Asthma in Toddlers & Preschoolers

• Asthma in a 4 year old
• Asthma in 2 year old - will it go away?
• 3yo's asthma attacks - what is causing them?

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Asthma in a 4 year old

Jan 2006

My son recently developed asthma symptoms and my husband and I are uncertain about the best way to treat it. What has us feeling anxious is that both our Kiaser doctor and our naturopatic doctor have told us that wheezing and coughing can have a kindling effect. The more you cough and wheeze the worse it gets and the longer you have it.

He is coughing and wheezing all the time and having about one, sometimes two coughing attacks at night during which he wakes up coughing hard and crying. The wheezing is slight but pretty constant now.

I'd love to hear from parents who have used accupressure, herbs or homeopathy to treat or cure asthma in their young child. What did you do to rule out allergins or find them? How severe were the symptoms and how long did it take for the remedy to work? Do you have books or resources to recommend about avoiding using steriods to treat childhood asthma.

Here's a little bit of background. My son is 4 and had severe food allergies as a baby. He outgrew the food allergies at about 3 expect for a peanut allergy. He has been allergic to fragrance but we've never noticed he had hay fever or other allergies until this summer. Over the summer he started coughing at night.

When Fall came he developed a very bad cold and coughing. At that point Kaiser's prescription for him was Albuterol in an inhaler. When that didn't clear it up they prescribed Flovent, a steriod in an inhaler.

We did the routine but 4 days after the 10 day treatment the symptoms were exactly the same as before. At that point I became very reluctant to try the Flovent/steroid again. We'd like to avoid using steriods like the Flovent he was prescribed. We are also concerned that the albuterol inhaler might not be a good thing long term though we are using it when he has a coughing attack at night.

I have taken him to both an acupuntuirist and a naturopathic doctor. I have confidence in both. However, he's gotten better and worse with these treatments and a little worse now. You see my dilemma. I don't expect anyone to make a diagnosis and tell me what to do. Your stories or resources would be greatly appreciated. Karen

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I have two kids with viral-triggered asthma. Their symptoms appeared at about 13 months. I urge you not to discount the traditional medical advice for asthma. I also urge you to consult an allergist. You can do a lot to lessen the severity and frequency of allergy-triggered attacks by keeping your house clean, running an ionizer and addressing your kids' allergy triggers.

Both my kids are on daily doses of Singulair, which is not a steroid. My 6-year-old has a moderate daily dosage of Flovent via inhaler and a daily dosage of Pulmicort via nebulizer. My 2-year-old, who gets yeast infections from the Flovent, gets two daily doses of Pulmicort via nebulizer. These are their preventive care. When either child has a cold, we add Xopenex and/or Albuterol to the mix as both preventive care and to address any coughing or wheezing. Yes, the preventives are steroids. However, these are inhaled, rather than intravenous, which reduces the risk. And you're weighing two risks here; the risks of asthma are severe. Have you seen the movie, ''Four Weddings and a Funeral''? The actress who played Scarlett died in her 30s of an asthma attack.

Every allergist I've seen has downplayed the risks of the steroids when compared with the risks of untreated asthma. Our treatment has kept both kids out of the hospital. My son has not had a severe attack in four years. As far as your son not responding to the treatment, I would suggest that you may need a higher dose. When my son was having severe attacks, we needed to give him maximum dosage. Only when the attacks subsided did we then lessen the dosage. It's not like a cold or even labor, where you want to use the minimum amount of medicine to keep comfortable. With asthma attacks, you need to get the bronchial passages open and stop the inflammation.

Ultimately, once the attack (wheezing or coughing) has stopped, you should be able to get on a preventive schedule and lower your son's meds dramatically. I would also encourage you to have your son checked for a sinus infection, which can interfere with effective asthma treatment. Keep in mind, too, that nebulizers are more effective than inhalers for getting the medication into the lungs. I wish you the best of luck. Gwynne

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I'm concerned that you're looking for an alternative treatment you can feel better about, when standard treatment with albuterol and Flovent could help your son feel better right now. If he is as symptomatic as you indicated, this is no time to change his treatment regimen.

