Wheezing in infants and toddlers — what to do?
Wheezing is common in small children — around a third of all children will have an episode of wheezing before they are three years old. Although it’s common, we still don’t quite know the best thing to do about it. The problem is that wheezing, like fever, is a symptom of a disease, not a disease itself. It’s not one thing. Every physician who treats small children in the office, the emergency department, or the pediatric intensive care unit is often faced by the dilemma of what to do with a wheezing small child.
In such children wheezing is often triggered by a viral illness. When it happens in infants it is often caused by a virus we call RSV (short for respiratory syncytial virus) and causes a disorder called bronchiolitis. For those children, we know that not much of anything helps the symptoms — all we can do is provide supportive care and wait for the illness to run its course. What about wheezing children who don’t have bronchiolitis? Can anything help them?
The problem facing the doctor is that all the treatments we’ve tried over the years for small children who wheeze are taken from how we handle older children who have chronic, frequent wheezing — what we call asthma. These treatments work for asthma, yet they often don’t for wheezing that isn’t. A certain number of children who have their first spell of wheezing will go on, over years, to develop true asthma. But most wheezing toddlers won’t progress to asthma — they will have an episode or two (or three) of wheezing and then “grow out of it.” If you bring your infant or toddler to the doctor for a first (or second) episode of wheezing, the doctor has no way of knowing which of these two things will happen. There are a few clues, such as a family history of asthma, which will increase the chances of future asthma, but there’s no good way to tell.
How do most doctors handle this problem? Most will try a dose or two of asthma medications (inhaled albuterol and/or budesonide, or oral prednisolone are commonly used) just to see if it helps. If the child gets better, they can be continued.
My point is that you should understand that for this problem — wheezing in an infant or toddler — your doctor is handicapped by not being able to predict the future. Only time will tell. It’s a frustrating, but common medical scenario.