Wheezing in Children: Diagnosis and Management
Wheezing in Children Diagnosis and Management
A Comprehensive Overview by Age Group
Introduction
to Wheezing in Children
Definition:
Wheezing: Continuous coarse whistling sound
produced by oscillation of narrowed or compressed respiratory airway.
Inspiratory of expiratory/ High or low pitched. 
Mainly expiratory and polyphonic in
nature(sometimes It's monophonic).
Wheezy Child: A child whose wheezing persists more than one
month and/or has had 3 or more wheezing attacks
#Prevalence: Common in children and can be a symptom of
various underlying conditions.
Wheezing type in chilhood:
*Transient wheezer: One episode or few episodes of wheezing.
No further episodes beyond 6 years.
*Non-atopic wheezer: Wheeze during viral infections and
continue to have recurrent airway obstruction during early school years.
(Viral)
*Atopic(persistent)/IgE associated wheeze/asthma: Start to
have symptoms later in life which continues into adulthood
|
Atopic Wheezing (Asthma) |
|
50 % : before 3rd year, 80 % : before 6th year • Family
asthma history Allergic rhinitis or atopic dermatitis in patient • Eosinophilia,
high serum lgE level, BHR(+) |
|
• Early
aeroallergen sensitization |
Causes of
Wheezing in Children
#Wheezing in children typically begins during infancy or
early childhood, often associated with viral infections like bronchiolitis.
Many children experience their first wheezing episodes before the age of three,
particularly during episodes of viral respiratory infections. For a significant
number of children, especially those who have transient wheezing due to
infections, the condition tends to resolve by the age of five or six as their
airways grow and their immune systems mature. However, for children with
underlying asthma or allergic conditions, wheezing may persist into later
childhood and sometimes even into adolescence or adulthood. Early
identification and management are crucial to prevent long-term complications
and to potentially reduce the duration and severity of wheezing episodes.
•
Infants (0-1 year):
•
Common Causes: Viral bronchiolitis (e.g., RSV),
congenital airway anomalies, gastroesophageal reflux.
•
Toddlers (1-3 years):
•
Common Causes: Asthma, viral infections, foreign
body aspiration.
•
Preschoolers (3-5 years):
•
Common Causes: Viral-induced wheezing,
early-onset asthma.
•
School-aged Children (5+ years):
•
Common Causes: Asthma, allergic reactions,
respiratory infections.lmmuno deficiencies.
Clinical Evaluation of Wheezing
History Taking: Focus on the frequency,
duration, and triggers of wheezing episodes.
Physical Examination: Includes observing the
breathing pattern, auscultation of lungs, and identifying signs of respiratory
distress.
Family History: Consider genetic predispositions like
asthma.
Diagnostic Approaches
Lung Function Tests: Such as spirometry, especially in
older children.
Imaging Studies: Chest X-ray, CT scan if structural
abnormalities are suspected.
Allergy Testing: To identify potential triggers.
Diagnostic Approaches
Lung Function Tests: Such as spirometry, especially in
older children.
Imaging Studies: Chest X-ray, CT scan if structural
abnormalities are suspected.
Allergy Testing: To identify potential triggers.
#Why do
Children tend to wheeze more than Adults? *Children have smaller airway
passages, therefore higher resistance.
*Less chest compliance.
*Elastic tissue recoil is lower than adults and
fewer collateral airways-prone to obstruction and atelectasis
#Differential
Diagnosis
*Acute Asthma
*Bronchitis
*Bronchiolitis
*Laryngeotracheobronchitis (Croup)
*Bacterial Tracheitis
- FB aspiration
*Esophageal FB
The medical literature can also be difficult to
negotiate as wheezing syndromes are given myriad labels. In asthma alone these
include viral wheezing, pre-school wheeze, episodic viral wheeze and multiple
trigger wheeze.
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