Many people confuse inhaled steroids with the oral ones used in life- threatening emergencies (Prednisone). Prednisone is scary stuff, and has saved many lives over the years (including my own). The side- effects/long-term effects of inhaled asthma medications (inhaled directly into the lungs instead of passing thorugh the blood) are minor, especially when compared to their ability to help assure your son a long, healthy, active life -- free of ER visits and permanent lung damage.

If you don't like your doctor, find one you trust and listen to him (her). If the prescribed aerosol inhalers don't seem to work effectively, ask about getting a nebulizer.

If you are willing to treat your child proactively and as directed by a good doctor, there is no reason he should be as sick as he seems to be right now. The time to change course, or explore new options, is when he is stable and symptom-free.

You can contact me if you have questions. Because of a past tragic event I now take asthma very seriously Heather

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My son, who is almost 4, was diagnosed with ''cough-variant'' asthma when he was 2. He was coughing constantly at night and if he got a cold, it would get even worse. Kaiser gave us the Albuterol inhaler, which didn't seem to help that much. We decided to try Singulair, and that seemed to really help. After a few months, when the weather became warm again, we took him off it.

On a more holistic note, I got mattress, pillow, and comforter covers (the ones that protect against dust-mites)for his bedding and mine because I read that dust mites are a potential trigger for asthma. I ordered it all on-line from a store specializing in allergy products...sorry I can't remember the name. I also bought special detergent for the bedding that is supposed to keep it free of dust mites.

Sometimes we use one of those HEPA air purifiers in his room. And occasionally we'll use a humidifier, which seems to help in the winter when the air is drier from the heater.

My cousin who is a massage therapist/naturopath recommended the herb astragalus, for general immune system building, but to be honest, I never gave it to him. I did buy kids' multivitamins at Whole Foods that had echinacea and some other herbs, though.

Good luck! Melissa

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Hi, We have a 9 month old with asthma who has been at least a little congested since the beginning of november(!). We are on a learning curve with the asthma thing too and will be interested in other responses. One thing in your post that caught my attention was that you stopped the steroid way too early. They don't generally have an effect for at least a week and that is if they are given consistently as perscribed. Also, inhaled steriods are considered topical and not nearly as harmful long term as oral steroids. That being said you should rinse your childs mouth out or give him something to drink after each dose of steroid medication to prevent thrush.

My pediatrician also shares with view of the ''kindling effect'' though he used different words. Seems like your child should have something with a more immediate effect to prevent the wheezing. Our daughter is on pulmocort (steroid) and xopenex (a fancy kind of albuterol since the regular stuff doesn't touch her)

I don't know what the effects are of albuterol after a time. I imagine they might build up a resistance to it and be less sensitive to it as is the case with most drugs. But you should not stop giving a drug just because of a nebulous feeling that its not good to give. you need concrete information from your md and others with more experience with the drug and from the drug companies too. Asthma can be very serious. As a nurse I have had patients who DIED from asthma attacks. kids often grow out of asthma and allergies but I think this is more likely if it is controlled during their childhood.

this is an airway issue - that means oxygen to the brain.

please, please do not take uneducated chances with your baby's health.

good luck

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Asthma in 2 year old - will it go away?

Sept 2004

My two-year old daughter had a cold that turned into pneumonia when she was 15 months old. The ER treated her with albuterol. At that time we were told that it wasn't uncommon for young children to have colds that triggered asthma attacks, but that as the child got bigger they would outgrow the asthma and colds would just be colds. Three months later she had a cold that triggered a very mild asthma attack (18 months old), and then last month, at 23 months old, she ended up in the ER again with a serious asthma attack, again when she caught a cold. Now, one month later, she just turned two and, again, she woke up with a cold and three hours later can't breath and is getting albuterol. This is four times in 10 months! Has anyone had a young child who outgrew asthma? We're trying to get a sense of whether this is something that will be a lifelong problem, or whether it might just go away. My husband and I both come from families with no health problems, so it's a bit of an adjustment for us. I've read the archives, but this subject isn't addressed. Rebecca

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My 4-1/2-year-old son and 18-month-old daughter are being treated for asthma. (They don't technically diagnose asthma in infants; the official diagnosis is at 2, but the signs are there.) They both had their first attacks at about 13 months, triggered by viruses. My son was hospitalized with RSV and pneumonia that led to a severe sinus infection. We've been to several allergists and are now very happy with one in Palo Alto who is very aggressive in her treatment.

