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Condition
Asthma (Baby and infant)
Class
Respiratory system
Description
Asthma is a common condition that affects the small airways or tubes in the lungs called bronchioles, making it difficult to breathe.

Babies and infants often develop coughs and wheezes but, although these are symptoms of asthma, it does not mean that the child has asthma as many other illnesses affecting the airways have similar symptoms. It is estimated that only about one third of children who had a wheeze when they were a baby will have asthma later in life.

Doctors will usually delay making a diagnosis of asthma until the baby is at least 12 months old when the baby’s lungs are better developed and a more complete pattern of symptoms has emerged.
Causes
One of the commonest causes of wheeze in babies and infants that can be confused with asthma is a condition called bronchiolitis that usually occurs as a result of a viral infection. To understand why asthma and bronchiolitis can be confused, it is important to know something about the structure of the airways in the lungs.

The airways or bronchioles have an outer muscular wall and a soft inner lining. The outer muscular wall controls the size of the opening of the airway. When the muscles relax the opening of the airways gets bigger, making it easier to breathe and allowing more air into the lungs. When the muscles contract the opening of the airways gets smaller, making it harder to breathe and allowing less air into the lungs. The cells of the soft inner lining produce mucus which helps trap dust and other small particles in the air.

Babies have very narrow bronchioles. When babies get a respiratory infection such as bronchiolitis, the lining of the bronchioles becomes swollen and produces more mucus. This makes the baby’s bronchioles even narrower, obstructing the flow of air in the lungs and causing a wheeze when the baby breathes. Also, the presence of mucus in the lungs makes the baby cough in an attempt to clear it.

When an infant has asthma, the cells in the bronchioles become overly sensitive and are easily irritated by substances such as dust, pollen, cigarette smoke, animal fur, even cold air. The muscles in the walls of the airway contract making it difficult to breathe. At the same time, the inner lining of the airway becomes swollen or inflamed and produces lots of mucus. The swelling of the lining and the increased amount of mucus make the narrowed airway even narrower and breathing even more difficult, causing wheeze and cough.

No one knows exactly why some babies develop asthma and others do not. It is probably a combination of genetic and environmental factors. Babies are more likely to develop asthma if there is a history of asthma, allergy or eczema in the family. Environmental factors such as house dust mite, pollution, passive smoking (including the mother smoking during pregnancy), or a viral infection probably combine with genetic factors to increase the chances of getting asthma.

There are also numerous other causes that are thought to increase the risk of babies developing asthma. For example, babies who are born by caesarean section, who are born prematurely, who are born overweight, who are bottle-fed instead of breast fed, even if born in the autumn. However, while there does appear to be an association between asthma and some of these factors, not all are universally accepted by doctors.
Symptoms
Symptoms of respiratory infections such as bronchiolitis, colds and influenza are very similar to the symptoms of asthma. Both cause wheezing and cough and the baby will show signs of having difficulty in breathing. If a baby has a wheeze due to a virus, the wheeze will only occur infrequently during times of infection and the baby’s temperature will also be raised. However, if a baby or infant has asthma they will develop a wheeze or dry cough without showing other signs of infection such a runny nose or high temperature. Wheeze caused by asthma may also occur frequently, on several occasions, often getting worse at night, or after the baby has been out in the cold air or near animals.
Treatment
If treatment is required, many doctors will use the same medicines to make breathing easier for babies with a wheeze, whether its cause is viral or asthma. Treatment falls into two main categories - relievers and preventers.

Relievers
Relievers work quickly to ease the symptoms and help the baby or infant breathe more easily. They should be used at the first signs of wheeze beginning. Relievers include drugs such as salbutamol that relax the muscles in the airways, widening the airways and so making breathing easier.

Sometimes, very young babies do not respond well to drugs such as salbutamol. In such circumstances, another reliever called ipratropium bromide may be used.

Preventers
Preventers include drugs known as inhaled steroids such as beclometasone or budesonide. These drugs act to reduce the sensitivity of the airways to irritant substances. When used regularly they reduce inflammation of the airways. However, because there is a risk that steroids may inhibit growth in young children, many doctors are against the use of inhaled steroids for long periods and do not recommend their use in viral wheeze.

