Asthma in Children, Babies: Causes, Symptoms, Diagnosis, Treatment, Medications and Prevention

Asthma in Children, Babies: Causes, Symptoms, Treatment


Anyone can have asthma, including infants and adolescents. The tendency to develop asthma is often inherited; in other words, asthma can be more common in certain families. Moreover, certain environmental factors, such as viral infections specially infection with respiratory syncytial virus or rhinovirus, may bring the onset of asthma. Recent medical reports suggest that patients with asthma are likely to develop more severe problems due to H1N1 infection. It has also been suggested that there is an association between day-care environment and wheezing. Those who started day care early were twice as likely to develop wheezing in their first year of life as those who did not attend day care. Other environmental factors, such as exposure to smoke, allergens, automobile emissions, and environmental pollutants, have been associated with asthma.

What is asthma?


Asthma in Children, Babies Causes, Symptoms, Diagnosis, Treatment, Medications and Prevention
Asthma in Children, Babies

Asthma affects the airways, the small tubes known as the bronchi, that carry air in and out of the lungs. If your child has asthma, the airways of their lungs are more sensitive than normal.
When your child comes into contact with something that irritates their lungs, known as a trigger (see below), their airways narrow, the lining becomes inflamed, the muscles around them tighten, and there is an increase in the production of sticky mucus or phlegm.
This makes it difficult to breathe and causes symptoms such as:
  • wheezing
  • coughing
  • shortness of breath
  • tightness in the chest
Many children with asthma can breathe normally for weeks or months between flares. When flares do occur, they often seem to happen without warning. Actually, a flare usually develops over time, involving a complicated process of increasing airway obstruction.

Asthma attack


A sudden, severe onset of symptoms is known as an asthma attack, or an acute asthma exacerbation. Asthma attacks can sometimes be managed at home but may require hospital treatment. They are occasionally life threatening.

Causes of asthma in children 


Asthma in children usually has many causes, or triggers. These triggers may change as a child ages. A child's reaction to a trigger may also change with treatment. Viral infections can increase the likelihood of an asthma attack.

Increased risk Asthma


Asthma in Children, Babies: Causes, Symptoms, Diagnosis, Treatment, Medications and Prevention


The likelihood of developing wheezing and asthma is increased if:
  • there is a family history of asthma or other related allergic conditions (known as atopic conditions) such as eczema, hay fever or a food allergy 
  • your child develops another atopic condition such as eczema, hay fever or a food allergy
  • your child develops acute bronchiolitis (a lung infection, common in babies, that is caused by a virus )
  • your child is exposed to tobacco smoke, particularly if the child's mother smokes during pregnancy
  • your child was born prematurely
  • your child was born with a low birth weight (less than 2kg or 4.5lb)

Asthma in Children, Babies Causes, Triggers


Respiratory infections: These are usually viral infections. In some patients, other infections with fungi, bacteria, or parasites might be responsible.

Allergens (see below for more information): An allergen is anything in a child's environment that causes an allergic reaction. Allergens can be foods, pet dander, molds, fungi, roach allergens, or dust mites. Allergens can also be seasonal outdoor allergens (for example, mold spores, pollens, grass, trees).

Irritants: When an irritating substance is inhaled, it can cause an asthmatic response. Tobacco smoke, cold air, chemicals, perfumes, paint odors, hair sprays, and air pollutants are irritants that can cause inflammation in the lungs and result in asthma symptoms.

Weather changes: Asthma attacks can be related to changes in the weather or the quality of the air. Weather factors such as humidity and temperature can affect how many allergens and irritants are being carried in the air and inhaled by your child. Some patients have asthmatic symptoms whenever they are exposed to cold air.

Medicines: The class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, can trigger asthma for some people, although are fine for most. Children under 16 years of age should not be given aspirin. 

Exercise (see below for more information): In some patients, exercise can trigger asthma. Exactly how exercise triggers asthma is unclear, but it may have to do with heat and water loss and temperature changes as a child heats up during exercise and cools down after exercise.

Foods containing sulphites: Sulphites are naturally occurring substances found in some food and drink. They are also sometimes used as a food preservative. Food and drinks that are high in sulphites include concentrated fruit juice, jam, prawns and many processed or pre-cooked meals. Most children with asthma do not have this trigger, but some may.

Emotional factors: Some children can have asthma attacks that are caused or made worse by emotional upsets.

Gastroesophageal reflux disease (GERD): GERD is characterized by the symptom of heartburn. GERD is related to asthma because the presence of small amounts of stomach acid that pass from the stomach through the food pipe (esophagus) into the lungs can irritate the airways. In severe cases of GERD, there may be spillage of small amounts of stomach acid into the airways initiating asthmatic symptoms.