What I have been told is this: Asthma may be triggered by viruses, allergies or the environment (or a combination). Based on two extensive surveys, it is thought that children whose asthma attacks are triggered by viruses grow out of them. Those whose attacks are triggered by allergies or the environment may have the attacks all their lives. However, it is possible for a child without allergies but whose attacks are triggered by viruses to develop allergies later in life and experience attacks triggered by those allergies. Regardless of the type of trigger, it is thought that children whose parents have allergies are more prone to asthma.

I would advise you to get a reference from your pediatrician for a good allergist (or from a friend or relative). I'm in the South Bay, so mine probably wouldn't be good for you. There are some wonderful preventive treatments (some with steroids and some non-steroidal medications) that can stave off the attacks, so you won't wind up in the ER, anymore. (My sympathies. I often think the ER is the worst place to be when you're sick.)

I have to tell you that quite a few youngsters in my children's daycare/preschool are being treated with nebulizers (a compressor system that turns the medication into a mist to be inhaled). Unfortunately, daycare is part of the reason they're all getting so many viruses, which in turn are triggering the respiratory troubles.

It's a tough time for you (and I'm going through it, as well, with my daughter), because toddlers are so prone to colds. But as they get older and their immune systems mature, the colds will ease off, too. And the attacks will abate. I'm seeing that with my son.

Your allergist can also point you to good literature on asthma and support groups (they're searchable on the web, too). You didn't ask about insurance, but here's a word to the wise: You should make sure your health insurance is up to date. We had to get private coverage for a time last year, and despite the number of kids with asthma, we found that asthma is considered a pre-existing condition that many insurers won't touch. (If this should happen to you or anyone you know, be sure to challenge the ruling through HIPPA, the Health Insurance Portability and Accountability Act.) Good luck, and if you have any other questions or just want to chat, send me an email. Gwynne

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My two boys are now 23 and 24. The older one had major asthma problems (hospitalized a couple of time when he was 3 and 4), and the younger one's asthma was not quite as severe. My older son still needs to take medicine to control his asthma, but he leads a relatively normal life. He still has to watch his diet (milk products are a trigger for him). The younger one has grown out of it, except for annoying sinuses (he's always sniffling). He doesn't watch his diet any more. It was allergies that triggered their asthma (environmental and foods), so once we handled that, the asthma did not show up as much. KS

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I can relate to your statement that it's been an adjustment to have a child with asthma when there are no health problems in your family. My parents always gave me the impression while I was growing up that asthma and allergies were a product of weak minds and sheltered children. My daughter had her first asthma attack at almost 15 months old. She is adopted and we don't know her medical history, but she has allergies and eczema as well, which tend to go together. (This doesn't sound like the case with your daughter.) After trying to keep her medication to a minimum we agreed with the allergist at 18 months to get more aggressive with her treatment, since by then she had three more incidents (of unknown cause, although at least one was triggered by a cold)) which required 5-7 day treatments with prednisone (albuterol was never enough, although I think the degree of severity of her symptoms still kept her in the mild to moderate asthma range). We put her on an inhaled steroid (Flovent), a leukotriene inhibitor (Singulair), and an antihistamine (to make her less sensitive to allergic triggers, which might have been contributing to her asthma attacks). Her breathing, even when she wasn't ''sick'', got markedly better, and we're convinced that the daily meds allowed her lungs to fully heal, which wasn't the case with the ''less is more'' way we were treating her condition earlier on. Our allergist counseled us on why a more aggressive approach is good, but he was experienced enough to know that we needed time to weigh the pros and cons of more meds first (what, give our daughter steroids? no way). So that in combination with getting older has brought her to a stage where her asthma is quite mild now. We stopped the daily antihistamine in December 2004 (at about 3-1/2 years old) and the daily Flovent in May 2004 (almost 4 years old) of this year. Her acute phases have not gotten more frequent with the reduced medication - yippee. We ramp up (with Flovent and albuterol) now only if she exhibits a hint of sickness (coughing, which is the first symptom with her; if she's getting a cold her cold symptoms come a day or two later). So, to answer your question, her allergist says that a lot of kids outgrow it or it gets less severe as they get older and that's what we've seen with our daughter. I wish the same for you. Please email me if my message raises any questions that I might be able to answer. carol

