What is wheezing baby syndrome?

We refer to wheezing baby syndrome as the wheezing in the chest that occurs in children up to two years of age, which may or may not be related to respiratory problems. This wheezing can be continuous (persistent) or temporary. It is very common to confuse the term "wheezing baby" with asthma. They are not synonymous. Asthma can be one of the causes of a wheezing baby, but it is not the only one.

Symptoms

The main symptom of a wheezing baby is chest wheezing, technically known as a wheeze. The child may have continuous wheezing for a month or at least three episodes of wheezing within two months. The intensity of the wheezing varies: it can be mild, without causing difficulty breathing; moderate, when there is some respiratory difficulty requiring hospitalization for treatment and oxygen supply; or severe, when it causes respiratory failure requiring ICU admission and ventilatory support through artificial respirators.

Causes

There are several causes of wheezing baby syndrome. The most common are of pulmonary origin, especially viral infections, such as bronchiolitis. Other causes include gastroesophageal reflux, foreign body aspiration (beans, peanuts, popcorn, small objects, among others), lung diseases such as bronchopulmonary dysplasia in premature infants, cystic fibrosis, and asthma itself. Non-pulmonary causes are less frequent but can also cause wheezing, such as heart failure, airway malformations (e.g., vascular rings), mediastinal tumors, tracheomalacia, tuberculosis, among others.

Diagnosis

The diagnosis of a wheezing baby is clinical. A good clinical history and physical examination are sufficient to determine the cause of the wheezing, but in some cases, at the pediatrician’s discretion, additional tests may be necessary. The most difficult diagnosis at this age is asthma, due to the variety of causes that lead to wheezing. However, some criteria can be used to consider this possibility: the presence of atopic dermatitis and parents with a history of asthma. When these criteria are present, the risk of developing asthma in the future is 60%, and when negative, about 10% of children develop asthma.

Treatment

The treatment of a wheezing baby depends on the cause. However, during an acute episode, the use of inhaled bronchodilators, especially salbutamol, is indicated. Occasionally, oral corticosteroids may be necessary for 5 to 10 days if there is no improvement with the bronchodilator.

Environmental hygiene is essential to avoid exposing the airways to irritants such as dust, mites, mold, and animal hair. Avoid rugs, curtains, carpets, and the child’s contact with stuffed animals. Smoking should be discouraged, as exposure to cigarette smoke increases mucus production and airway reactivity.

Follow-up with a pediatrician should be routine for constant evaluation and selection of the best treatment for each child.

By Einstein Editorial Board