Just Breathe – The Challenge of Diagnosing Asthma in Very Young Children

One of the difficulties of diagnosing asthma in babies and toddlers is that it’s not very easy to measure lung function in small children. So, in trying to make a diagnosis, your pediatrician will rely heavily on your child’s symptoms and other information.

Your pediatrician will ask whether your baby tends to wheeze, cough, or breathe fast when he has a cold, is near animals, or is in a place that’s dusty or tainted by smoke. Make sure you tell your pediatrician about any excessive coughing that your child has, particularly nighttime cough and prolonged cough after a cold, even if there is no wheezing, because asthma can be present with coughing being the only symptom. Your pediatrician will also ask whether you or other family members have asthma, hay fever, or eczema, or if there’s anyone in the family with recurrent bronchitis or sinus problems.

Your pediatrician will listen carefully to make sure that the sounds your baby is making are coming from the airways of the lungs, and not from the baby’s voice box higher up in the throat or the nose. Sometimes babies breathe noisily as a result of laryngotracheomalacia, a temporary weakness in the cartilage near the vocal cords. They grow out of this as the tissues become firmer.

If your baby starts wheezing after breathing in a foreign object (such as a bit of food or a small toy) that has become lodged in a bronchial tube, he needs urgent medical attention. Unusual conditions related to airway development or prematurity can also cause wheezing in infants. In general, an unexplained frequent cough or daily cough in infants may mean serious disease and should be evaluated by your pediatrician or pediatric pulmonologist.

Your pediatrician will check to make sure your baby is maintaining a satisfactory rate of growth and development. Most infants with asthma make good progress and are otherwise healthy. If your pediatrician is concerned that your baby may be growing too slowly or failing to thrive, tests for conditions other than asthma will be ordered. Certain tests, including a sweat test to rule out cystic fibrosis, may be necessary when your doctor wants to be sure your baby’s wheezing and chest symptoms are not caused by a condition with symptoms that are similar to asthma.

Chest radiographs may be ordered during your baby’s first wheezing bout to make sure that there isn’t a problem in the lungs. If asthma is diagnosed, repeated radiographs are rarely needed because the problem is in the bronchial tubes, which cannot be seen very well in radiographs. Your pediatrician is not likely to recommend allergy testing right away for your baby unless you suspect that wheezing always occurs after your child has been around a certain item, like an animal, or has consumed a certain food. However, keep in mind that food allergy is rarely a cause of asthma in infants and toddlers, although it may be a trigger for eczema.

Sometimes the easiest and best way to diagnose asthma in a young child is to treat with asthma therapy and see if the child improves. This is because, for the most part, medications for asthma help only asthma and not other conditions. If improvement is seen, asthma is the likely diagnosis. If this approach is taken with your child, help your pediatrician by monitoring your child’s symptoms carefully so you can give good feedback as to whether the medications have helped.