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Treating asthma in children under 5

Asthma in children under 5: Asthma symptoms and treatments can be different from those in older children.

By Mayo Clinic staff

Most children with asthma develop symptoms before age 5. There are a number of conditions that can cause asthma-like symptoms in young children. But if your child's symptoms are caused by asthma, early diagnosis is important. Asthma treatment in children improves day-to-day breathing, reduces asthma flare-ups and helps reduce other problems caused by asthma.

Asthma in children varies by age group. Infants, toddlers and 4-year-olds are diagnosed and treated differently than teens and adults are. Asthma in children also varies from child to child, and symptoms may get better or worse at certain times. In some children, asthma symptoms improve with age.

Asthma can't be cured, but you can keep symptoms at a minimum by using a written asthma action plan you develop with your child's doctor to track symptoms and adjust treatment.

Asthma symptoms in children under 5

Common asthma symptoms in children under 5 include:

  • Coughing
  • Wheezing
  • Trouble breathing
  • Chest pain
  • Recurring bronchitis

Some children have few day-to-day symptoms, but have severe asthma attacks now and then. Other children have persistent mild symptoms or symptoms that get worse with activity or other triggers such as cigarette smoke or seasonal allergies.

  • If your child is an infant, you may notice slow feeding or shortness of breath during feeding.
  • If your child is a toddler or older, you may notice a decreased desire to run and play due to breathlessness. Your son or daughter may become fatigued easily and cough when exercising.
  • For many children under age 5, asthma attacks are triggered or worsened by colds and other respiratory infections. You may notice that your child's colds last longer than they do in other children, or that signs and symptoms include frequent coughing that may get worse at night.

Asthma emergencies
For some children, severe asthma attacks can be life-threatening and require emergency room treatment. Signs and symptoms of an asthma emergency in children under 5 years old include:

  • Gasping for air
  • Trying so hard to breathe that the abdomen is sucked under the ribs when he or she breathes in
  • Trouble speaking because of restricted breathing

Tests to diagnose and monitor asthma in young children

Diagnosing asthma can be tricky in young children. Wheezing, coughing and other asthma-like symptoms can occur with conditions other than asthma, such as viral infections. For this reason, it may not be possible to make a definite diagnosis of asthma until your child is older.

For older children and adults, doctors can use breathing tests (lung function tests) such as spirometry or peak flow measurement. As your child gets older, these tests may be used to help pinpoint an asthma diagnosis and track how well treatment's working. Generally, children under age 5 aren't able to do these tests.

Your child's doctor may be able to check for inflammation in your child's airways with a test that measures levels of nitric oxide gas in the breath. In general, higher levels of nitric oxide mean your child's lungs aren't working as well as they should be, and asthma isn't under control.

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References
  1. Guidelines for the diagnosis and management of asthma: Summary report 2007. Bethesda, Md.: National Heart, Lung, Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed Dec. 1, 2010.
  2. Boguniewicz M, et al. Allergic disorders. In: Hay WW, et al. Current Diagnosis & Treatment: Pediatrics. 19th ed. New York, N.Y.: McGraw-Hill; 2009. http://www.accessmedicine.com/content.aspx?aID=3409411. Accessed Dec. 1, 2010.
  3. Liu AH. Childhood asthma. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders; 2007. http://www.mdconsult.com/das/book/body/10te0024376-12/727446153/1608/440.html#4-u1.0-B978-1-4160-2450-7..50145-6--cesec11_3422. Accessed Nov. 22, 2010.
  4. Robinson PD, et al. Asthma in childhood. Pediatric Clinics of North America. 2009;56:191.
  5. Updated information on leukotriene inhibitors: Montelukast (marketed as Singulair), zafirlukast (marketed as Accolate), and zileuton (marketed as Zyflo and Zyflo CR). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm165489.htm. Accessed Nov. 22, 2010.
  6. FDA drug safety communication: New safety requirements for long-acting inhaled asthma medications called long-acting beta-agonists (LABAs). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm200776.htm. Accessed Nov. 22, 2010.
AS00034 Jan. 12, 2011

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