It’s that time of year again when infants and toddlers get what seems like an endless stream of coughs, fevers and runny noses. Respiratory virus season is upon us!
Often these illnesses are mild. However, sometimes children develop additional symptoms such as difficulty breathing or, as doctors call it, “respiratory distress”. Signs of respiratory distress can include bobbing of the head or grunting with each breath, flaring of the nostrils, wheezing (a low pitch sound, usually when breathing out), stridor (a high-pitched sound, usually while breathing in) or using the muscles of the neck or around the ribs to breathe. Changes in color including a blue or purple color or becoming very pale can also be concerning. If your child is showing any of these symptoms, it’s important to seek medical attention immediately.
What Causes Respiratory Distress?
There are many causes of respiratory distress in young children. So many, in fact, that it’s impossible to list them all here. Often, it is an issue related to the lungs (e.g. asthma or viral infections like bronchiolitis or croup) but can also be related to the heart (e.g. congenital heart disease), immune system (e.g. a severe allergic reaction) or almost any other body system. This is one of the reasons why children in respiratory distress need a thorough medical assessment.
Two of the most common causes of respiratory distress that result in emergency department visits and admissions to hospital are bronchiolitis and asthma (1). Bronchiolitis tends to affect children in the first year of life and asthma tends to affect children after a year of life. However, there is a period around the first birthday where respiratory distress could be caused by either. So, let’s have a look at each condition in a little more detail.
What is Bronchiolitis?
While you may not have heard of bronchiolitis, you may have heard of RSV (respiratory syncytial virus). Bronchiolitis (which is different than the bronchitis that adults get) is a viral infection of the lower respiratory tract that can cause symptoms of fever, cough, runny nose, wheeze, brief pauses in breathing and respiratory distress. Has grandma warned you about the cough “moving to their chest”? Well, that’s bronchiolitis in grandma speak.
One third of children will get bronchiolitis before the age of two years. This is because the viruses that cause it, including RSV, are very common and often give adults mild symptoms (e.g. simple head cold), however, these viruses have a greater effect on the tiny airways of infants and so can become very serious for this age group. In fact, it is the most common cause of hospital admissions in the first year of life (ref).
Treatment of bronchiolitis may include simple things that can be done at home such as maintaining good hydration (don’t worry so much about solid food until they are feeling better)
and gentle nasal suctioning. Sometimes clearing the nasal passages with suction at home is enough to stop the respiratory distress. However, if your baby is not feeding well and seems dehydrated or the respiratory distress does not resolve with nasal suctioning, they should seek immediate medical attention. A medical professional may need to give extra oxygen, help with re-hydration or use other measures.
What is Asthma?
Asthma is also caused by inflammation in the lower airways. The main symptoms of asthma flares (or what some people used to call asthma attacks) include cough, wheeze, chest tightness and respiratory distress (see the symptoms of respiratory distress above). Sound familiar? And here’s the kicker, although asthma isn’t caused by viruses, viruses can certainly cause a flare in asthma. So can many other things such as allergens, pollution, cigarette and cannabis smoke, exercise and even cold air and strong emotions.
A child is more likely to have asthma if they have conditions like eczema or environmental allergies or if a family member has asthma, eczema or allergies.
Treatment of asthma flares often involve inhalers that help open up the airways and sometimes steroid medications that can be given by mouth or IV. It’s worth pointing out that these therapies are not recommended for bronchiolitis and this is one major difference between the treatment of respiratory distress caused by the two illnesses. Like bronchiolitis, oxygen may also be needed during an asthma flare.
Many people think that you cannot diagnose asthma until you are old enough to do a breathing test called a pulmonary function test (PFT). Luckily, that’s not true anymore! Now we can diagnose “pre-school asthma” based on a child’s symptoms and response to asthma therapy. This means we can diagnose asthma as early as around a year of age. Therefore, if your child is around a year of age or older and has had multiple episodes of respiratory distress, it is worth thinking about asthma as a potential cause. If you are interested in learning more about asthma diagnosis, click here.
How can I prevent these issues?
Remember COVID? Well, all the things we used to talk about during the pandemic will help prevent bronchiolitis. That means good hand hygiene, avoiding people that are sick, cleaning surfaces and covering sneezes and coughs. Vaccines for influenzae and COVID (which also cause bronchiolitis) are also highly recommended if your child is eligible. Some babies may be eligible for shots that prevent RSV as well.
Asthma is a little harder to prevent but the good news is it can be controlled so that flare-ups are prevented. All the above measures for bronchiolitis will also help prevent viruses that can cause asthma flares. Likewise, avoiding known asthma triggers, taking prescribed controller medications regularly and following an Asthma Action Plan provided by your doctor will help keep asthma controlled.
So, what do I need to remember?
· Remember the signs of respiratory distress and seek medical attention if they develop
· Bronchiolitis is a viral infection (caused by viruses such as RSV) that can cause respiratory distress, particularly in infants less than two years old
· Asthma is a chronic condition that causes respiratory distress and can be diagnosed as early as one year of age
· Prevention is the best treatment!
Click here for information on Dr. Liam Fardy’s Asthma Clinic
Click here for information on Dr. Megan Burke’s Allergy Clinic
Don’t have a family doctor? Check out Dr. Jessica Fowler’s appointment based walk-in Clinic
References:
https://cps.ca/en/documents/position/asthma-in-preschoolers
https://cps.ca/en/documents/position/bronchiolitis
https://cps.ca/en/documents/position/managing-an-acute-asthma-exacerbation