Question
The doctors think my one-year-old may have asthma, but they have to wait until he’s two to make a firm diagnosis. Do you have any tips on how I should manage this until then? And what challenges are we facing with such a young child with asthma?
Answer
Asthma is a chronic airway disease. The symptoms of asthma might not always be the same and range from mild and occasional to severe and chronic. Asthma is the most common childhood disease affecting 12.5 percent of children. Whether asthma is mild or severe, the symptoms should never be ignored as untreated asthma is a concern and it can lead to greater respiratory distress.
You are correct in that diagnosing asthma in young children is challenging and not always possible. The challenge exists because there are no diagnostic tests much before age six. The diagnostic test that we use is called a spirometry test where airflow can be measured as well as the response to medications. In addition, young children with cough, colds and wheezing may not always have asthma. We can see so-called wheezy bronchitis, croup, and chronic cough for different reasons, all being called asthma. For that reason, the developing history over time helps the doctor to be sure if indeed the symptoms are asthma.
As the Asthma Society points out, young children have narrow airways and can have six to eight colds a year. In children, compared to adults, the common cold triggers 90 percent of asthma attacks compared to 40 percent in adults.
Triggers can be allergic and non-allergic and it is important to see if you can identify these triggers. You can observe what triggers there might be such as perfume, emotions or recurrent infections. Make sure your environment is smoke-free. We also know that house dust and mites can be triggers so it is important to have rooms as dust-free as possible.
The diagnosis in this young age is based on the allergy history of both your baby and family as well as the personal health history of your child. To that end, we also note that asthma is more common in children who were born four weeks or more before their due date. If you as parents have a history of allergies, eczema or asthma, then that increases the risk your children will have asthma as well.
Follow your doctor’s advice about management and understand how and when to use the medications properly. Always talk to your doctor before stopping any medications.
Dr. Marla Shapiro is a medical doctor, author, broadcaster, lecturer and parent.
Originally published in ParentsCanada magazine, May 2014.
