Wheezing episodes are common in children especially in the first few years of life. Almost 30% of children get at least one wheezing episode before 3 years of age. Some children get frequent and troublesome wheezing episodes. Some of these children can have an underlying worrisome diagnosis.

What is the common cause of wheezing in babies?
The most common cause of wheezing in young children is viral infections like RSV and rhinovirus. In these episodes children develop fever, cold, cough and then develop wheezing. Some children also get fast breathing or respiratory distress. These episodes typically last for 1-2 weeks.

What are the causes of repeated episodes of wheezing in young children?
The most common cause of repeated episodes of wheezing in infants and young children are wheezing related viral respiratory tract infections. Some children with repeated wheezing episodes also go on to develop asthma. Most of these children response to bronchodilators and steroids.

Some infants and young children with repeated episodes of wheezing can have an alternate diagnosis. These could be bronchiectasis (swollen and dilated airways), tuberculosis (TB), congenital problems like tracheo-bronchomalacia, cystic fibrosis (CF), compression or the windpipe due to a blood vessel or a lymph node, H type Tracheo-esophageal fistula (abnormal communication between the windpipe and feeding pipe). Mechanical problems like gastroesophageal reflux (GERD) and foreign body aspirations can also lead to wheezing.

What are the clues which suggest alternate causes of wheezing in infants and young children?
Children who get repeated wheezing very early in infancy (less than 6 months of age) and have severe episodes requiring hospital admissions are likely to have underlying problems. Infants and children having persistent noise from there also have higher chances of having an underlying problem. Children having a persistent wet cough, cough with phlegm, not gaining adequate weight are also at a higher chance of having an underlying problem. Last but not the least, children with wheezing but a poor response to treatment need to be evaluated for other causes of wheezing.

In children having the above mentioned clues the chances of having an underlying worrisome problem is high. These children should be investigated for alternate causes of wheezing.

What investigations are required in infants and young children suspected to have an underlying problem?
Infants and children with suspected to have alternate causes of wheezing requires investigations for diagnosis of the underlying cause. These are specialized investigations and hence be tailored according to the individual child after a detailed history, examination and review of all old records including chest xrays. The investigations might include flexible bronchoscopy, CT scan chest, sweat chloride level and investigations for Gastro-esophageal reflux, etc.

In case your infants or young child is having repeated wheezing with any clues suggesting alternate diagnosis or poor response to treatment you need to consult a pediatric pulmonologist for evaluation, investigations and treatment.