Inflammation of the upper airways (including the nasal passages and the sinuses): Inflammation in the upper airways, which can be caused by allergies, sinus infections, or lung (respiratory) infections, must be treated before asthmatic symptoms can be completely controlled.

Nocturnal asthma: Nighttime asthma is probably caused by multiple factors. Some factors may be related to how breathing changes during sleep, exposure to allergens during and before sleep, or body position during sleep. Furthermore, as a part of biological clock (circadian rhythm), there is reduction in the levels of cortisone produced naturally within the body. This may be a contributing factor for nighttime asthma.

Food allergies: Although uncommon, some people may have allergies to nuts or other food items, known as an anaphylactic reaction. If so, these can trigger severe asthma attacks.

Asthma can sometimes be life threatening. See treating asthma in children for more information about how to manage your child’s asthma. Speak to your doctor or asthma nurse for further advice.


How Common Is Asthma in Children?


Asthma is the leading cause of chronic illness in children. It affects over 9% of children in the United States and, for unknown reasons, is steadily increasing. Asthma can begin at any age (even in the very elderly), but most children have their first symptoms by age 5.

There are many risk factors for developing childhood asthma. These include:

  • Nasal allergies (hay fever) or eczema (allergic skin rash)
  • A family history of asthma or allergies
  • Frequent respiratory infections
  • Low birth weight
  • Exposure to tobacco smoke before or after birth
  • Black or Puerto-Rican ethnicity
  • Being raised in a low-income environment

Why Is the Rate of Asthma in Children Increasing?


No one really knows the exact reasons why more and more children are developing asthma. Some experts suggest that children spend too much time indoors and are exposed to more and more dust, air pollution, and secondhand smoke. Some suspect that children are not exposed to enough childhood illnesses to direct the attention of their immune system to bacteria and viruses.

Symptoms of Asthma in Children, Babies


It can be easy to confuse asthma with a cold or flu, especially since colds and flus can actually trigger asthma symptoms. So it's important to learn how to recognize the most common symptoms of asthma.

Asthma in Children, Babies: Causes, Symptoms, Diagnosis, Treatment, Medications and Prevention
Asthma in Children, Babies

Wheezing

  • Wheezing is when the air flowing into the lungs makes a high-pitched whistling sound.
  • Mild wheezing occurs only at the end of a breath when the child is breathing out (expiration or exhalation). More severe wheezing is heard during the whole exhaled breath. Children with even more severe asthma can also have wheezing while they breathe in (inspiration or inhalation). However, during a most extreme asthma attack, wheezing may be absent because almost no air is passing through the airways.
  • Asthma can occur without wheezing and be associated with other symptoms such as cough, breathlessness, chest tightness. So wheezing is not necessary for the diagnosis of asthma. Also, wheezing can be associated with other lung disorders such as cystic fibrosis.
  • In asthma related to exercise (exercise-induced asthma) or asthma that occurs at night (nocturnal asthma), wheezing may be present only during or after exercise (exercise-induced asthma) or during the night, especially during early part of morning (nocturnal asthma).

Coughing: 


Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma. Cough due to nocturnal asthma (nighttime asthma) usually occurs during the early hours of morning, from 1 a.m. to 4 a.m. Usually, the child doesn't cough anything up so there is no phlegm or mucus. Also, coughing may occur with wheezing.

Chest tightness: 


The child may feel like the chest is tight or won't expand when breathing in, or there may be pain in the chest with or without other symptoms of asthma, especially in exercise-induced or nocturnal asthma.

Other symptoms of Asthma in Children, Babies:


 Infants or young children may have a history of cough or lung infections (bronchitis) or pneumonia. Children with asthma may get coughs every time they get a cold. Most children with chronic or recurrent bronchitis have asthma.
Symptoms can be different depending on whether the asthma episode is mild, moderate, or severe.

Some asthma symptoms are loud or obvious, such as coughing and wheezing. But there are also the quiet, less obvious symptoms of asthma you may need to look for in children, such as

  • Intermittent chest pain
  • Fatigue and lack of energy
  • Limiting play activities by the child
  • Irritability

It's helpful to remember that asthma symptoms are not just heard - they can also be seen. If your child is experiencing any of these symptoms, but you're just not sure if it's asthma, it's important to speak to your child's doctor. And if any of these symptoms are severe, don't hesitate to contact the doctor immediately or head straight to the emergency room.

How Can I Tell if my Child Has Asthma?


