing asthma.

Asthma Action Plan

An Asthma Action Plan provides detailed information and instructions for managing your child’s asthma. It includes information about their medications, symptoms, warning signs and the management plan.

Information in an Asthma Action Plan includes:

  • Regular medications when they are well
  • Medications when your child is not well
  • Medications and instructions when their symptoms are getting worse
  • Warning signs – when to call for help

Asthma Action Plan are important tools available to assist with asthma self-management at home. Their effectiveness in reducing the risk of emergency complications has well been proven.

An Asthma Action Plan is a document recommended by your paediatrician or GP in case you child experiences symptoms. To create an Asthma Action Plan, you should consult with your doctor to identify the main two or three signs indicate your child’s asthma symptoms are worsening.

It also includes the actions you should take, to address this, and thereby limit the speed and severity of the asthma symptoms.

Your child’s Asthma Action Plan should frequently be reviewed and updated yearly by your experienced GP, and always in collaboration with the carer of the person with asthma.

Asthma Medication: Relievers And Controllers (Preventers)

Asthma medications fall into two main groups:

  • Relievers, which treat asthma symptoms
  • Controllers (preventers), which prevent asthma symptoms.

Asthmatic children may take one, two or even three of these types of medications. Considering the severity of the symptoms and the frequency of asthma attacks, your GP will prescribe the most appropriate medications for your child.

Relievers

Short-acting beta-2 agonists like salbutamol (Ventolin, Asmol) are the drugs most commonly used to treat asthma symptoms and asthma attacks. These drugs help to relax the narrowed small airway passages and make it easier for air to get through.

Controllers (Preventers)

Drugs to prevent asthma symptoms are very important. They can reduce inflammation in the airway passages, relax the airway muscles for prolonged periods of time, or target the underlying factors that cause inflammation and allergies.

Asthma preventers include inhaled corticosteroids, corticosteroid tablets or mixtures (prednisolone), sodium cromoglycate (Intal), montelukast (Singulair) and biologics like omalizumab and mepolizumab (Xolair and Nucala).

How To Use An Inhaler

Asthma is a chronic inflammatory disease of the airways characterised by reversible airways narrowing and bronchospasm; it limits the air flow out of the lungs. This narrowing is almost always completely reversible if children receive appropriate treatment quickly. Many different genetic, infectious, and environmental factors may increase the risk of developing asthma including:

  • Viral infections
  • Exposure to tobacco smoke
  • Pollution
  • Stress
  • Family history – Children with a personal or family history of certain medical problems, such as asthma, allergies, anaphylaxis, or eczema are at increased risk of developing asthma.

Bronchiolitis

Bronchiolitis is a common viral chest infection in young babies which causes inflammation and mucus to build up in the airways, making it more difficult to breathe.

Bronchiolitis is most common in babies under six months, but sometimes occurs in babies up to 12 months old. If your baby has bronchiolitis, you should avoid contact with other people in the first few days, as bronchiolitis is a contagious disease.

Symptoms Of Bronchiolitis

Bronchiolitis usually starts as a winter cold. After a day or so, difficulty breathing, wheeze and cough would be more prominent.

  • Runny nose
  • Stuffy nose
  • Fast and noisy breathing
  • Laboured breathing (increased effort to breathe)
  • Cough
  • Irritability
  • Fever (Mild, not always present)
  • Difficulties eating or drinking
  • Many infants also have an ear infection (otitis media).

Treatment For Bronchiolitis

Medicines do not usually help treat bronchiolitis and babies need to rest and have small feeds more often, so they don’t get too tired when feeding and do not get dehydrated. It is best treated like any other viral infection.

  • Make sure your baby rests enough.
  • Breastfeed or give formula or water more often than usual.
  • Paracetamol can be given if needed.
  • Avoid smoking around your baby.
  • If your baby is very distressed and having trouble feeding, they may need to be admitted to hospital where they can be closely observed, given oxygen and possibly fluid through a nasogastric tube or a drip into the vein.

Croup

Croup, also known as laryngotracheitis, is a common childhood respiratory illness which can cause inflammation of the voice box (larynx), windpipe (trachea) and airways to the lungs (bronchi). This can cause a change in voice and characteristic “croupy” cough that sounds like a seal or bark. There are several viruses that have been found to cause croup, the most common being parainfluenza virus.

Croup is a common disease in young children, mostly between the ages of 6 months and 3 years. Some children may have two or more bouts of croup in their early life. It often occurs in outbreaks or epidemics in the winter.

  • Croup is rare after the age of 6 years. However, teenagers and, very rarely, adults may get croup.
  • Croup can last for a few days and usually the symptoms are more severe at night. Before the cough develops, your child may have sore throat, fever, red eyes, runny nose, or poor appetite.
  • Croup is usually mild and treatable at home. However, it’s an infectious illness that can rapidly become serious.
  • Severe croup can cause breathing difficulties in general but if your child’s skin “caves in” around their neck or ribs when they try to inhale, you should seek urgent medical treatment.

Your doctor may prescribe a medicine called prednisolone or dexamethasone. This helps reduce the swelling and inflammation in the airways, making it easier for your child to breathe. It will work in four to six hours. If the croup is severe, another medicine, called adrenaline, may be given through a nebuliser or an injection. This medicine relieves the spasm and swelling until the steroids (prednisolone) starts to work.

Antibiotics will not help, as croup is a viral infection. There is no proof that anti-allergy medications like antihistamines are of benefit with croup.

Go to your GP or hospital if your child has any of the following symptoms:

  • High temperature
  • Dribbling/drooling
  • Cannot swallow properly and is not drinking enough
  • Becomes pale or blue after coughing spell
  • Becomes drowsy and floppy
  • Breathing difficulties
  • Restless, distressed, irritable or delirious.

Your Trusted Paediatrics & Child Health GP in The Shire

When you contact your Paediatrics & Child Health GP at Shire Doctors and Dentists, we help to diagnose your child’s health issues, and most importantly, find treatments and ways to manage these conditions to ease your concerns.

Sometimes all it takes is 10 minutes time with a Paediatrics & Child Health GP and it can save countless hours of worry, so please don’t hesitate to reach out – make an appointment online or by calling 02 9063 8650 to see a children’s health GP at Shire Doctors and Dentists today.