Spacers
The relievers and preventers are available as inhalers which are small aerosols designed to deliver a measured dose of the medicine to the lungs. As babies and infants are unable to use inhalers properly, a doctor may also prescribe a spacer and a face mask to be used with the inhalers. A spacer is just a large plastic cylinder that allows the inhaler to be attached at one end, and the face mask at the other. The inhaler is puffed into the spacer, allowing the baby to breathe normally through the face mask. As the baby breathes through the face mask it inhales the active medicine from the spacer.
When to consult your pharmacist
If your child has been prescribed an inhaler and you want help and advice on how to use it with a spacer and face mask, talk to your pharmacist.

If your child is under 2 years of age and the wheeze or cough is due to a viral infection, do not give your child medicines that have been prescribed for others in the family as they may not be suitable. Talk to your pharmacist for advice.

Preparations containing paracetamol and ibuprofen are helpful if your baby has a high temperature, but check with your pharmacist first. Glycerol, honey and lemon mixtures help relieve coughs. If your baby is over 3 months of age, vapour rubs or sodium chloride nose drops may clear nasal congestion and help feeding.
When to consult your doctor
Always see your doctor if your baby develops a wheeze or a persistent cough, and seek advice urgently if your baby or infant shows signs of difficulty breathing.

If your baby develops an occasional wheeze, then its cause is very likely to be viral. Your doctor will listen to your baby’s chest and look for signs of an infection.

If your baby frequently wheezes, your doctor may suspect asthma. You will be asked whether there is any history of allergies in the family and to describe your baby’s symptoms and when they occur. When your baby is a little older, your doctor may perform skin, blood and lung function tests to confirm asthma.
Caring for a baby with asthma
It may sound strange, and it may be difficult at first, but the best thing to do for acute back pain is to try to remain active. Resting for a day or so in an attempt to reduce pain is only likely to make the pain last longer. The sooner you start normal activities, the faster recovery is likely to be. Take things easy at first, make movements that are the least painful, do gentle stretch exercises and gradually build up your level of activity. Do not stay in the same position for prolonged periods.

Use simple analgesics such as paracetamol or ibuprofen to help ease the pain as you start to exercise, but do not take them for long periods. Applying hot or cold packs, or rubbing in liniments or topical anti-inflammatories to the area of discomfort may also help ease pain.

When recovered, continue your exercises. Do as many exercises and sports as you can. The more exercises and the more varied the exercises, the stronger your back will be. Try to maintain a good posture when sitting or standing, do not slouch, keep your head and neck in line with your spine and try to contract your stomach muscles to give support to the spine. If your work involves long periods in front of a computer, ask your health and safety officer to make sure that your chair and computer screen are positioned correctly. Take regular screen breaks, get up and move around.

To avoid back pain recurring learn to lift heavy objects properly and try to lose any excess weight.
Useful Tips
  • Bend the knees and keep your back straight when lifting heavy loads. Do not attempt to lift objects that are too large or too heavy to be lifted with reasonable ease
  • Back-strengthening exercises which focus on correct posture, like the Alexander Technique, will help keep the spine and back muscles strong and supple. This minimises the risk of a strain or spinal injury
  • A correct sitting posture (with your bottom towards the back of the chair) will help keep the back in its correct, natural position. Likewise, sleeping on a firm mattress will help support the spine
  • There are chairs, mattresses and other products available that are specifically designed to help ease back pain
  • Do not take pain killers regularly or for long periods, and do not exceed their recommended dosage
Further information
Asthma UK is the charity dedicated to improving the health and well-being of people in the UK whose lives are affected by asthma. Asthma UK runs an advice line operated by asthma specialist nurses. Its website provides comprehensive information about asthma and gives practical advice on Nursery and Child care for parents.
Asthma UK Adviceline
Asthma UK
Summit House
70 Wilson Street
London
EC2A 2DB
Helpline: 0800 121 62 44
www.asthma.org.uk


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