Wheezing (Other Than Asthma)

• Breathing sound that is high-pitched and tight
• A purring or whistling sound
• You can hear it best when your child is breathing out
• Use this guide only if your child has not been diagnosed with asthma

Causes of Wheezing

• Bronchiolitis. This is the main cause in the first 2 years of life. Bronchiolitis peaks at 6-12 months. This is a viral infection (usually RSV) of the small airways. These small airways are called bronchioles.
• Asthma. This is the main cause after age 2. The first attack of asthma can be hard to diagnose. Asthma is defined as attacks of wheezing that recur.
• Airway Foreign Object (Serious). Suspect this when there is a sudden onset of coughing, choking and wheezing. A clue is wheezing heard only on one side. Common examples of inhaled objects are peanuts and seeds. Peak age is 1 to 4 years.
• Nasal Sounds. When the nose is congested, it can produce some whistling sounds. This can happen during a cold or with nasal allergies. Unlike wheezing, the breathing is not tight. Also, nasal rinses with saline will make the sound go away.

Call 911 Now

• Wheezing and life-threatening allergic reaction to similar substance in the past
• Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food
• Severe trouble breathing (struggling for each breath, very tight wheezing, can barely cry)
• Passed out or stopped breathing
• Bluish lips or face
• Choked on a small object or food recently
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Wheezing, but none of the symptoms above. Reason: needs a doctor's exam.

Care Advice for Mild Wheezing

What You Should Know About Wheezing:

• Wheezing is a high-pitched purring or whistling sound.
• Wheezing means the lower airway is tight.
• This is often part of a cold, but it can become worse.
• Here is some care advice that should help until you talk with your doctor.

Coughing Fits or Spells:

• Breathe warm mist (such as with shower running in a closed bathroom).
• Give warm clear fluids to drink. Examples are apple juice and lemonade.
• Age less than 6 months, only give breastmilk or formula.
• Age 6 - 12 months. Give 1-2 teaspoons (5-10 mL) each time. Limit to 4 times per day.
• Age older than 1 year. Give as much as needed.
• Reason: both relax the airway and loosen up any phlegm.

Homemade Cough Medicine:

• Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using the these tips:
• Age 6 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-2 teaspoons (5-10 mL). Give 4 times per day when coughing. Caution: do not use honey until 1 year old.
• Age 1 year and older: use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.

Nasal Saline to Open a Blocked Nose:

• Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
• Step 1: put 3 drops in each nostril. If under 1 year old, use 1 drop.
• Step 2: blow (or suction) each nostril out while closing off the other nostril. Then, do the other side.
• Step 3: repeat nose drops and blowing (or suctioning) until the discharge is clear.
• How Often: do nasal saline when your child can't breathe through the nose.
• Limit: if under 1 year old, no more than 4 times per day or before every feeding.
• Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
• Reason for nose drops: suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open.
• Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
• For young children, can also use a wet cotton swab to remove sticky mucus.

Humidifier:

• If the air in your home is dry, use a humidifier. Reason: dry air makes coughs worse.

Smaller Feedings:

• Use small, frequent feedings whenever your child has the energy to drink.
• Reason: children with wheezing don't have enough energy for long feedings.

Avoid Tobacco Smoke:

• Tobacco smoke makes coughs and wheezing much worse.

Return to School:

• Your child can return to childcare after the wheezing and fever are gone.

Call Your Doctor If:

• Trouble breathing gets worse
• Wheezing gets worse
• You think your child needs to be seen
• Your child becomes worse