Why is my child wheezing? Asthma, croup, and other breathing issues

Parents will often tell a doctor, “My child is wheezing.” But what does that really mean?
Noisy breathing can be in the upper airway or the lower airway (chest). Upper-airway issues include minor issues such as increased nasal secretions (or “snot”). They also include more serious issues:

• Anatomic problems, especially in infants
• Foreign bodies in toddlers and young children
• Croup

Clearing the upper airway can often differentiate whether the issue is just obstruction in the nose from congestion or something more serious. If noisy breathing persists after attempting to clear “snot,” a visit to a pediatric provider is likely needed.

Upper-Airway Issues

Foreign Bodies

Foreign bodies and croup can both cause upper-airway obstruction. Foreign bodies in the nose are a common cause of pediatric urgent care visits. If you can see the foreign body and remove it easily, go for it. However, children are often uncorporative and scared.
If the object is not easily removed, close the unaffected nostril, get a good seal over the mouth, and blow gently into the mouth. This will sometimes force out the foreign body. Many parents do not want to try this as they find it gross! At KidMed, we have several cool ways to remove foreign bodies

Croup

Another common cause of upper airway obstruction is croup. Croup is usually caused by a viral infection. The symptoms often include a fever, runny nose, and a diagnostic barky cough. At its worst, it can cause breathing trouble, with a sucking-in sound called stridor. Kids that have trouble breathing and a barky cough need to be seen immediately. A severe obstruction can make it difficult for them to breath.
Home treatment for a mild croupy cough is humified air (e.g. steamy shower, humidifier) or going out into the cold air. If the croupy cough does not improve with these measures, seek treatment from a pediatric provider. Unfortunately, croup worsens as kids lie down, which often results in late-night visits. Children who have trouble breathing with croup are treated with a special nebulizer called racemic epinephrine—humified air or oxygen and steroids.

Lower-Airway Issues

Wheezing

Wheezing is the most common cause of lower respiratory tract problems. It can be caused by many things. The most common causes are mild infections (e.g. bronchiolitis) and reactive airway disease. (Its chronic form is called asthma.)
Less-common causes of wheezing include pneumonia, congenital lower-airway abnormalities, foreign bodies, and certain heart conditions. Not everything that causes wheezing is a reactive airway issue or asthma.
If your child is wheezing—and has never wheezed before—they should be evaluated immediately by a pediatric provider. A provider will first determine if the child is, in fact, wheezing. Then, the provider will determine the cause and appropriate treatment.
For kids with a history of wheezing, home treatment (including rescue inhalers and nebulizers) may be tried first. If the wheezing fails to improve after a couple of days, or if your child shows signs of breathing difficulty, they should be evaluated immediately. Signs of trouble breathing are

• Fast or hard breathing.
• Sucking under and between the ribs and under the neck (retractions).
• And grunting or nasal flaring in smaller children.

Pneumonia and Bronchitis

Other common lower respiratory tract problems are pneumonia and bronchitis. A good rule of thumb is that a cough and fever for more than 72 hours should be evaluated.
Most kids under the age of three are not corporative for lung exams, and abnormal breath sounds are difficult to hear, even in older, corporative kids. As a result, chest X-rays are helpful for finding pneumonia, even when pneumonia is not identified with a stethoscope. A common fallacy is that a normal white blood cell count will rule out pneumonia. This is not true.
In most kids, bronchitis is largely viral and does not need to be treated. However, it is occasionally confused with mycoplasma (also known as walking pneumonia or asthmatic bronchitis). Both can be treated effectively.

When is a breathing issue serious?

Most pediatric wheezes and coughs are not serious, and resolve without professional care. Nor does a recurrent cough or wheeze necessarily mean your child has asthma. Many ailments are simple viral infections that have a disproportionate impact on children’s narrow airways (even more so for premature babies, whose airways are less developed).
Serious breathing issues require immediate medical attention. If your child is choking or their skin begins to turn blue, dial 911 immediately. Indicators of serious breathing issues include:

• Difficulty breathing or choking
• Rapid or irregular breathing
• Persistent noisy breathing while at rest
• Blue or very pale skin

If a breathing issue appears less urgent but interferes with your child’s day-to-day activities—playing, interacting, eating—take your child to your pediatrician or pediatric urgent care.

How to help your child with an everyday cough or wheeze

Parental care at home can make it easier for your child to manage a minor illness. For infants, comforting your child with soothing words or a song can help mitigate the effects of a cough or wheeze. The loud, sudden noise of a cough can startle a child. For children of all ages, frequent consumption of small amounts of liquid helps maintain hydration.
While appropriate for older children, infants and young children should not be given over-the-counter cough medicines, as these may make symptoms worse or hide a more serious underlying illness.
If your child has been diagnosed with asthma and has reliever medication, make sure you understand how to use the device properly. Your doctor should provide you with information about how much reliever to give at home and how often. If the reliever medication does not improve asthma symptoms, seek medical attention immediately.