Wheeze in toddlers with colds

Between the ages of 10months and 6 years many toddlers and young children will experience ‘wheeze’  associated with a cough and runny nose. This is similar to asthma and responds to asthma treatment.  The management of wheeze in toddlers involves giving ventolin given via a spacer device and mask. Occassionally some toddlers will require preventative medication. Hospitalisation is sometimes needed if oxygen is required.

What causes the wheeze ?PRinc_rm_illustration_of_narrowed_bronchiole

A simple cold virus, will interact with the smaller airways of toddlers, resulting in inflammation. This leads to the formation of tiny bubbles. When breathing air in and out, these bubbles burst and reform, much like the squeezing of a wet sponge. This is wheezing. If there is a large amount of inflammation (analagous to very wet sponge), there will be increased work of breathing. This condition occurs in up to 30% of children. Some will have only one or two episodes over the years, whereas other children will wheeze with every ‘cold’.  This latter group will require preventative medication.

Is this asthma ?

Asthma is similar, and many health professionals will call this asthma. However the main difference is that those children with genuine asthma will cough and wheeze when exposed to non viral triggers. These include allergies, exercise, changes in weather and even emotion. True asthma is more common in those children who have other allergies such as eczema, allergic rhinitis (hayfever) etc. For daycare’s and early childhood, calling it asthma is acceptable and using an ‘asthma management plan’ is appropriate.

How to manage wheeze associated with viruses

Treatment involves opening the airways with ventolin which is given by a mask and spacer device (see pic). The technique is important to ensure a tight seal around the face. This sometimes requires a firm hold which can be frustrating for parents when dealing with a fractious toddler. Make sure the mask is of good quality (silicon) and the spacer is the small type.  The dose of ventolin tends to be between 3 – 6 puffs. Each puff delivered separately with 3-5 breaths between each puff. Frequency and amount of ventolin given depends on the severity and is indicated in the table below.

Assessing wheeze and cough

The toddler or child will start coughing when suffering from a cold. The cough will sound slightly moist and initially breathing will be unaffected. However in some instances there will be shortness of breath. This is assessed by carefully watching the breathing. Assess the effort involved in breathing and use exercise as an analogy. So a mild increase in chest movement is similar to someone walking, moderate is how someone’s breathing looks when jogging and severe is what someone looks like who has just been sprinting. The table below summarises this. 

How to assess and manage wheeze
Severity Assessment of wheezeTreatment – using ventolin administered by maskOngoing treatment
MildSimilar to walking – your child will be comfortable, but there is slight increase in rate of breathing and effort. Talking is still easy without pauses for breaths. Give ventolin, 3-4 puffs, every 3-5 hours depending on response and whether there is improvement or deterioationAs the wheeze and cough disappears the ventolin use can be weaned. If still slight cough, then continue two puffs of ventolin twice per day
ModerateSimilar to Jogging – your child will still be comfortable, but the chest is moving more than usual and talking requires pauses for breaths. Give ventolin 4-6 puffs initially every 1-2 hours. If improvement noted move to mild treatment. If deterioation then move to severe treatment and seek urgent medical helpContine to use ventolin frequently. If there is limited response sometimes prednisolone is required to help with the inflammation. Seek medical advice if treatment appears to be not working.
SevereSimilar to Running – your child is clearly short of breath, talking is difficult and there is considerable effort with each breath.Give 6 puffs of ventolin. This can be given quite frequently and seek medical help. Do not hesitate to call an ambulance if worried and continue to give ventolin.Severe attacks that result in hospitalisation often require preventative treatments. These are safe and effective and lessen the severity and amount of medication required.

 

What preventatives are useful ?

  • Singulair – This chewable tablet can be given to toddlers over the age of two years. It works to block some of the inflammatory chemicals released by the airways in response to the virus. It is not a steroid.  Its onset of action is quick so it can be used at the first sign of a cold.   In some children who get lots of episodes during the winter months, singulair can be given daily.  This will prevent significant coughing and wheezing.
  • Flixotide – This is an inhaler to be used with a spacer. It is effective as an alternative to singulair and is used for those who are too young for singulair. An inhaled steroid with no side effects when used as directed, it takes several weeks to work.shutterstock_219961792

Some Facts about wheezy toddlers.

  • If your child has wheezing in response to changes in temperature, or humidity, allergens such as dust mite, and exercise, this is more typical of childhood asthma.
  • Sometimes recurrent episodes need to be prevented. The medication of choice for this is Singulair. This medication normalises the response of the airways to the virus, lessening the chance of wheezing. It is safe, is not a steroid and is an option for those toddlers who get lots of ‘winter’ colds. It is administered as a tablet form given each night. It is chewable, like a smarty.
  • Influenza A is a common trigger for particularly severe episodes, so annual vaccination is strongly recommended.
  • Passive smoking will certainly contribute to this condition.
  • In the olden days these children were labelled as having a weak chest.
  • Ventolin syrup has no effect on wheezy toddlers.
  • Beware of alternative treatments and their claims. There is no evidence that wheat and diary have any role in viral induced wheeze.
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