Asthma in Infants
Asthma affects over 6 million children in the U.S. making its one of the most common chronic illnesses in children. What few people realize is that asthma affects infants and toddlers as well as older children. Studies show that 50 to 80 percent of children with asthma experience symptoms before they turn 5. However, it's not always easy to tell if a child has asthma or a temporary respiratory condition. Below we have provided a fact sheet to help you learn more about asthma, how to recognize its symptoms, and the best ways to manage your child's illness. If you suspect your baby is developing asthma, it's important to be proactive and make an appointment with your doctor as soon as possible.
Asthma is considered a respiratory disease. It occurs when a person's airways become chronically inflamed. Inflammation narrows the airways, making it harder to breathe normally. Asthma also makes your airways more sensitive to irritants and other allergens, which is known as hyperactive airways. With hyperactive airways, the respiratory system overreacts to minor irritants that normally would not cause a reaction in someone without asthma. People with asthma often have "triggers" that can cause them to start showing symptoms, such as mold, pollen, dust, or dander.
Asthma is a chronic, long-term condition, meaning that once a person's airways become sensitive, they stay that way for the rest of their life. This does not mean a person will consistently experience the same severity of symptoms at every age, many people have asthma that gets worse or better at different stages of their life. About 50% of children "outgrow" their asthma once they reach their teenage years, but the condition seems to reappear as they hit adulthood, usually within their late 30s or early 40s.
The biggest difference between childhood and adult asthma is the severity. Infants have much smaller airways than adults, which means that even mild bronchial swelling can cause an emergency situation. Tightened, inflamed airways and excess mucus produced by the immune system can easily block the flow of air, making it extremely hard for a baby or young child to breathe. This can lead to a baby needing immediate medical intervention if the parents are not equipped with the proper medication to open the airways.
Respiratory infections are often the first trigger to cause an asthmatic episode in infants. Afterward, the child will continue to experience symptoms even after the infection has been treated. The biggest hurdle parents face is the fact that babies cannot express what kind of symptoms they're feeling, making it harder to come to a conclusion of what the problem is. As a precaution, if a baby has a respiratory infection, they should be closely monitored to see if they continue to show symptoms of asthma.
Currently, the exact cause of asthma is still unknown. It's believed that there could be many different causes as to why a certain person develops asthma. However, there are certain risk factors that appear to increase the risk of a baby having the condition.
A baby's genetics can play a part in whether they have asthma. If a child has a family history of asthma, allergies, or eczema, especially in parents and grandparents, it could increase their chance of acquiring the disease.
Many studies suggest that mothers who smoke during pregnancy have an increased risk of their baby being born with asthma as well. There is a clear potential impact of cigarette smoking by the mother on the child's lung development, pulmonary function test results during childhood, and development of childhood asthma. In general, children of smokers have lower lung function test results in childhood. This can also have important impacts on the lung function tests of children that develop asthma whose mother's smoked during pregnancy. These can especially impact the small airways (FEF25-75) function results.
Lastly, premature babies are at a higher risk of asthma. This is because premature babies have an underdeveloped immune system, making it much easier for them to develop chronic health conditions.
It can be hard to determine if a baby's respiratory symptoms are caused by asthma. The symptoms of asthma are often very similar to other medical conditions, including bronchiolitis, acid reflux, pneumonia, and upper respiratory infections. When analyzing a baby's symptoms, parents should monitor how long the symptoms have been present, and whether they continue after treatments.
The primary symptoms of asthma in babies include:
- Labored breathing
- The baby's belly moving more than usual while breathing
- The baby's nostrils flare while trying to breathe
- Panting or heavy breathing during regular activities that normally don't cause problems for other children
- Frequent, chronic coughing
- Fast or shallow breathing
- Fatigue or loss of interest in activities
- Difficulty feeding or sucking
- Pale blue color in the face, lips, or fingernails (cyanosis)
Typically, these symptoms will be worse during the winter.
Diagnosing asthma in infants and young children can prove to be very difficult. As previously mentioned, a baby is not able to communicate their symptoms to a doctor. In general, they may just appear fussy or upset, but this can be a symptom of many different things. Additionally, typical lung function tests that are performed on adults can't be done with babies.
A doctor will review the baby's symptoms and perform a physical examination. They'll talk to the parents about their baby's medical history as well as their family's history of asthma. Parents should mention if they've noticed any environmental triggers that cause their baby to have breathing problems. If needed, the doctor may order a chest X-ray or blood tests. If the doctor suspects that your baby might have asthma, they'll prescribe asthma medications to see how the baby responds. If breathing becomes easier with medication, it can help determine a diagnosis of asthma.
Primary care doctors are often equipped with the medical knowledge and tools to make asthma diagnoses, but if you're worried about making an accurate diagnosis, you can refer to a doctor that specializes in asthma, such as a pediatric allergist or pulmonologist. Still, it can take some time to come to a final diagnosis. Your child will most likely be monitored for symptoms up until the age of 5 when they can usually start communicating their symptoms.
The good news about asthma is that most adult medication is safe to use on babies and toddlers, though the dosage and type of administration may be altered. The standard course of treatment for asthma management often includes a cocktail of medications, including liquid and inhaled drugs. Some asthma medication is used for short-term relief, while others are meant to prevent asthma flare-ups in the long-term. Since each child has their own unique symptoms, parents and their doctors need to develop a specific asthma treatment plan that outlines what to do depending on the severity and frequency of asthma attacks.
