General concepts regarding childhood asthma can be found on the page Asthma. Childhood asthma is unique in that complaints are often lacking, and for those youngsters under age four or five, breathing tests are not routinely performed to help confirm variable airway narrowing Therefore, parents as well as physicians must rely on signs and symptoms, and response to therapy to help guide the diagnosis and therapy. For many small children who have a bad cough and wheeze with upper respiratory infections, symptoms are not due to asthma, are infrequent, and are usually not very serious. For those kids who have frequent bouts of significant, prolonged cough with or without wheeze, with respiratory infections, the diagnosis of asthma is likely.
Because children will often not complain of shortness of breath or chest tightness, symptoms of cough and wheezing are important indicators of airway narrowing or obstruction. As noted in the general review of asthma, airway narrowing can occur with only one symptom such as cough, which is probably the most common sign of asthma in children. Other important signs of airway narrowing, which increases the work of breathing for asthmatics, include an increase in respiratory rate. With more severe airflow obstruction, retractions may be seen as indentations between the ribs from sucking in of air. This is a sign of significant narrowing of the airway and should prompt urgent treatment and if persistent, evaluation.
Most children under age 5 who wheeze with upper respiratory infections do not have chronic asthma and will outgrow their symptoms by about 6 years of age. However, for some youngsters, wheeze and cough that occur frequently, especially if sometimes they are not associated with respiratory infections, symptoms may indicated the onset of chronic moderate asthma. If this is the case, then daily therapy with anti-inflammatory, controller medication is often recommended by experts in the field. See Asthma Guidelines.
Up to 90 percent of severe asthmatics at any age, including adolescent or adult developed the first asthma symptoms before age 5. And approximately 70 to 80 percent of all patients with chronic asthma developed symptoms by age 5. Therefore, it is very important to try to determine if a young child has intermittent asthma symptoms that he or she will outgrow, or if symptoms are the first signs of chronic asthma.
An important challenge for medical providers and parents is identifying the young child with cough and wheeze who has actual chronic asthma that will persist through childhood and possibly through adulthood, and would benefit long term with daily therapy. There are certain factors that indicate a high probability that asthma symptoms such as cough and wheeze are early signs of chronic asthma. These indicators are signs or symptoms of allergy and include the following: the presence of eczema or other symptoms of allergy such as nasal/sinus symptoms and/or eye allergic reactions; food allergy; cough and/or wheeze apart from colds; a family history of allergy, especially if the mother or both the mother and father have allergy or asthma; and positive allergy skin test reactions. An evaluation by an allergist can help determine whether or not a young child may have transient intermittent asthma symptoms or may have chronic asthma and should be on daily therapy. It is important to understand that airway inflammation and narrowing which are characteristics of asthma, may not necessarily cause obvious symptoms if these are mild or moderate in severity. It is difficult to know if there is airway narrowing because young children cannot perform the breathing tests that can reveal narrowing in older children and adults. Signs of possible inflammation and airway narrowing include cough with or without wheeze occurring with activity or at rest.
For additional information at this time, visit the helpful links below.
▪ Tips on childhood asthma from the American Academy of Allergy, Asthma and Immunology Childhood Asthma
▪ General Review of asthma and treatment from the AAAAI : Asthma
▪ From the National Institutes of Health (NIH) :Asthma Guidelines
▪ For older children who use peak flow meters: Peak Flow Meters