Asthma in infants , toddlers and children

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• Family history of asthma, allergies, or atopic dermatitis 
• Premature delivery.
• A viral infection (such as respiratory syncytial virus, or RSV), especially when the baby is less than 6 months old.
• Having mother who smokes during pregnancy 
• Approximately, 80% of children that will have asthma, develop signs and symptoms before the age of 5.  

In infants and toddlers, it may be hard for parents, and even doctors also, to recognize signs and symptoms of asthma. 

• Bronchial tubes in infants, toddlers and preschoolers are already very small and narrow, and colds and other illnesses can inflame airways, making them even smaller and more irritated due to internal swelling.  
• Asthma symptoms will vary from one child to other. The difficulty with infants is that they cannot express to you how they are feeling.  

Children with asthma may experience difficulty breathing – you may notice their abdomen moving more when inhaling or exhaling and the nostrils of their nose may flare in and out. You may also notice:  

• Wheezing or a whistling sound while breathing 
• Fast, shallow breathing with increased respiratory rate.
• Coughing, commonly dry and paroxysmal, at night time.
• Fussiness and tiring easily , which may lead to refusal to breast feed.
• Problems eating .
• Blue tint to skin and fingernails, in severe cases 

It can be very difficult for doctors to diagnose asthma in infants because it is not easy to measure lung function in children who are preschool age or younger. Diagnosis will depend on the parents and the symptoms they report, as well as the family’s medical history.  Asthma Predictive Index is helpful for children

The doctor may inquire about when your child coughs or has trouble breathing. It might be helpful to take notes at home about the time of day and what your child is exposed to when symptoms are present. Also inform the doctor about any family members that have asthma or allergies in details.  

• Infants can receive asthma medications through an inhaler, but often a nebulizer with a mask is a more efficient and effective way to deliver their asthma medication. A nebulizer is a machine that delivers liquid medication in a warm mist.  MDI with a spacer is another good option.
• Be mindful to follow the medication instructions given to you by your doctor and on the package insert.  

Asthma is the one of the most common chronic conditions in children and affects nearly 1 in 10 children. It is also the very common reason children miss school – an average of 13.8 million lost days of school each year. Asthma in children can be especially more serious because children have smaller airways than adults.  

• Asthma may be diagnosed with a medical examination and a test that measures the airflow in and out of the lungs- spirometry.
• If your child has recurrent colds and bronchitis, and symptoms recur on exposure to certain allergens or irritants , than it may be asthma.

• Inform your child’s pediatrician if anybody in your family has asthma, allergies or atopic dermatitis. These conditions often run in families; if they present in yours, it’s more likely your child will have them.   

• You may be referred to an allergist who may perform skin or blood tests to see whether your child has any allergies that can trigger asthma symptoms. These tests can be done at any age. You can help your child’s doctor by completing a childhood asthma control test prior to your 

At times when asthma is suspected, the doctor will put your child on a trial of asthma medication to see if it works. If your child gets better in symptoms while taking the medicine, it might be a signal that your child’s symptoms are due to asthma. The medicines depend on how severe your child’s symptoms are and how often they occur.  This is called Therapeutic Trial.

The goal of management for children include:  

• Managing the child’s environmental factors to avoid triggers 
• Treating airway inflammation and bronchospasm with medicines. 
• Keeping asthma in control so activity does not need to be limited .
• Teaching the child about asthma, their medications and how can they  be as healthy as possible in a way they can understand.

Children may develop asthma symptoms due to a variety of reasons – viruses, allergens and irritants are some of the causes. 

Sometimes the time of year, such as during monsoon/ winter asthma peak occurs, which can cause a child to develop symptoms of asthma. Here are some suggestions on what you can be done: 

• Review the inhaler technique with your child. Ask about using a valved holding chamber or spacer – a handheld device that attaches to the inhaler and captures and directs the medication to the airways. 
• Make sure your child remains on an inhaler medication schedule throughout the year, when advised by an allergist, even when there are no symptoms.   
• Involve children in the conversation with doctor, also helping them understand when, why and how to take medicines and other ways to keep asthma under control. 

Asthma is rarely outgrown – as it often persists into adulthood.

•  However, some parents experience the symptoms of asthma go away as their child grows. 
• This can be the result of the child’s lungs gradually growing larger or the immune system adapting over time. 
• But,However, sensitivity to allergens as an asthma symptom trigger may still persist. And for many of them, symptoms often reappear years later.