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Our 26 month old twin daughters both have asthma. They don't get awheezing attack, but rather a persist and deeply wrenching cough. Colds trigger attacks, as do other mysterious triggers. We think dust and pet dander are two. It took us about eight months of attacks to establish a ''case'' that our girls were not suffering from persistent colds but do/did have asthma. Our confirmation came during one of our visits to the ER. Once it became clear that their asthma was recurring, they were prescribed steriods and xopenex (another version of albuterol but with fewer size effects) to get us through the flu season. These have helped TREMENDOUSLY. Our doc says to make sure they get flu shots too.

We are told too that they may ourgrow their asthma. They have a cousin, age 10, who has outgrown his. And their father outgrew his asthma around the same age. mom of coughers

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My son also developed viral induced asthma as a toddler, and I remember how scary those attacks were. I remember one time his little voice calling out to us, ''I can't breathe, I can't breathe.'' Truely frightening.

We used Albuterol both in the inhaler form and also pill. For whatever reason he was better at taking the pill than the inhaler. I think we had to get the pill at a special pharmacy. From about 2 to 4 he'd get asthma with every chest cold. Slowly the number of attacks lessened as he got older. Also, he got fewer colds. Thankfully, by about age 6 the asthma attacks were a thing of the past.

I'd do EVERYTHING I could to reduce the amount of cold viruses that come into your house. Get in the habit of EVERYONE washing their hands with soap and warm water EVERY time they enter the house.

Use paper towels. Kitchen towels are notorious for harboring germs. Don't share towels in the bathroom. Make sure that you child doesn't play with sick friends. Explain to other moms the potential critical consequences of a severe asthma attack and enlist their support to help keep their sick kids away from yours.

And lastly, try to keep calm during an attack. If your child picks up that you or dad are frightened, he will get even more frightened too. After an asthma attack we'd bring him into our bed to sleep with us and he'd always have a good night sleep after that without further episodes. parent who's been there and done that

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I empathize with your situation and have some thoughts for you. Our 2-year old was diagnosed with asthma at 1 during allergy testing (turns out no allergies) that her Dr. had ordered due to a constant runny nose and night coughing. This Dr. (not her regular one) gave her a nebulizer because she didn't like her breathing, and said that she definitely had asthma. As you say, this was very hard for me to accept because neither my husband or I have any health problems or family history of asthma. With our daughter's case, the way it presented itself was constant, terrible night coughing (rather than attacks per se) any time she had a cold, which was practically all the time from the time she started daycare at 4 months. After almost a year of this nightmare, either her immune system kicked in or (who knows?)- the coughing stopped. We had had her on a low dose of a Flovent inhaler-I don't know if it did any good, but we stopped it as a trial in the spring and haven't needed it. Albuterol never really seemed to help as a rescue measure. She's had really minimal illness this year, and only ONE cold the entire year triggered the coughingOur daughter's Dr. won't accept her asthma diagnosis; he doesn't diagnose it until age 3 since ''so many outgrow this response to colds.'' So, it may be better in this way that her asthma trigger is colds and not allergies. That said, and I don't want to give medical advice I'm not qualified to give, but 4 attacks in such a short time seems like too much! Too much for your daughter, too much stress for you. From what I've read (I had to educate myself, knowing nothing about asthma previously), it's possible to control it much better than that through regular (as opposed to rescue) medication (there are many different options). If you haven't consulted with your Dr. about this already, it seems like a good step. You'll also find that if you talk about your situation, you'll find MANY parents in the same boat as asthma is REALLY common here. Many parents of older kids told me that the kids did indeed ''grow out of it.'' There are also many educational/support resources through the county Dept. of Public Health, Kaiser, and Mothers of Asthmatics (find it on the web). Somewhere I read that parents commonly feel ''despair'' after a child's diagnosis, but I think with all of the new med options and support available, it's something you can adjust to if necessary, even if it's scary. Good luck. anon