If your child has asthma, they will most likely be provided an inhaler and a nebulizer. Both of these are called bronchodilators made up of a medication called albuterol. Albuterol works by relaxing muscles and opening the breathing passages. Inhalers are handheld devices that can be easily stored in a child's backpack or a cabinet at home. They are known as "quick release" or "rescue inhalers" and are meant to be used when a child is experiencing acute asthma symptoms. While it does not prevent future symptoms from occurring, it can provide immediate relief and save a child from an asthma attack.
Nebulizers, also known as "breathing machines", are small machines that use compressed air to create a medicated mist for babies to inhale through a face mask. Typical treatments last 10 minutes and allows the baby to accumulate a large amount of albuterol in the body to help relieve long-term symptoms. A baby with chronic or severe asthma may get several breathing treatments a day to help them breathe easily for longer periods of time. Nebulizers can be critical to helping a baby manage their asthma as they grow.
Some children need additional medication to manage their asthma. Corticosteroids are the main medications used to treat severe and acute asthma symptoms. These are usually made in a liquid form with a fruity taste for the child to take daily. Prednisone is a common steroid prescribed that acts as an anti-inflammatory medication by suppressing the child's immune system. When the immune system is suppressed, it prevents the airways from becoming inflamed when it encounters an environmental trigger. Steroids are strong and usually only need 2-4 weeks to provide full relief, and continue to work in the body after completing treatment. However, children have different reactions to steroids and can cause interactions with other health conditions, so precautions should be taken before prescribing one.
Managing asthma will be a long-term process. Until the child is old enough to start managing their own symptoms, it will be up to the parents to provide all medications, stick to a treatment plan, and closely monitor the child's symptoms. Parents should work closely with their child and inform them as they get older about how to recognize and communicate how they're feeling. There are some additional tips that may help manage a child's symptoms, including:
- Learn the specific symptoms of the child, what their triggers are, and the general "pattern" of when and how their asthma appears. Parents should be able to identify when a child needs regular medication or needs to go to the emergency room.
- Develop and stick to an asthma treatment plan with a doctor. Include a course of action in the plan to follow if the child experiences acute symptoms. Use the plan every single day, even if the child seems symptom-free. Asthma symptoms tend to vary, and having no symptoms does not mean the asthma has gone away.
- Teach your child as they grow to tell you if they're having trouble breathing or are not feeling well.
- Cover the child's pillow and mattress with hypoallergenic casings.
- Wash bed linens, carpets, and stuffed animals regularly.
- Vacuum weekly or more depending on symptoms.
- Don't allow pets in the house or in the child's room if animal dander is a trigger.
- Use air purifiers with a HEPA filter.
- Do not smoke in the house and avoid exposing the child to any kind of smoke. Smoke is almost always a trigger for childhood asthma and can make symptoms much worse.
- Be careful about certain foods, as children with asthma may be more prone to developing food allergies. Slowly introduce foods and monitor their responses. Common foods that trigger allergies include nut-based foods, dairy products, fish, wheat products, eggs, and soy products.
Maybe. It's hard to tell if a child will continue to have asthma symptoms as they grow into adulthood. One thing we know for sure is that once a person develops sensitive airways, they stay that way for life. This is true even for asthma symptoms that change over the years. However, a person's airways grow bigger and stronger as they mature, which can make it easier for them to manage symptoms over time.
Around half of children with asthma will "outgrow" their condition, meaning once they hit adolescence symptoms seem to go into remission. Teenagers and young adults may go years without any present symptoms. But in general, asthma tends to reappear later in life, usually by late 30s or mid-40s. Even if a person appears to be asthma-free, they may still have the same environmental triggers. Dander, pollen, and mold can all cause asthma at any age.
People with asthma who aren't currently experiencing symptoms should still always keep their medication on hand. Inhalers should always be close by, just in case acute symptoms reappear. Nebulizers should be stored somewhere safe, with albuterol ampules ready. The last thing someone needs is to have an asthma attack and not be ready for it.
Asthma can cause a lot of complications in a child's life. Children with asthma may struggle to transition into different seasons, especially in spring and autumn when there's increased levels of pollen. Being chronically sick early in life can make it harder to regularly attend school, and parents may need to stay at home more often to monitor their child.
However, the wide majority of children with asthma are able to have full and successful lives as they learn how to manage their illness independently. Once the child is able to communicate their symptoms, it becomes much easier to handle. If your infant is struggling with asthma, just continue to hang on, because it won't be this hard forever. In fact, some mothers feel like asthma brought their family closer together by being more sensitive and in-tune with their child's illness.Sources and Additional Literature
Moral, L., et al. (2019). Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines. Society of Pediatric Allergy and Clinical Immunology, 47(2), 107-121.
Grigg, J., & Ducharme, F. M. (2019). Asthma in the Preschool Age Child. Kendig's Disorders of the Respiratory Tract in Children (pp. 677-685).
Gern, J. E. (2019). Rhinoviruses and the onset of asthma. Rhinovirus Infections: Rethinking the Impact on Human Health and Disease, 121.
Shioya, H., et al. (2019). Characteristics of breath sound in infants with risk factors for asthma development. Allergology International, 68(1), 90-95.
Kwong, C. G., & Bacharier, L. B. (2019). Management of Asthma in the Preschool Child. Immunology and Allergy Clinics, 39(2), 177-190.
Fischer, P. R. (2019). Viruses, Food Allergies, and Childhood Wheezing. Infectious Disease Alert, 38(8).