Wheezing is caused by narrowed airways (bronchioles) in the lung. There are many causes of wheezing. It sounds like a high-pitched whistle when the child breathes out, but may also occur with breathing in when the child is having more problems. Sometimes, wheezing can only be heard with the doctor's stethescope.  There may be   rapid breathing (over 40 breaths per minute), tight, difficult breathing and a cough.

• The main concern is noting how much difficulty breathing is present. If you feel your child's breathing is so difficult that you do not have time to call the doctor, call for emergency rescue (911).
• Wheezing with symptoms of a cold (congestion, cough and sometimes a fever) in infants under one year of age is often caused by a virus called respiratory syncytial virus (RSV). It occurs in epidemics during the winter months. This is called bronchiolitis (not the same as bronchitis). About 1 to 2% of these children will need to be hospitalized for dehydration or because they need oxygen. About 30% of children who develop bronchiolitis may go on the have asthma later in life. Bronchiolitis may occur in children as old as 3 years old, but babies under 6 months are at highest risk for complications and severe symptoms.
• Asthma is defined as recurrent episodes of wheezing. Most children who develop this have a family history of asthma, hay fever and/or eczema. Situations that may aggravate asthma include: pollens (note seasonal occurrences), dusty environments, smoke from tobacco or fires, animal danders, feathers, flowers, paint, perfumes, aerosol sprays, live Christmas tress, or dust from turning on a furnace. Also colds due to viruses and secondary bacterial infections such as an ear infection, pneumonia, sinusitis, and strep throat may cause a child to wheeze. Some children will develop exercise-induced asthma, where one sees that when they run or play hard, they start to cough or wheeze.
• Aspiration of a foreign body may also produce sudden onset of wheezing. If you suspect your child may have had a choking episode on some hard food or foreign object and is wheezing, alert your physician immediately.
• Anaphylaxis is a potentially life-threatening allergic reaction to a food or medication that may be associated with hives (itchy welt-like rash) and a sudden difficulty in breathing. If breathing is extremely labored, call 911 immediately.
• "Spitting up" in babies is called gastroesophageal reflux and this may cause wheezing because the child will spit up and aspirate some of the fluid into the lungs.  This causes irritation in the lungs and then the baby may start wheezing.

• Moderate or severe difficult breathing
• Lips become bluish
• History of a choking episode on food or object
• Associated hives and suspicion of an allergic reaction to food or medication and having difficult breathing or coughing
• Signs of dehydration
• Infant less than 2 or 3 months of age

• First episode of wheezing without any signs of difficult breathing
• The child has a history of asthma and the usual medications do not seem to be helping and is having mild difficulty breathing
• Signs of secondary infection - earache, sore throat
• Fever more than 72 hours
• Is unable to sleep because of wheezing

Medications. Medications for asthma require prescription drugs that are called bronchodialators. Bronchodialators come in oral syrups or tablets, inhalers that are puffed into the lungs or may be provided by using a nebulizer that delivers a mist of medication to the child over 5 to 15 minutes.  If your child has a history of asthma and you have used these medications in the past, you may use these as needed when attacks occur as guided by your physician. Steroids for serious asthma attacks should only be used after discussion with the physician, unless they have already established guidelines for you to use these.

Bronchiolitis in the infant. Fluids need to be encouraged to avoid dehydration. Bulb syringing and clearing the nose of mucous, especially before eating is helpful (see colds for how to use the bulb syringe) in younger infants. Using a humidifier will also help breathing for an infant. Prescription medications, like the bronchodialators, may be prescribed by your doctor depending on the severity of the illness.

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