What is wheezing and what are the common causes in children?

Wheezing is a very common problem in infants, children and adolescents.

What is wheezing?

Wheezing is a whistling sound made while your child breathes. It's heard most clearly when the child exhales, but in severe cases, it can be heard when the child inhales. It's caused by narrowed or inflamed airways. Wheezing sound is usually heard with a stethoscope but sometimes can be audible without it as well. Wheezing may be a symptom of a serious breathing problem that requires diagnosis and treatment.

Why few children have frequent episodes of wheezing?

The most common causes are asthma in an older child and wheezing related viral respiratory tract infections in a younger child.

There can be other not so common causes like bronchiectasis (swollen and dilated airways), tuberculosis, congenital problems like tracheo-bronchomalacia, cystic fibrosis, 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 and foreign body aspirations can also lead to wheezing.

My child has frequent episodes of wheezing. What investigations are needed?

Initially we would take a detailed history and examine the child. This would be followed by review of all old records and chest xrays if any. Most children may not need any further investigations.

In some children we would do a chest x-ray and a lung function test (breathing test). Older child can usually do a blowing type of lung function test also called as spirometry while in younger children we would do impulse oscillometry where the child just needs to breathe slowly in the lung function testing machine. These can be easily done by children. Some children in addition might need a Xray of the sinuses and Xray for evaluation of adenoids, since sinusitis and adenoid hypertrophy can be associated with wheezing in children.

Some children might need specialized tests as detailed below

Some children might need further investigations to identify the cause of wheezing. These investigations include flexible bronchoscopy, CT scan of chest, investigations for Gastro-esophageal reflux, sweat chloride testing etc. Kids might need one or more of the mentioned investigations depending on a particular case. These are specialized investigations done at our division of pediatric pulmonology at BLK Super Specialty Hospital.

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