Not all children have the same asthma symptoms, and these symptoms can vary from episode to episode in the same child. Possible signs and symptoms of asthma in children include:

  • Frequent coughing spells, which may occur during play, at night, or while laughing or crying
  • A chronic cough (which may be the only symptom)
  • Less energy during play
  • Rapid breathing (intermittently)
  • Complaint of chest tightness or chest "hurting"
  • Whistling sound when breathing in or out -- called wheezing.
  • See-saw motions in the chest from labored breathing. These motions are called retractions.
  • Shortness of breath, loss of breath
  • Tightened neck and chest muscles
  • Feelings of weakness or tiredness
While these are some symptoms of asthma in children, your child's doctor should evaluate any illness that complicates your child's breathing. About half of infants and toddlers with repeated episodes of wheezing with shortness of breath or cough (even though these illnesses usually respond to asthma medications) will not have asthma by the age of 6. Because of this, many pediatricians use terms like "reactive airways disease" or bronchiolitis when describing such children (instead of labeling them as asthmatic).


Diagnosing Asthma in Children, Babies


Diagnosing asthma can be difficult and time-consuming because different children with asthma can have very different patterns of symptoms. For example, some kids cough at night but seem fine during the day, while others seem to get frequent chest colds that don't go away.

Asthma in Children, Babies: Causes, Symptoms, Diagnosis, Treatment, Medications and Prevention

To establish a diagnosis of asthma, a doctor rules out every other possible cause of a child's symptoms. The doctor asks questions about the family's asthma and allergy history, performs a physical exam, and possibly orders laboratory tests (see Tests Used to Diagnose Asthma). Be sure to provide the doctor with as many details as possible, no matter how unrelated they might seem.

Categories of asthma

The severity of asthma is classified based on how often the symptoms occur and how bad they are, including symptoms that happen at night, the characteristics of episodes, and lung function. These classifications do not always work well in children because lung function is difficult to measure in younger children. Also, children often have asthma that is triggered by infections, and this kind of asthma does not fit into any category. A child's symptoms can be categorized into one of four main categories of asthma, each with different characteristics and requiring different treatment approaches.

Mild intermittent asthma:


 Brief episodes of wheezing, coughing, or shortness of breath that occur no more than twice a week is called mild intermittent asthma. Children rarely have symptoms between episodes (maybe just one or two flare-ups per month involving mild symptoms at night). Mild asthma should never be ignored because, even between flares, airways are inflamed.

Mild persistent asthma: 


Episodes of wheezing, coughing, or shortness of breath that occur more than twice a week but less than once a day is called mild persistent asthma. Symptoms usually occur at least twice a month at night and may affect normal physical activity.

Moderate persistent asthma: 


Symptoms occurring every day and requiring medication every day is called moderate persistent asthma. Nighttime symptoms occur more than once a week. Episodes of wheezing, coughing, or shortness of breath occur more than twice a week and may last for several days. These symptoms affect normal physical activity.

Severe persistent asthma:


 Children with severe persistent asthma have symptoms continuously. Episodes of wheezing, coughing, or shortness of breath are frequent and may require emergency treatment and even hospitalization. Many children with severe persistent asthma have frequent symptoms at night and can handle only limited physical activity.


Treatment of Asthma in Children, Babies

The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child's lung function as close to normal as possible, to allow your child to maintain normal physical activity levels (including exercise), to prevent recurrent asthma attacks and to reduce the need for emergency department visits or hospitalizations, and to provide medicines to your child that give the best results with the fewest side effects.

Asthma in Children, Babies: Causes, Symptoms, Diagnosis, Treatment, Medications and Prevention

In general, doctors start with a high level of therapy following an asthma attack and then decrease treatment to the lowest possible level that still prevents asthma attacks and allows your child to have a normal life. Every child needs to follow a customized asthma management plan to control asthma symptoms. The severity of a child's asthma can both worsen and improve over time, so the type (category) of your child's asthma can change, which means different treatment can be required over time.

Children with asthma can be grouped into one of three clinical categories. Treatment depends on which category your child is in.

Episodic asthma 


Symptoms occur several times a year, usually in association with a cold or viral infection. If your child has episodic asthma, she might wheeze or cough for a few days, and should respond rapidly to treatment. In between attacks, she’s in good health and enjoys an unrestricted lifestyle with no asthma symptoms. She usually onlyneeds treatment for acute asthma attacks, and doesn’t need to take any asthma medications in between attacks. Most children with asthma fall into this group.

Persistent asthma 


Children with persistent asthma have several acute attacks each year, usually more frequently than those with episodic asthma. Children with persistent asthma might also have symptoms in between attacks.

If your child has persistent asthma, he might have an intermittent cough, or a wheeze triggered by exercise. He’ll usually be given medication on a daily basis to prevent acute attacks.

Chronic asthma 


This is the smallest group of children with asthma. If your child has chronic asthma, her symptoms are ongoing, and she needs to take several medications a day.

