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Asthma is one of the most common medical conditions among people of all ages, and more than ten percent of small children have it.
Even so, much about asthma is still a mystery, and diagnosing the condition is particularly difficult in babies — who cannot express their symptoms or follow instructions for breathing tests.
Diagnosing asthma in babies usually combines a process of elimination, tracking symptoms, and evaluating risk factors.
Your baby’s doctor must play a central role in determining the presence of asthma, but you as a parent can help identify signs of the condition in your child, largely through close observation of the baby and evaluation of his or her risk factors.
Evaluating Risk Factors
Trace your baby’s family history of asthma and allergies.
As with many medical conditions, a family history of asthma (especially in a parent) is a strong indicator that a baby may develop the disease.
However, any family history not only of asthma but also many types of allergies or skin conditions like eczema will increase the risk to your baby.
Most forms of asthma, many types of allergies, and certain skin conditions like eczema share close commonalities as conditions caused by over-zealous body responses to potential dangers.
Parents don’t pass on a specific allergy. They can, however, pass along an “allergic tendency” — so a parent with a pollen allergy has a greater risk of having a child with asthma.
Watch for signs at birth or early in life.
Regardless of inherited traits, some babies are more prone to asthma as soon as they are born.
For a variety of possible reasons including lung development, premature babies are more likely to develop asthma.
Children who develop allergies or eczema at an early age are also more likely to have asthma.
Many cases of infant asthma form in combination with viral respiratory infections (colds), and may or may not go away thereafter.
If your baby is diagnosed with one of these conditions, talk to your doctor about the steps you should take to watch for asthma.
Identify environmental factors.
Smoking is bad for your baby in countless ways, including the fact that it increases the risk of developing asthma.
Smoking while pregnant increases this risk, as does keeping the baby in a home where smoking occurs.
Frequent exposure to other forms of smoke (such as from a wood-burning fireplace) may also increase the risk of asthma.
Exposure to common allergens like dust, dander, and pollen can also make asthma more likely.
Especially if your baby is already at an elevated risk for developing asthma, you may want to reconsider keeping pets in the home.
Watching for Wheezing
Monitor your baby’s breathing patterns.
The lungs and airways of a baby are smaller than those of older kids or adults and still developing, so it should be no surprise that asthma can present differently in newborns and infants.
For instance, babies rarely wheeze (because of asthma or otherwise) before reaching two months of age, and most episodes of wheezing in the months thereafter are usually caused by colds or factors other than asthma.
So, while wheezing is a critical sign of possible asthma, it is not the only thing you should look for.
In small babies, increased breathing rates (with or without wheezing) are sometimes one of the few apparent indicators of asthma.
Babies have higher respiration rates than older kids or adults, usually about 30 to 60 breaths per minute for newborns and 20 to 40 breaths per minute for the remainder of the first year of life
If your baby is breathing at least 50% more rapidly than normal (that is, 45 to 90 breaths per minute for a newborn), you should seek medical attention.
Some experts argue for an even more conservative threshold, advising that anything over 40 breaths per minute when resting comfortably or sleeping should trigger a timely medical evaluation.
Keep track of wheezing episodes.
Wheezing is a common symptom in babies who have colds, and can also indicate a range of medical conditions ranging from harmless to serious.
Generally speaking, a single wheezing episode (so long as it is not severe and lasts no longer than a day or two) is not a strong indicator of asthma.
Multiple bouts of wheezing, however, make the possibility more likely.
It can be difficult to tell if the baby is truly wheezing, or if the noises are coming from their upper airway, such as the nose.
Your baby’s pediatrician can listen to your baby’s chest to determine if your baby is wheezing or not.
The Asthma Prediction Index (API), a simple but often effective diagnostic guide used regularly by physicians, considers four or more wheezing episodes within one year that last one day or more and impact sleep to be strong predictive indicators of asthma.
When in doubt, seek medical advice sooner rather than later regarding wheezing episodes.
Asthma and other breathing conditions can quickly turn very serious in babies.
Identify possible triggers for wheezing.
The more information you can provide regarding the surrounding conditions of your baby’s wheezing episodes, the more likely it is that your baby’s doctor can make an informed asthma diagnosis.
Take notes and bring them to your baby’s medical appointments.
Take note of whether a wheezing episode occurs in combination with a viral infection, in proximity to common allergens, or after exposure to smoke.
Asthma-induced wheezing can also occur during periods of laughing, crying, or active playing.
Additionally, it can become more pronounced during rapid changes in weather, in cold conditions, or at night.
Seeking a Medical Diagnosis
Seek immediate help for a possible asthma attack.
Asthma attacks can be serious at any age, but can be particularly dangerous for newborns and infants.
Their tiny airways can become quickly blocked off during an asthmatic episode.
When in doubt, err on the side of caution and seek medical help quickly, especially if you know that your child is at an elevated risk for asthma. Watch for important signs such as:
Grunting when breathing or feeding.
Repeated or ongoing waves of coughing, wheezing, or shortness of breath.
Fast breathing, especially if accompanied by a labored breathing effort.
In a baby, you may see significant chest contractions that cave in the abdomen and expose the ribs.
The nostrils might also flare widely.
The baby seeming very tired or very agitated due to having to work harder to breathe.
Paleness or redness in the face, or blue skin under the fingernails or the lips.
Crying that becomes soft, short, or stops altogether.
A refusal or inability to feed.
Accept that diagnostic options for babies are limited.
It is difficult to diagnose asthma in children under six — and especially babies — because most of the tests require deep, directed inhaling and exhaling.
An accurate diagnosis also benefits from the patient being able to describe his or her symptoms, which babies cannot do.
In many cases, diagnosing asthma in babies involves a process of elimination and “educated guessing” by the doctor.
The doctor will consider the baby’s allergy and health history, the family history of asthma and allergies, the results of a physical examination, and the information you provide regarding the type, timing, and location of symptoms.
Blood tests and other lab work may also be conducted to reach at least a tentative diagnosis.
Your baby’s doctor may also order a chest x-ray to help with the diagnosis, and to rule-out other causes of wheezing or trouble breathing.
Ask your doctor about the API test for childhood asthma.
Many physicians utilize the Asthma Predictive Index (API) for kids under three.
This predictive tool gives a fairly accurate indication of the likelihood that a young child will develop asthma at some point.
It combines factors like wheezing episodes, family history, and signs of skin conditions or allergies to calculate the likelihood.
According to the API, your child has an increased likelihood of developing asthma if:
he or she has had four or more wheezing episodes in the past year that a) lasted at least one day and b) affected sleep … AND
has one of the following:
a parent with asthma, diagnosed atopic dermatitis, or evidence of air allergen sensitivity … OR
has two of the following:
evidence of food allergies, blood eosinophilia of greater than four percent, or wheezing episodes apart from colds.
Use prescribed asthma medications as a safety measure and diagnostic tool.
In some cases, a pediatrician may decide that it is best to “play it safe” and prescribe asthma medications even when a diagnosis is unclear.
If there exists a decent likelihood that a baby has asthma, the benefits of using medications usually outweighs the risks of side effects.
Your baby will usually be given medications to treat active wheezing or coughing as needed.
They may also require a daily medication to help prevent symptoms.
As with asthma sufferers of all ages, the primary medications are delivered as an inhaled mist.
For babies, a nebulizer and face mask are typically used, but inhalers with spacers and masks are often used for babies with good results.
The medications may also be used as a diagnostic tool for babies.
Essentially, if the asthma medications alleviate or eliminate your baby’s symptoms, then your child probably has asthma.