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Asthma in children under 5

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

By Mayo Clinic staff

Many children are diagnosed with asthma each year, and over half of them develop symptoms before age 5. If your child has breathing problems you think might be caused by asthma, see a doctor. Early diagnosis of asthma in children is important. Proper treatment not only improves day-to-day breathing and reduces asthma flare-ups — it may also help prevent damage to your child's growing lungs.

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 get better with age. While asthma can't be cured, it can be managed by following the treatment plan you develop with your child's doctor.

Asthma symptoms in children under 5

The most common asthma symptoms in children under 5 include:

  • Coughing
  • Wheezing
  • Difficulty breathing
  • Recurring pneumonia

Some children have few day-to-day symptoms, but have bad asthma attacks now and then. Other children have regular, mild symptoms or symptoms that get worse with activity or other triggers ranging from cigarette smoke to 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 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 signs and symptoms include a lot of coughing that may get worse at night.

Asthma emergencies
For some children, severe asthma attacks can be life-threatening and require a trip to the emergency room. 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

While your child's doctor may identify asthma as the cause of your child's symptoms right away, diagnosis in young children can be tricky. In children under 5, diagnosis is usually based on symptoms reported by parents, and what the doctor finds in a physical exam.

In older children and adults, doctors often measure lung function with tests called spirometry or peak flow measurement. As your child gets older, these tests might help. Generally, children fewer than 5 are unable to do these tests.

If it's available, your child's doctor may be able to check the inflammation in your child's airways with a newer test that measures nitric oxide levels in your child's breath. In general, higher levels of nitric oxide mean your son or daughter's lungs aren't working as well as they should be — and asthma isn't under control.

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References
  1. Schatz M. Pharmacotherapy of asthma: What do the 2007 NAEPP guidelines say? Symposium: Overview of the 2007 NHLBI Asthma Guidelines. Allergy and Asthma Proceedings. 2007;28(6):628.
  2. Li JT (expert opinion). Mayo Clinic, Rochester, Minn. July 23, 2008.
  3. Milgrom H. Chronic cough. In: Leung DY, et al. Pediatric Allergy Principles and Practice. St. Louis, Mo.: Mosby; 2003:321.
  4. Moss MH, et al. Asthma in infancy and childhood. In: Adkinson NF, et al. Middleton's Allergy: Principles and Practice. 6th ed. Philadelphia Pa.: Mosby; 2003. http://www.mdconsult.com/das/book/body/100024376-7/727439687/1183/535.html#4-u1.0-B0-323-01425-9.50075-7_2434. Accessed April 23, 2008.
  5. Hoecker J (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 7, 2008.
  6. Park M (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 5, 2008.
  7. Stewart LJ. Pediatric asthma. Primary Care. 2008;35(1):25.
  8. Liu AH. Childhood asthma. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/100024376-12/727446153/1608/440.html#4-u1.0-B978-1-4160-2450-7..50145-6--cesec11_3422. Accessed April 23, 2008.
  9. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Summary report 2007. Journal of Allergy and Clinical Immunology. 2008;121(6):1330.
  10. Szefler SJ. Advances in pediatric asthma in 2007. Advances in Asthma, Allergy, and Immunology Series 2008. Journal of Clinical Immunology. 2008;121(3):614

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Jan. 16, 2009

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