Treating asthma in children under 5

Asthma in children under 5: Understand symptoms, medications and treatment plans.

By Mayo Clinic Staff

Asthma is ongoing (chronic) inflammation of airways in the lungs. This inflammation makes the airways vulnerable to episodes of difficult breathing (asthma attacks). Common triggers include allergies, colds and exercise. Asthma is managed by controlling inflammation with drugs, avoiding triggers when possible and using medications to treat asthma attacks.

Diagnosing and managing asthma in children under age 5 can be difficult. In infants and young children, the primary symptoms of asthma — wheezing and coughing — may be caused by other conditions. Also, standard diagnostic tests used to measure how well someone is breathing cannot be used easily or accurately with children under age 5. Some treatments available to older children for managing asthma are not recommended for infants and preschool children.

For these reasons, the management of asthma in children under 5 requires careful and relatively frequent monitoring. You can help minimize asthma symptoms by following a written asthma action plan you develop with your child's doctor to monitor symptoms and adjust treatment as necessary.

Asthma symptoms in children under 5

Common asthma signs and symptoms in children under 5 include:

  • Cough
  • Wheezing, a high-pitched, whistle-like sound when exhaling
  • Trouble breathing or shortness of breath
  • A tight, uncomfortable feeling in the chest

The severity and patterns of symptoms may vary:

  • Worsening of symptoms at night
  • Short periods of coughing and wheezing between periods of time with no symptoms
  • Frequent or chronic symptoms with episodes of worse wheezing and coughing
  • Seasonal changes based on prevalent infections or allergy triggers

Asthma symptoms may be triggered or worsened by certain events:

  • Colds or other respiratory infections
  • Allergy-causing agents (allergens), such as dust, pet dander or pollen
  • Activity or exercise
  • In infants, feeding
  • Exposure to cigarette smoke or other airborne irritants
  • Strong emotional reactions, such as crying or laughing
  • Gastrointestinal reflux
  • Changes or extremes in weather

Asthma emergencies

Severe asthma attacks can be life-threatening and require emergency room treatment. Signs and symptoms of an asthma emergency in children under age 5 include:

  • Gasping for air
  • Breathing in so hard that the abdomen is sucked under the ribs
  • Trouble speaking because of restricted breathing

Tests to diagnose and monitor asthma in young children

Diagnosis of asthma in children under age 5 can be challenging. The primary symptoms may indicate other conditions. With older children a doctor can use a breathing test that measures how well the lungs work, but these tests are not useful with younger children, who may have trouble following instructions and breathing exactly as directed.

If your child under age 5 has symptoms that might indicate asthma, your doctor or asthma specialist will likely use several pieces of information to make a diagnosis.

Medical history

Your doctor will likely ask a number of questions, such as the following:

  • Is there a family history of asthma?
  • How often do symptoms occur?
  • Does coughing wake your child at night?
  • Do the symptoms accompany a cold or are they unrelated to colds?
  • How often do episodes of breathing difficulty occur?
  • How long do they last?
  • Has your child needed emergency care for breathing difficulties?
  • Does your child have any known pollen, dust, pet or food allergies?
  • Is your child exposed to cigarette smoke or other airborne irritants?

Laboratory tests

Other tests may include the following:

  • Blood test. Your doctor can measure the levels of certain white blood cells that may be elevated in response to infections.
  • Chest X-ray. A chest X-ray may reveal changes in the lung when asthma is moderate to severe. It may also be used to rule out other conditions.
  • Allergy test. A skin or a blood test may indicate if your child is allergic to a suspected or likely allergen.

Trial treatment

If your doctor suspects your child has asthma, he or she will likely prescribe a trial treatment. If your child has relatively mild and infrequent symptoms, he or she may take a short-acting drug. If breathing improves in the time and manner expected for that treatment, the improved breathing would support a diagnosis of asthma.

If the symptoms are more regular or severe, your doctor will likely begin a drug for long-term management. Improvement during the next four to six weeks would support a diagnosis and lay the groundwork for an ongoing treatment plan.

It's important for you to keep track of your child's symptoms during a treatment trial and to follow instructions carefully. If you have followed the instructions and there is no improvement within the trial period, your doctor will likely consider another diagnosis.

Sept. 20, 2016