Asthma control in infants

Overview

Asthma control in infants means managing the symptoms of asthma in babies and very young children. Asthma is a condition that makes the airways (the tubes that carry air in and out of the lungs) become narrow and swollen, causing breathing problems. In infants, it can be hard to diagnose, but controlling it helps prevent serious breathing trouble and keeps your baby healthy and comfortable.

Yes, asthma is one of the most common long-term conditions in children. In infants, it is often first noticed after a cold or respiratory infection, and it affects about 5-10% of young children in the UK.

It affects babies and toddlers, typically starting before age 1. It is more common in children who have a family history of asthma, eczema, or allergies, and in boys slightly more than girls.

Symptoms

Common symptoms

• Wheezing – a high-pitched whistling sound when breathing out
• Coughing, especially at night, after crying, or during naps
• Rapid or noisy breathing

Symptoms in children

• Cough that won’t go away, often worse at night or in the early morning
• Trouble feeding or sucking because of breathlessness
• Being more irritable or tired than usual
• Using stomach muscles to help breathe (seen as tugging between ribs or at the neck)

Symptoms in older adults

• Asthma control in older adults is different and not directly relevant to infants.

Causes

Main causes

• A combination of genetics and environmental factors – the exact cause is not known, but the airways react strongly to certain triggers
• Common triggers in infants include colds and other viral infections, allergens (like dust mites or pet dander), and smoke exposure

Risk factors

• Family history of asthma, eczema, or allergies (especially in parents or siblings)
• Personal history of eczema or food allergies
• Exposure to tobacco smoke before or after birth
• Premature birth or low birth weight

When to see a doctor

See a doctor urgently if:

• Your baby has any of the emergency symptoms listed above – call your local emergency number immediately
• Your baby’s wheeze or cough gets worse quickly, or they are working hard to breathe

Book a routine appointment if:

• Your baby has a cough or wheeze that lasts more than a few weeks
• You notice your baby is coughing or breathing faster after playing, feeding, or sleeping
• You want a proper diagnosis and a written asthma action plan

Diagnosis

Diagnosing asthma in infants can be tricky because they cannot do breathing tests. Doctors rely on your baby’s symptoms, a physical exam, and how they respond to a trial of asthma medication. They may also rule out other causes like bronchiolitis or reflux.

Tests that may be done

• Listening to the chest with a stethoscope for wheezing
• Checking oxygen levels with a small clip on the finger or toe (pulse oximetry)
• Sometimes a chest X-ray or trial of inhaler medicine to see if symptoms improve

What to expect at your appointment

Your doctor will ask about your baby’s symptoms, when they happen, and any family history. They may ask you to keep a symptom diary. If asthma is likely, they may prescribe a low-dose preventer inhaler to use every day and show you how to give it. They will follow up to see if it helps.

Treatment

The goal of treatment is to keep your baby’s airways open and free from symptoms so they can breathe, feed, sleep, and play normally. Treatment usually involves two types of inhalers: a ‘preventer’ taken every day to reduce swelling in the airways, and a ‘reliever’ used quickly when symptoms appear. Your doctor will create a written plan tailored to your baby.

Self-care at home

• Keep your baby away from smoke – avoid smoking near the baby and keep the home smoke-free
• Reduce exposure to dust mites – wash bedding at 60°C, avoid soft toys in the cot, and vacuum regularly
• If you have pets, keep them out of the baby’s bedroom and off furniture often used by the baby
• Breastfeed if possible – it may lower the risk of asthma and related symptoms
• Use a spacer device with the inhaler – it helps the medicine get into the lungs more effectively

Medical treatments

Doctors may prescribe inhaled corticosteroids (a type of preventer medicine) to use every day, and a short-acting bronchodilator (a reliever medicine) for when symptoms come on suddenly. These are given through a spacer and mask in infants. Your doctor will tell you exactly when and how much to use. Never give any medication without medical advice.

When is surgery considered?

Surgery is not used for asthma control in infants.

Living with this condition

Most days, your baby can lead a normal life if asthma is well-controlled. You will give the preventer inhaler daily as prescribed, and watch for early signs like a night-time cough or faster breathing. Keep your doctor’s numbers handy and follow the written plan.

Lifestyle tips

• Avoid triggers like smoke, strong perfumes, and dusty environments
• Keep your home well-ventilated and clean
• If your baby goes to daycare or has older siblings, be aware that colds can trigger symptoms – but you can still let them socialise
• Make sure everyone who cares for your baby knows about the inhaler and the plan

Diet and exercise

Breastfeeding is recommended if possible. As your baby starts solids, introduce new foods one at a time to watch for allergic reactions. There is no special diet for asthma, but a healthy balanced diet is good overall. Exercise is fine when your baby feels well – encourage lots of tummy time and movement.

Mental health and emotional wellbeing

Caring for an infant with asthma can be stressful and worrying. You may feel anxious about flare-ups or giving medications. This is normal. Talk to your health visitor or doctor about your concerns. Joining a parent support group can also help you feel less alone.

Prevention

There is no sure way to prevent asthma in infants, but you can reduce the chances of it developing or triggering flare-ups. For example, avoiding smoking during pregnancy and after birth, and keeping the home free from common allergens, may help. Breastfeeding for the first few months is also linked to a lower risk.

Vaccines

Make sure your baby gets all routine vaccinations on schedule, including the flu vaccine from 6 months old. Infections like flu can trigger asthma attacks, so vaccination helps protect your baby.

Screening programmes

There is no routine screening for asthma in infants. However, if your baby has a strong family history of asthma or allergies, your doctor may monitor them more closely.

Complications

If left untreated

• Frequent or severe asthma attacks that may need hospital care
• Trouble feeding and gaining weight due to breathlessness
• Missed sleep for the baby and the family, affecting overall health
• In rare cases, a severe attack can be life-threatening

Long-term outlook

With good treatment and avoidance of triggers, most infants with asthma symptoms can be well-controlled and live normal, active lives. Many children see their symptoms improve as they grow older, especially if they only had mild wheezing with colds. Even if asthma continues, modern medicines are very effective at keeping it under control.

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