Up to three-fourths of children with asthma develop the condition in their first five years of life. Often, asthma begins as a viral respiratory infection. Instead of getting better quickly, a child’s cough or labored breathing seems to linger. It’s a good idea to see your child’s health care provider when a cold seems to stick around. That’s especially true for very young children, whose lungs are still developing and don’t work as efficiently as those in older children.

Diagnosis

Diagnosing asthma in babies and young children can be tricky. The major problem is that wheezing, coughing, and hard breathing also can mean bronchitis, pneumonia, and more rarely, a variety of serious conditions, including cystic fibrosis (a rare genetic disease that causes lung problems), heart disease, and immune system disorders. To decide if your child truly has asthma, your doctor will do a detailed medical history and physical examination.

Working With Your Health Care Provider

If your child has anything beyond very mild asthma (characterized by just occasional symptoms), you should probably see an asthma specialist If you are in a health maintenance organization (HMO), ask your primary care provider to refer you to a pediatric asthma specialist, usually an allergist.

Medication

Few studies have been done on asthma medicine in children under 3 years old. If your doctor thinks medication is needed, he or she might prescribe cromolyn, which has a strong safety record. It’s likely that you’ll try a short course of medication and see how your child’s symptoms respond. Then, you might stop the medicine altogether. The kind and amount of medication will depend on the severity of your child’s asthma. In general, doctors try to get asthma under control quickly and then slowly reduce the medicine level. This approach varies among doctors, however, and it may vary with the age of the patient.

Some drugs are not safe for infants. In particular, theophylline can be dangerous because it builds in the body during a fever, and fevers are common among babies. Ask your health care provider about asthma medication in infants.

The most effective asthma medications are inhaled. These drugs go straight to the lungs, working quickly to relax the airways that spasm during an asthma attack and remain chronically swollen. Some young children can’t use asthma inhalers, so they breathe in medication using a compressed-air machine called a nebulizer. This machine allows them to slowly inhale medication over the course of about 10 minutes. Usually, young kids wear a face mask to breathe in medicine; older children can use a nebulizer with a straw-like inhaler device. Nebulizers must be cleaned carefully and regularly so bacteria don’t build up and get inhaled, causing infection.

When you have an infant with asthma, it’s important to watch out for early symptoms of an asthma attack. With your health care provider, you will create an asthma management plan that lists, step by step, what to do when early symptoms appear. Your management plan should include things like whether you go to the emergency room or doctor’s office, how you’ll get there, how much it will cost, who else you will notify, and who can watch your other children. Make copies of your management plan to share with family members, babysitters, or close friends. Also, keep a copy at work and home.

In general, you should go immediately to the emergency room if your baby’s:

• skin starts looking pale or red
• chest starts to get big
• cry become shrill, short, and soft
• breathing rate increases
• suckling or feeding stops
• nostrils open wider
• skin between the ribs seems pulled tight

During an asthma attack, do not try to treat your baby at home by, for example, giving him or her lots of liquids. The key is to be prepared and get medical care quickly.