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Boy can I relate to your situation! Our son, now almost 4 1/2, had his first asthma attack and hospitalization at 13 months. It was also virus-triggered. He then was hospitalized about 6 or 7 times over the next 18 months or so--all virus-triggered. The good news is that most kids do seem to outgrow the severity and frequency of the attacks, and you as parents will get pretty good at learning to prevent and/or minimize the attacks. I think it's now been over 2 years since he's been hospitalized, and he rarely has any problems at all when he gets colds. It was a very tough time though, and we had to do daily treatments of pulmicort (preventive), and had to add xopenex (a form of albuterol that does not have the extreme side effects), atravent, and even prednisone (nasty stuff!) when things got bad. He was (and still is) in daycare, so he pretty much had colds every other week. It was a really difficult and stressful time for all of us, and I also had a lot of trouble because I'd never had an allergy to anything and it was a very foreign thing for me. I strongly recommend getting together a good team of doctors who can consult with each other and whom you feel you can trust. We are in Kaiser now, but at the time we were with the Pediatric Medical Group in Berkeley. Our primary doc was Steve Kowaleski, who was great, and the other docs came to know our son well too and were all wonderful. We also had an allergist, Jim Nickelson, who was across the hall from the pediatrician, so whenever we went to Dr. K. he would just call Jim and he'd say come on over. We also occasionally saw a pediatric pulmonary specialist, Nancy Lewis, in Walnut Creek. Finally, we saw a cranio sacral chiropractor in Santa Rosa. That was a hike! But we only went every 6-8 weeks or so and we felt it helped. I could go on and on, but basically I wanted to say hang in there and more likely than not it will get better, easier, less severe, and less frequent. You'll become somewhat of an expert and that will help you feel more in control. Today our son is on only singulair--one chewable pill per day. We actually put away the nebulizer equipment only recently--it had been a permanent fixture on our kitchen counter for so long that one day I finally realized we hadn't used it in months! The machine itself is still on the floor in the living room, but I'm thinking about putting that away too! Please feel free to email me if you'd like to speak live--every child is different, but your situation and feelings do sound very similar! Best of luck! Tracy

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My son had almost the same problem and my son is 2.5 years old. He had a cold before July 4th, which turned into some bad coughing and wheezing, but no physical effects. He still played and ate the same, but had a very bad cough. We went to the pediatrician, who gave me liquid Albuterol. This did not make it go away. Another visit, this time we were given a nebulizer with Albuterol and PulmiCort. I gave him these every day as prescribed with very little change. We eventually went to see a specialist who thinks that he put something up his nose. We will probably need to take him in for a probe. His pediatrician said that asthma is not well understood and that it could be one episode or be brought on by colds. Hang in there, it may go away by itself as he gets older. ARA

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3yo's asthma attacks - what is causing it?

March 2004

My 3 year old daughter has now had 3 asthma attacks and I am dumbfounded. We used organic cotton diapers, have an organic cotton bed, and even run our only car on biodiesel. She eats no processed food and is vegetarian (although she does eat limited dairy - maybe that's a culprit?) We clean our house with only completely benign natural cleaners and the only thing we've ever used in our yard is horse manure. She has had no vaccinations and has never had antibiotics. There is no hereditary asthma that we know of. I am still nursing her. I thought I had done everything I could to prevent her from getting asthma - it seemed practically out of the question - but here she seems to have it. What am I missing? Is there some toxic gas leaking in our home? Does anyone have any experience or knowledge with the real reason behind asthma and what I might be able to do to eliminate the cause of it?
frustrated natural mom

