Asthma is a chronic respiratory condition in which the tubes that carry air in and out of the lungs (the bronchi) become inflamed and narrowed. Among children who develop asthma, nearly half show their first symptoms before age 1. About 70 to 80 percent of children with asthma also have allergies—especially to airborne allergens such as animal danders, pollens, and dust mites. For these babies, allergens can trigger asthma flare-ups. Keep in mind that asthma doesn't come and go—the bronchial tubes are not only abnormal during an acute asthma attack, but remain inflamed and oversensitive during symptom-free periods as well.
Certain triggers, such as pollen, respiratory viruses, or tobacco smoke, can cause the bronchial tubes to narrow. This tightening is made worse by inflammation, a thickening of the muscles lining the tubes, and an increased production of mucus.
Rates of asthma have dramatically increased in infants and toddlers, and while the reason is not known for certain, factors that are suspected to play a role include: exposure to cigarette smoke, air pollution, and pet dander; early entry into childcare (which brings an increased exposure to viral illnesses); an early end to breastfeeding; and infection with respiratory syncytial virus. Other culprits include cockroaches and dust mites. A history of asthma and/or allergy in a parent, especially the mother, is the greatest predictor of asthma in a baby.
An acute asthma attack creates cough and congestion, rapid or difficult breathing, and a whistling noise when exhaling. A baby may be anxious and restless and struggling to breathe. Between acute bouts, she may cough frequently, especially at night.
Wheezing in an infant may simply be due to "reactive airways," rather than true asthma. Because infant and toddler airways are extra sensitive, they become narrowed easily, for example, during a respiratory illness or when exposed to cigarette smoke. In fact, only one third of infants who have bouts of wheezing in their first year will go on to have asthma in later childhood.
If your baby is coughing or wheezing, her doctor will likely first try to rule out medical conditions besides asthma. Skin and blood tests may be helpful in identifying any related allergies. You may be asked to keep a diary of your baby's symptoms for several weeks to try to identify asthma triggers in your child. About 70 percent of children with asthma are sensitive to cat or dog allergens. Sadly, parents may need to find a new home for the family pet.
Children with asthma usually require both daily "controller" medications, to reduce bronchial inflammation, and "rescue" treatment medications (known as bronchodilators), to quickly relax and widen the bronchial tubes during asthma attacks. In babies, medication can be given by a nebulizer that converts liquid medicine into a fine mist, an inhaler with a face mask, or oral syrup.
Children at greatest risk for severe asthma attacks are those whose disease is not well-controlled on a daily basis. Ask your child's doctor to provide you with a written instruction plan. Since asthma flare-ups are often triggered by related allergies, reducing your baby's exposure to irritants such as tobacco smoke, air pollution, or cold winter air can be a big help.
In addition to breastfeeding and avoiding tobacco smoke, it may be possible to delay or prevent asthma in high-risk infants by using air conditioning to keep airborne allergens to a minimum, not having a furry pet; and eliminating dust catchers like stuffed animals and drapes in your child's room. Since the influenza virus is a strong asthma trigger, an annual flu vaccine, beginning at 6 months of age, can help prevent acute attacks. To learn more, contact The American Academy of Allergy, Asthma, & Immunology (800-822-2762) or the The Allergy and Asthma Network/Mothers of Asthmatics (800/878-4403).
Pediatrician Marianne Neifert, M.D., is the author of Dr. Mom's Guide to Breastfeeding.