Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Respirtory Infections and Asthma in Small Children



There are numerous respiratory conditions which occur in young children. Altogether these are the most common reasons for a visit to a pediatrician. They can range from a simple stuffy nose in a small infant to the common cold in any age child to full blown pneumonia. Many of these conditions seem to overlap and are very confusing. To help sort out these conditions, I will list the normal anatomical parts of the respiratory tract and some comments as to their function and how they become involved in disease. Then I will outline step by step each condition with details on diagnosis, home treatment and when to contact your doctor. I will also briefly cover what to expect from the doctor or from possible hospitalization if that is needed.


A. Respiratory Tract in Children

The respiratory tract in children consists, in simple terms, of the nose and throat, larynx, windpipe (trachea), lung tubes (bronchi), small lung tubes (bronchioles), and air sacs (alveoli). All of these parts of the respiratory tract are vitally important for normal respiratory functioning. Their primary purpose is to bring oxygen into each cell in the body and then to expel carbon dioxide from the body. In infants, the components of the respiratory tract are considerably smaller than in older children and adults. Because of this small size they become blocked quite rapidly and are involved in several unique conditions found primarily in infants.

A simple way of approaching respiratory diseases in children involves tracking the respiratory system from the nose and throat down all the way to the air sacs or alveoli. The upper portion of the respiratory tract begins with the nose and throat. Of course this is where air enters our body and carbon dioxide leaves our body. The nose also warms and humidifies air as it enters the body. Moving down the respiratory tract we come to the larynx. This includes components such as the vocal cords which are important in voice production, and the epiglottis which is important in blocking food from entering the respiratory tract. Any inflammation of the larynx, vocal chords or epiglottis causes difficulty with breathing. This typically manifests itself as either croup, laryngitis or epiglottitis. Below the larynx is the windpipe (trachea) which moves air down the respiratory tree. It is involved in croup and rarely in tracheitis. Moving down the respiratory tract further we come to the bronchi. These are large air tubes which move the air down the respiratory tract and regulate air flow in and out of the lungs. Whenever the bronchi become swollen and tight from inflammation and bronchospasm, the patient has asthma. Moving lower into the respiratory tract, the bronchi branch into smaller air tubes called bronchioles. The bronchioles also regulate air back and forth in the respiratory tract and become involved in viral infections causing bronchiolitis. Finally the bronchioles connect with the alveoli or air sacs in which the actual oxygen and carbon dioxide exchange takes place.

The respiratory tract protects itself from infection by transporting mucous from the lower components up to the upper respiratory tract or mouth and nose. There is also a complex set of immune cells present throughout the lungs which add to this protection.



Stuffy nose is a very common condition in infants from the time of birth until they pass their first or second year. This can be due to something as simple as cold air blowing on them or irritants in the air such as powder or dust or cigarette smoke. Since babies in the first three months are not comfortable breathing through their mouth and breathe more naturally through their nose, it is important to treat this condition. The most simple treatment includes spraying salt water spray into the nose and suctioning out the nose with a bulb syringe. If the runny nose progresses from a clear thin drip to a thick yellow- green color and causes difficulty with breathing, your pediatrician should be consulted.



The common cold is caused primarily by numerous upper respiratory viruses. Colds are transmitted primarily through respiratory secretions and by a persons hands. The best way to prevent transmitting this to your child is to avoid other small children who have colds and to use frequent hand washing. Should your child develop a cold, the symptoms will include things such as runny nose, cough, low grade fever, nasal congestion and blockage. Most of the time this is self limiting and can be treated with salt water nasal flushes, vaporizers (cool or warm mist), and over the counter cold or cough medicines. Should the cold progress, to include high fever (over 101 degrees F.), a sick appearing child, or increasing respiratory symptoms such as an uncontrollable cough or difficulty sleeping and feeding, then your pediatrician should be consulted. Frequently this will lead to a secondary infection such as an ear infection, a sinus infection or a throat infection and may require antibiotics.



Croup is a common condition in young children with symptoms such as inspiratory striderous sounds and hoarseness. The raspy sound seems to come on suddenly, usually late at night or in the early hours of the morning. It may be associated with significant respiratory distress with sucking in of the skin between the ribs, called retractions. The treatment for mild croup is a vaporizer, (cool mist) along with an effective cough medicine. Should the croup be at all serious and not respond to simple use of a vaporizer and a cough medicine, your pediatrician should be consulted. He may continue the above mentioned treatments as well as hospitalization. In the hospital, treatments may include things ranging from inhalation treatments with bronchodilator medications to IV fluids, antibiotics and strong cough suppressants. Most of the time croup is mild and self limiting but in severe cases it can be life threatening and so, obviously, should be checked by your pediatrician.



