Diagnosing Children

An insidious type of problem is the general behavior of the child. If the child is having uncontrolled asthma, he does not feel well and if the child does not feel well, this can be manifested in a variety of ways. He may become very withdrawn and passive or, on the other hand, he may become hyperactive or a behavior problem, or just difficult to deal with. We have seen several children on medications such as Ritalin, which attempts to decrease the "hyperactivity" who, in fact, have uncontrolled asthma and when the asthma is brought under control, the abnormal behavior which had been such a problem, seems to fade. Thus frequently, behavior disturbances may, in fact, be a manifestation of uncontrolled asthma.

When the patient is initially seen, we take a detailed history in an attempt to find out what the symptoms are. Is it coughing, wheezing, frequent colds or frequent colds that linger? What are the precipitating factors?

Every asthmatic has to be treated as an individual. There are no two asthmatics that are alike. The final common pathway may be wheezing and coughing, but so many different factors are involved that we attempt to determine the specific profile. What are the factors that set off an attack?

When we examine the patient, we listen to the chest and we are looking for wheezing or other noises that we may hear. If the patient is underweight or short in stature, this, too, might be a sign of uncontrolled asthma. We also look at the skin to see if there are signs of eczema, which frequently occur with asthma. In addition, nasal problems, such as hay fever, frequently go along with asthma.

Signs & Symptoms of Asthma in Infants

Although it is more common for asthma to begin after the first year of life it can start at any age, and in many children symptoms are present in the first year.

Asthma may take several forms in infants. Some babies have acute episodes of wheezing and difficult breathing, as do older asthmatic children. However, in others asthma may take the form of chronic cough, noisy breathing, or colds that always "go into the chest."

Diagnosing Asthma in Infants

For the baby who is having the more typical, clear-cut attacks of shortness of breath, cough, and wheezing immediately relieved by anti-asthmatic medication, the diagnosis is not difficult. However, in other children the picture is not as clear, and other conditions must be considered.

Cystic fibrosis is a genetically determined disease which causes bronchial obstruction and may mimic asthma. Congenital malformations of the respiratory tract, defective swallowing reflexes which allow food to get into the bronchial tree, and heart disease which causes excessive fluid to accumulate in the lung — all may cause difficult, noisy breathing, and in some cases your doctor may need to have special studies performed to rule them out.

A particularly difficult problem is posed by bronchitis and bronchiolitis, viral infections of the respiratory tract whose symptoms may be identical to those of an acute asthma attack. It may be impossible to be sure of the correct diagnosis at the initial attack, and only continued observation will eventually allow a definite diagnosis to be made. The presence of asthma should be strongly suspected in any infant having repeated attacks of "bronchitis" or "bronchiolitis."

What Causes Asthma? And Why My Child?

Essentially, asthma is a condition in which the respiratory tract is excessively irritable and unstable. The basic cause of this abnormal irritability is not yet known, but when it is present a variety of stimuli can act on the lung to produce the symptoms of asthma. These stimuli may include allergic reactions, respiratory infections, weather changes, exercise, emotional upsets, irritants such as cigarette smoking and other factors in the child's environment. None of these factors is the basic cause of asthma, but they are the immediate triggers of symptoms in the asthmatic infant.

Heredity is an important determinant of whether or not an infant develops asthma, since it is known that asthma and related conditions (hay fever, eczema) tend to run in families. However, heredity alone may not be the only factor involved, and many physicians suspect that environmental stresses may also be involved in producing the asthmatic lung.

Can Asthma Be Prevented?

A baby's genetic background of course cannot be changed. However, if environmental stresses are important, the avoidance of these factors might be expected to prevent or delay the development of asthma. The difficulty is that we do not yet know what these environmental factors may be. Some physicians feel that diet is important, and advise breast feeding for most of the first year of life. Others feel that certain viral respiratory infections may affect the lung in such a way as to make it asthmatic and that the development of effective vaccines against such viruses may be a promising approach. At the present time one can only say that both of these suggestions are unproved theories and more research will be needed before a proven approach to the prevention of asthma will be available.

Treating Asthma in Infants

Even in infancy, effective approaches to the treatment of asthma exist. Since at the present time we cannot change the excessive irritability of the lung which is at the root of asthma, treatment consists of two general approaches: the identification and avoidance of stimuli which trigger symptoms, and the use of medication to modify the response of the asthmatic lung to these stimuli. Unfortunately, many factors which may trigger symptoms in babies, such as respiratory infections, weather changes, and crying cannot be avoided. However, others can be removed from the infant's environment. Irritating substances in the air, such as aerosol sprays, should not be allowed in the infant's room, and there certainly is no excuse for smoking being allowed in any home in which an asthmatic child lives. Allergens such as pollen are not as important in infants as in older children or adults, but occasionally allergenic foods in an infant's diet may trigger wheezing. When a food is suspected as a trigger for asthma, this can be tested by simply removing the food from the diet to see if symptoms are relieved, and then returning it to the diet to determine if symptoms worsen.

The other main approach is the use of medication. Some medications which are useful in older children cannot be used for infants because of the amount of cooperation required in their administration. However, there are several prescriptions available which, in the hands of a physician experienced in the use of anti-asthmatic medication, can be used safely and effectively even in very young infants.

Parents sometimes ask about the use of vaporizers or croup kettles for attacks of asthma. Although these devices have not been proven to have a definite effect on asthma, some children seem to be more comfortable with them. For safety's sake, hot steam kettles should not be used for babies old enough to climb out of bed.