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Asthma symptoms in infants and young children 

 In young children, cough is often the only symptom of asthma.

Asthma symptoms generally include coughing, wheezing, and shortness of breath, but asthma symptoms vary widely among children. Some cough all night but are symptom-free during the day, while others seem to get frequent chest colds that just won’t go away.

Children have very small, narrow airways, and can wheeze when they have a viral infections. First episodes of cough, runny nose and fever that happen in cold and flu season (fall, winter and early spring) is likely not asthma. If your child has several more episodes of wheeze and cough, it is more likely to be asthma. The most common cause of asthma in infants and children under three years of age is a cold. Even after the cold is gone, asthma symptoms and airway swelling can last for several weeks. 

Diagnosing asthma in young children

Healthcare providers are often reluctant to give a diagnosis of asthma to infants and very young children because children often cough and wheeze with colds, chest infections like bronchitis, and other conditions responsible for asthma-like symptoms.

Since there is no diagnostic test available for children younger than six years of age, making a diagnosis in this age group is more difficult than in older children. Over the age of about six it is possible for a child to have a spirometry test. This is a simple test that measures a child’s airflow through the large and small airways. Results reveal if the child’s airflow can be improved with medication. Reversibility of airway obstruction is a key feature of asthma. If administering a bronchodilator reverses airway narrowing significantly, the diagnosis is probably asthma.

Preparing for your child’s visit to your healthcare provider

During your appointment, your healthcare provider will conduct a physical exam and may order some tests, like x-ray, blood tests, allergy skin tests, and pulmonary function tests (PFTs).

The physician will take a detailed history of:

  • Family allergy/asthma, with emphasis on parents
  • Child’s allergy history – e.g. eczema
  • Child’s history of illness to date e.g. frequency of colds
  • Child’s symptoms: Severity, frequency and duration of symptoms. What brings an end to the symptoms for example if the child has a cold, do the symptoms disappear when the cold is over?
  • Child’s triggers: what have the parents observed with respect to exposures to allergens or irritants, such as smoke, perfume, infection or emotions

This information will help your healthcare provider understand your child’s pattern of symptoms.

What can you do if your child has been diagnosed with asthma?

If your child has just been diagnosed with asthma, know that you are not alone. Asthma Canada and your healthcare team have many resources available to you.

  • Start by learning as much as you can about the condition. Work closely with your child’s healthcare provider to monitor your child’s asthma symptoms. Ask questions and clarify any information you are unsure about.
  • Reach out to Asthma Canada’s FREE Asthma & Allergy HelpLine to speak with a Certified Respiratory Educator.
  • Begin keeping a diary to keep track of what non-allergic triggers affect your child’s asthma. This will help you identify your child’s triggers, and develop strategies to avoid them.
  • Learn all you can about your child’s medications. This includes possible side effects of medication and the appropriate technique for administering medication.
  • Ask you healthcare provider about developing a Kids Asthma Action Plan. And Asthma Action Plan monitors asthma symptoms and has a written plan to follow when symptoms change.
  • Join Asthma Canada’s membership alliance (ACMA) to connect with other Canadians living with asthma or impacted by asthma.

How do I know if my infant or child has Severe Asthma?

If you are concerned that your infant or child’s asthma may be severe, observe their behavior for the indicators below and speak to your healthcare provider right away.

Learn more about Severe Asthma in Children

Observe your infant for any of the following indicators of Severe Asthma:

  • Sits up, refuses to lie down
  • Stops feeding
  • Audible wheezing
  • Pale or bluish-looking skin –anywhere
  • Irritable
  • Rapid breathing
  • Using accessory muscles of breathing-in, drawing of muscles at the neck when breathing – it may look like the skin is being tugged in. If you see this, your child must be assessed by a healthcare provider.

Observe your child for any of the following indicators of Severe Asthma:

  • Pale looking or bluish looking skin- anywhere
  • Breathless
  • Cannot walk or talk
  • Wheezing
  • Looks exhausted
  • Rapid breathing
  • Irritable
  • Peak flow less than 50% of personal best
  • Using accessory muscles of breathing-in, drawing of muscles at the neck when breathing – it may look like the skin is being tugged in. If you see this, your child must be assessed by a healthcare provider.

Learn more about Severe Asthma in Children

Frequently Asked Questions:

My baby is wheezing and was put on puffers; does that mean she has asthma?

Children are put on puffers when the physician has reason to believe their airways are inflamed and or congested. Putting a baby suspected of having asthma on a trial of medication is one way to determine if the child has asthma. If the symptoms repeatedly improve it is likely asthma and a treatment plan can be followed to keep the infant well controlled.

What is the most common cause of asthma in infants and children?

The most common cause of asthma in children under the age of three years is a cold. Even after the cold is gone, asthma symptoms along with airway swelling can last for several weeks.

How can the doctor know it is asthma when she is only two months old?

The diagnosis is based on the baby’s allergy and health history, physical exam and the parents’ history of allergy and asthma. A child with recurring bouts of coughing and wheezing with lingering symptoms is likely to have Asthma. Again, if the child responds well to a trial of asthma medications, this is also indicative of asthma.

I stopped giving the medication because the baby seems better is that OK?

Please talk to your child’s doctor before stopping any medication. The baby may seem fine to you but there may still be airway inflammation and premature discontinuing of medication can have an adverse effect on the child’s recovery.

Do I have to use steroids? Isn’t there another kind of medication I can use instead?

Steroids are known as Preventer or “Controller” medications and are the Gold Standard or treatment of choice for asthma. Steroids treat inflammation in the lungs, preventing asthma attacks and reducing symptoms. They are both safe and effective.

  • Anti-leukotrine Medications (LTRAs) are classified as non-steroidal preventer medications, designed to reduce inflammation in the lungs, improving asthma control and preventing asthma attacks. They are often combined with an inhaled steroid to treat children with more severe chronic or intermittent asthma. Used together, this combination may result in fewer symptoms and it may be possible for your doctor to reduce the amount of inhaled steroid required for good control of asthma symptoms.
  • Short Acting Bronchodilators are called “Reliever” medications and are used to treat the bronchospasm in the airways bringing quick relief for shortness of breath. These bronchodilators do not treat the underlying inflammation.
What about alternative medicines?

There are no regulations, dosing standards, or large clinical studies with alternative medicines. Using them is therefore not without risk.

Will my child out grow asthma?

The answer is maybe. Evidence shows that in approximately two- thirds of children diagnosed with asthma, the asthma will “quiet down” by puberty. However, one-third of these who were asthma free at puberty have asthma symptoms in their mid-twenties.

What is exercise-induced asthma?

Children who have exercise-induced asthma (EIA) develop asthma symptoms after activity such as running, swimming, or biking. The time varies from 5-20 minutes post exercise before symptoms appear. With the proper medications, kids with EIA can usually play sports without a problem. If exercise is the only asthma trigger, a medication that the child takes prior to exercising to prevent the airways from constricting may be prescribed, but usually exercise induced asthma is a sign of poorly controlled asthma.

Severe Asthma in Children

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