Bronchiolitis is an upper respiratory viral infection with involvement in the lower chest. This usually causes wheezing and fast breathing. It sounds very much like asthma and frequently is misdiagnosed as asthma. It can range from a very mild case easily treated by the parents at home with use of a vaporizer and cough medicines; more severe cases with very rapid respirations, poor color and difficulty sleeping and eating require hospitalization. Therefore, if wheezing, shortness of breath and rapid respirations seem to be progressive and getting worse, your pediatrician needs to be consulted. Treatments for severe cases include oxygen, IV fluids and IV medications. Also respiratory support ranging from bronchodilator inhalation treatments to anti-viral inhalation treatments done in a hospital setting. Again, most cases of bronchiolitis, like croup, are mild and self-limiting but a small percentage do become very severe and need quick medical attention.



Asthma is a common condition even in small children under age three. It is characterized by bronchospasm or tightening of the small lung tubes and by inflammation or increased mucous, white blood cells and chemical mediators throughout the lungs. Asthma is usually found in children who have a family history of allergies. This family history can include asthma as well as hayfever, atopic dermatitis (eczema) and occasionally food allergies. This may be found in one or both parents and other siblings or first cousins. Asthma can present similar to bronchiolitis in a small infant with wheezes and rapid breathing. One way to distinguish asthma is to note that the wheezing responds to bronchodilator medicines and that the wheezing usually recurs more than one time. Bronchiolitis usually occurs once and rarely twice. Asthma typically recurs several times a year with increased frequency in the Fall and Spring. It may be triggered by several factors including pollen inhalation, changes in weather, irritant inhalation (such as cigarette smoke or dust), exposure to cats or dogs, or cold viruses. If you suspect asthma in your child, you should consult your pediatrician so that proper diagnosis and a treatment plan can get started. The best way to treat asthma in small children is by inhalation treatments which is being used more and more as they become affordable and allow parents to provide medicines both to reduce the inflammation and the bronchospasm. The medicines for the inflammation include Intal or chromalyn sodium and one of several different topically active corticosteroid sprays. These are proving more and more effective and safe in several good long term studies in children around the world. The exact combination of medications will be worked out by your pediatrician.

Asthma in the past has limited the activities of many young children but is now very controllable with proper medications and understanding. Check with your pediatrician for local asthma and allergy support groups. Parents should understand the day to day medical plan for their child and emergency measures should the asthma be hard to control. This should all be written down and crystal clear. Hospitalization is rarely needed today for asthma because of nebulizers and other medical improvements.



Pneumonia is similar to all of the above conditions except the infection moves into the lower lungs and causes a greater degree of inflammation. This can be caused by several different viruses and bacteria. It is characterized by a child with fever from low grade to very high, rapid breathing, coughing which seems to be coming from deep in the chest. Other signs and symptoms include increased mucous production, usually with some color, yellow or green, compared to clear. Frequently there will be shortness of breath, retractions or sucking in of the skin between the ribs with each breath and occasionally very noisy breathing. This is best diagnosed with a chest X-ray. Depending on the cause or nature of the pneumonia (viral or bacterial) certain X-ray changes will be seen. This will guide your pediatrician in prescribing appropriate treatments including antibiotics either by mouth or intravenously in a hospital setting or by injection. Increased fluid intake, Tylenol for the fever, inhalational breathing treatments can help to open up the airways. Also, chest drainage is helpful with special techniques of clapping the hands over the chest to help facilitate mucous removal from the chest. Many cases of pneumonia, even in young children can be treated as an outpatient with close followup; however, almost any child under six months with pneumonia or any child of any age with serious pneumonia will usually require initial treatment in a hospital setting.

In summary, there are many respiratory conditions occurring in young children which parents should recognize. These range from mild stuffy nose and the common cold to severe bronchiolitis, croup, asthma and pneumonia. In most cases, home treatments can be initiated and frequently control the condition but whenever the condition seems to be getting worse, the pediatrician should be contacted right away for careful evaluation and treatment.


VAPORIZER OR HUMIDIFIER: Which is which and which should I use?

A vaporizer provides warm steam which is helpful for stuffy nose and upper respiratory congestion. A humidifier provides cool mist. This is more typically used for lower respiratory congestion such as bronchiolitis and croup. Another old fashioned way of providing mist for a child with acute spasmodic croup when you get caught short is simply to close the door of your bathroom and turn on the hot water faucet in your shower or bathtub until the room fills with steam. When using vaporizers or humidifier it is very important to dry them out and wipe them with a clean cloth in between each use. This will prevent mold growth and other micro organisms because of stagnant water sitting in them. The proper recommendation for cleaning is to turn the machine off and fill it with vinegar and water, ( about one tablespoon of vinegar per quart of water) and to let is soak for ten minutes. At least once a week cleaning is recommended. It is best not to use detergents because this can damage the operation of the machine. Again the important thing is to always wipe the machine dry between uses.