Is it Asthma?

Sometimes it’s hard to tell if a baby or small child has asthma or another disease with symptoms that are a lot alike.

It may be asthma if:

There is a history of repeated

• Coughing
• Wheezing (not all children with asthma will wheeze)
• Shortness of breath or fast breathing
• Chest tightness

Symptoms are made worse by

• Viral infection (such as a viral cold or bronchitis)
• Smoke (tobacco, wood, etc.) or other irritants (like strong perfumes or odors)
• Exercise or active playing
• Things the child is allergic to, such as pollen or animal fur
• Changes in weather/humidity
• Crying or laughing

Symptoms occur/worsen at night, waking the child and/or the parent.

Wheezing is very uncommon during the first two months of life, but in the next few months, first-time wheezing increases, usually the most between two and five months of age. Infants’ airways (compared to older children and adults) are smaller around, have less smooth muscle and make more mucus, which can lead to more coughing, wheezing, chest tightness, shortness of breath, or rapid breathing. Most wheezing during the first three years of life is related to viral respiratory infections, such as respiratory syncytial virus (RSV).

Respiratory viruses and symptoms of early asthma may be hard to tell apart, making diagnosis and treatment tricky. No single finding will tell the doctor that the child has asthma, but if the child has several of these findings, it means it is more likely. Learn more about how doctors diagnose asthma in young children.

Until recently, it had been hard to predict which child would develop persistent (life-long) asthma, and which would seem to “outgrow” it. But doctors and parents now have a tool to help them predict with reasonable accuracy if the child will develop asthma. This tool is called the Asthma Predictive Index, based on family history, allergies and wheezing history.

Because asthma is different in babies simply because their lungs do not work as well as the lungs of an older child or adult, an asthma attack can quickly cause lung failure. So learn how to keep your baby healthy!

• Have regular doctor’s visits, even when your baby is not having asthma symptoms.
• Make a complete Asthma Action Plan with your doctor and make sure you know how to recognize your baby’s green, yellow and red zones.
• Go over it with the doctor or asthma educator at each visit.
• Be ready. Don’t wait until your baby has trouble breathing before you learn what to do in an emergency.
• Know your baby’s Asthma Action Plan well, and think about how you’ll get to the doctor, emergency room or hospital, and who will care for your other children.

GREEN ZONE

• Baby feels good and acts normal. Follow your Asthma Action Plan to stay in this zone!

YELLOW ZONE OR RED ZONE

• If your baby has asthma symptoms, like wheezing, coughing or rapid breathing, take care of it right away! Follow the Asthma Action Plan your doctor gave you for taking care of asthma symptoms. Babies can change from a few symptoms to a severe attack very fast!

Warning signs for an asthma attack can be different between babies. Make sure you know what warning signs to look for in your baby. Get emergency help if:

• his or her breathing rate increases (to more than 40 breaths/minute while the infant is sleeping). To find breaths/minute, count the number of breaths the baby takes in 15 seconds and multiply that number by 4.
• suckling or feeding stops.
• the skin between your baby’s ribs is pulled tight while breathing.
• the baby’s chest gets bigger.
• your baby’s color changes from normal to pale or red in the face, fingernails blue.
• his/her cry becomes softer and shorter.
• his/her nostrils open wider.
• he/she is grunting during feeding.

DO NOT do these things if your baby is having asthma symptoms:

• DO NOT give your baby a lot of liquid to drink – normal amounts are okay.
• DO NOT have your baby breathe warm, moist air (like the mist from a hot shower or vaporizer).
• DO NOT have your baby rebreath into a bag held tightly over her nose and mouth.
• DO NOT give your baby over-the-counter medicines. Use only medicines the doctor has directed you to give for asthma.

Adapted from the Guidelines for the Diagnosis and Management of Asthma, National Asthma Education and Prevention Program of the National Heart, Lung and Blood Institute, 2007.