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What makes you think vaccinations would cause asthma? Or meat? Or disposable diapers? It seems like you feel that because you've been so ''pure'', your daughter doesn't deserve to have asthma. No one deserves to have asthma; it's a crummy disease to have. But, for better or worse, it's mostly hereditary. However, many children do get over it as they get older, and hopefully your daughter will be one of them. A Berkeley parent

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This may seem obvious, but do you have pets in the home? pet allergic

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I am sorry about your daughter; it is distressing to have a diagnosis of asthma after all your care. This may not come as a comfort, but when I developed asthma as an adult during my second year in the Bay Area, my doctor told me that air pollution is a significant factor. We like to congratulate ourselves in the Bay Area that our air quality is good, perhaps because it's better than L.A. But L.A. is not a great comparison. Take a look at the air over the Bay Area as you come in on a flight, or look at San Francisco from our side of the Bay on some delightful sunny (and still) morning. The orange-brown-yellow haze hanging over the area will make you sick at heart and will sicken your daughter, as it has me and many, many others. We live within a mile of I-80 with the millions of cars and heavy trucks filing past and then wonder why our lungs are struggling.

I ride my bike -- I really would plead with others to do the same or get on public transportation or a carpool or walk or get a ''hybrid'' car or at least not a gas-guzzler... we need cleaner air

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You need to find out if your child is wheezing due to an infection ( cold, or flu) or in fact may have asthma. You cannot make a diagnosis, but should immediately consult a doctor. Asthma is a serious condition and you should not attempt to treat you child with natural remedies. Many children experience asthma due to any number of factors, pollen, hayfever, seasonal allergies, dust mites, mold, can all be possible sources of irritation. Your child may have inherited allergies, or may have developed them by repeated exposure to allergens, or both. Only a doctor can test to find the cause. Dr. James Nickelsen at 2320 Woolsey St. in Berkeley is an excellent allergist who can assist you further. family with allergies

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According to information on webmd.com, asthma is often caused by allergies, and allergies are caused by a hyper-alert immune system. Maybe she was born this way, or maybe your family's ''natural'' lifestyle unnaturally protected your child from things she is now coming in contact with and her body doesn't know how to handle it. If an ''unnatural'' lifestyle caused asmtha, many more children, including mine, would suffer. LC

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I can totally understand your frustration! Our experience with asthma has been that our daughter gets asthma symptoms usually after a cold. It starts as a head cold that moves to her chest and then if she starts coughing in the middle of the night and her breathing is ''wheezy'' and labored, then we give her Albuterol. So I would say that the triggers for asthma are not always environmental...no matter how allergy-free your home may be...but due to a virus. I have often heard that children can ''outgrow'' asthma, but in the meantime, it can be baffling and frustrating.

So, I just wanted to say that we've been there and we know how difficult it is. You try to do all the right things, and still, your child is susceptible to asthma. (We recently moved from Alameda to Oregon...and one of our many reasons for moving was in search of better air for us to breath!) Alexis

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I don't believe anyone knows for sure why Asthma cases are increasing, but there are several plausible theories. One possible reason may be that people today live in cleaner, more sanitary conditions than they did before the industrial revolution, relatively free of disease-causing viruses and bacteria. This clean living affects our immune system. We are exposed to fewer viruses and bacteria than people were 100 years ago, so perhaps our immune systems have not learned to make Th1 cells as well, which means we have a greater proportion of Th2 cells in our bodies, which might lead to more allergies and more asthma. So it's conceivable that your very organic and clean living is actually not helping your child develop his/her immune system sufficiently.

Of course there are probably many other possible causes such as an overall increase in air polution, and in general spending a lot of time indoors in a well-sealed house can increase exposure to indoor alergens like dust-mites, mold, pets, etc.

Other studies have suggested that food plays an important role; kids who get more fruits, vegetables, and diary have less asthma. Also, children in countries with the highest seafood consumption were least likely to have asthma, which may be related to increasing the amount of omega-3 fatty acids in their diet. Also lowering trans-fat intake has been shown to help with asthma.

See http://www.child.com/kids/health_nutrition/asthma.jsp for some of this information. -Mike

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You didn't mention a possible (major) culprit: mold. It might be possible that moisture/mold exists in your basement or crawlspace. anon