Wheezing in children

June 26, 2013 Howard M. Uman, MD

Wheezing is one of the most common symptoms in children and adults. Wheezing refers to the high pitched, "musical" sounds generated from the respiratory tract. It may originate in multiple areas, from the nose, to the throat, to the lungs. When physicians use the term "wheezing", they are usually indicating the sounds produced by tightness in the lower airways ("bronchial tubes").

Wheezing is especially important in pediatrics because children have frequent respiratory infections. These infections are generally caused by viral infections which cause much irritation in the airways. In addition, the airways of children are small and more "sensitive," predisposing them to wheezing. The location of the irritation may be in the upper or lower respiratory tract. This means that wheezing can occur with just a cold as well as bronchitis or pneumonia.

Wheezing in most children will respond to treatment with a bronchodilator. (The exception is in children younger than 6 months old, who develop wheezing from irritation and mucous rather than "tightness.") Bronchodilators are inhaled and help wheezing and coughing by decreasing the tightness of the lower airways. The most common bronchodilator is albuterol.

Treatment of wheezing will often combine an anti-inflammatory medication (a "steroid") with the albuterol. This combination is particularly effective at decreasing wheezing, decreasing associated cough, and shortening the course of illness.

Parents often worry that wheezing indicates possible "asthma." Asthma is a lifelong condition in which wheezing may occur, with or without infection. About 1/3 of children who wheeze will continue to have more sensitive lungs, causing intermittent wheezing, after 5 years old. Children who continue having symptoms after 5 probably have asthma.

The most important initial step is recognition that the child with difficult coughing may be having associated wheezing. Cough that accompanies a respiratory infection may indicate nasal congestion, postnasal drip, or wheezing. When a cough is more frequent and bothersome, evaluation by a health care provider is indicated to clarify the cause and prescribe appropriate treatment.

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