Asthma medications for children


Asthma medications come in different forms, and combinations of medicines are often necessary. Medication can include:

Medications that can be inhaled as a mist from a hand-held inhaler, such as a metered dose inhaler or puffer, best breathed through a plastic chamber called a spacer device. Occasionally medications are inhaled from a nebuliser driven by a pump. The inhaler with a spacer device is just as effective and much more convenient.
Dry powders that can be inhaled from a hand-held inhaler (spinhaler or rotahaler).
Liquids, tablets or sprinkles that can be swallowed.
Most children over the age of two years can be taught to use a spacer or inhaler of some kind.

Acute severe asthmatic episode (status asthmaticus) often requires medical attention. It is treated by providing oxygen or even mechanical ventilation in severe cases. Repeat or continuous doses from an inhaler (beta-2 agonist) reverse airway obstruction. If the asthma isn't corrected using the inhaled bronchodilator, injectable epinephrine and/or systemic corticosteroids are given to reduce inflammation.

Fortunately, for most children, asthma can be well controlled. For many families, the learning process is the hardest part of controlling asthma. A child might have flares (asthma attacks) while learning to control asthma, but don't be surprised or discouraged. Asthma control can take a little time and energy to master, but it's worth the effort!

How long it takes to get asthma under control depends on the child's age, the severity of symptoms, how frequently flares occur, and how willing and able the family is to follow a doctor's prescribed treatment plan. Every child with asthma needs a doctor-prescribed individualized asthma management plan to control symptoms and flares. This plan usually has five parts.

Asthma medications


Asthma medications can be divided into the following categories:

Relievers, which are used to treat and relieve the symptoms of asthma.
Preventers, which are used to prevent acute attacks from occurring.
Controllers, which are used where asthma remains uncontrolled despite the use of relievers and preventers.
Some children take one, two or even three of these classes of medication. Your doctor will tell you the most appropriate medications for your child to take.

Relievers


Beta-2 agonists such as salbutamol (Ventolin, Asmol) and terbutaline (Bricanyl) are the most commonly used drugs for the treatment of acute symptoms of asthma. These drugs relax the narrowed breathing tubes and make it easier for air to get through.

Prednisolone (a steroid) is often given early during an acute attack to minimise the acute inflammation. This reduces the swelling of the lining of the air passages.

Preventers


Drugs used to prevent asthma are very important. They act either to reduce the effects of inflammation (which is the main underlying cause of the disease), or to minimise the effects of some of the cells in the airways that contribute to the inflammatory response.

Preventative medications need to be taken regularly every day. The drugs used for prevention include the following:

  • Inhaled steroids such as beclomethasone (Qvar), budesonide (Pulmicort), fluticasone (Flixotide) and ciclesonide (Alvesco), which can be inhaled and used to prevent attacks.
  • Steroid tablets or mixtures (prednisolone), which can be given by mouth to prevent attacks.
  • Sodium cromoglycate (Intal), which is an alternative to corticosteroids. This is inhaled on a regular basis, irrespective of whether your child has symptoms or not.
  • Montelukast (Singulair) is another alternative to corticosteroids. This is a tablet that needs to be taken every day.
One of the important advances in asthma management has been the introduction of inhaled steroids. In normal doses these have virtually no side effects and none of the problems that are associated with the long-term use of steroids taken by mouth.

Controllers


If your child’s asthma isn’t controlled by using preventers, and he’s more than five years old, your doctor will consider prescribing symptom controllers.

These drugs are a long-acting version of beta-2 agonists, so they act like salbutamol, but for longer. Examples include Serevant and Formeterol. These drugs must only be used in combination with a preventer. This is made easier by the availability of combination inhalers, such as Seretide (contains Flixotide and Serevant) and Symbicort (contains Pulmicort and Formeterol).

Antibiotics have no place in the treatment of asthma. There’s a misconception that an attack of asthma is often started by an upper respiratory tract infection – this can make people think that antibiotics can shorten the infection and the duration of asthma symptoms. But the majority of infections that trigger acute asthma are viral, and antibiotics won’t affect them at all.

Prevention for Asthma Children, Babies


The mainstay of asthma prevention is the appropriate use of preventative asthma medications.

You should also think about factors that might trigger attacks of asthma. Try to avoid cigarette smoke and exposure to animals that cause allergy symptoms, including household pets. Your child might be better off with non-allergenic bedding if she’s affected by goosedown or feathers. In some cases, you might need to remove your carpets to minimise dust and decrease your child’s exposure to the common house dust mite.

Prevention measures should be balanced with the need to limit big changes to the living conditions of your child and family. Big changes mightn’t be needed if your child only has mild symptoms.