Difficulties in the airways are explained by doctors at Great Ormond Street Hospital in our A-Z series on health
Wheeziness is caused by narrowing of the airways and is usually a symptom of asthma or bronchiolitis (infection of the smaller airways). Over the past 30 years asthma has become increasingly prevalent in children aged two to 15, and today it affects one in seven children in the UK.
One of the more convincing theories for this rise is the 'hygiene hypothesis' which claims that because children today are less exposed to environmental germs, they have a poorer immune system for fighting infections.
An inhaled foreign body in the airway can also cause wheezing. In all cases it is advisable to consult with the child's doctor to investigate the cause.
Common causes
Asthma
This condition affects the airways that carry air into and away from the lungs. It is difficult to diagnose in early childhood as so many children suffer from some sort of wheeziness or chest infection then. Those affected by asthma have particularly sensitive airways that become irritated by certain substances such as smoke, pollen, pet dust, house dust mites and colds.
Symptoms:
- Wheeziness or a whistling sound in the chest.
- Coughing, especially at night.
- Shortness of breath, particularly after exercise.
Treatment:
- Relievers. During an attack the muscles round the airways go into spasm and make them very narrow. These are inhaled medicines used to help relax these muscles to allow the child to breathe more easily again.
- Preventors. These are inhalers used daily to reduce inflammation in the airways that react badly to the triggers of an asthma attack. The medicines contain small doses of steroid medication. These are safe if the proper dose is used for the child's size and age.
Preventive action:
If a child has asthma, make sure you are aware of any particular triggers of attacks and find ways to avoid them.
- Encourage parents not to smoke in the company of children.
- Keep vulnerable children away from furry or feathery pets.
- Avoid exposure to known allergens such as house dust mite or pollens.
Bronchiolitis (RSV-virus)
Wheeziness can also develop from the respiratory syncytial virus, a common cause of acute bronchiolitis in young children aged under two during winter months. The disease is rarely life-threatening and most children make a full recovery. It is transmitted through direct contact with those who have coughs and colds, and in older children usually appears as a common cold.
Symptoms:
- In young children a runny nose and sneezing are common symptoms. However, the child's temperature can rise to 38* or 39*C.
- The child will then start coughing and experience breathing problems.
- Two to three days later, breathing may be more difficult and laboured and cause the child to hyperventilate. Whistling sounds from the chest may indicate the condition has worsened.
There is no readily available vaccine to prevent against RSV infection. In rare and complicated cases where it may be almost impossible for the child to breathe, they are usually admitted to hospital and given oxygen and medicine to help relieve the wheezing.
Preventive action:
- People with colds should wash their hands thoroughly with soap and water after blowing their nose or before cooking or toileting.
- Ensure the child in your care can breath easily and has plenty of fluids.
Whooping cough (pertussis)
Wheeziness may also be a symptom of whooping cough, which can be fatal in children. It is a highly infectious and preventable disease affecting mainly babies and young children. Mass immunisation has vastly reduced its incidence in developed countries, but we are seeing the reappearance of babies with the condition, caught from siblings who were not fully immunised.
Symptoms:
- Usually, bouts of coughing, often followed by a sharp intake of breath and characteristic whooping sound.
- A dry cough is usually evident for the first week, accompanied by a runny nose and mild fever.
- The cough gets more persistent.
- Coughing can persist for up to three months after the initial infection.
Treatment:
Antibiotics may be prescribed and the child should have plenty of fluids
