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

1. 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.
2. 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.
3. 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.
4. 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.
5. Humidifier:
   • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
6. 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.
7. Avoid Tobacco Smoke:
   • Tobacco smoke makes coughs and wheezing much worse.
8. Return to School:
   • Your child can return to childcare after the wheezing and fever are gone.
9. Call Your Doctor If:
   • Trouble breathing gets worse
   • Wheezing gets worse
   • You think your child needs to be seen
   • Your child becomes worse