Children's Hospital Colorado

Wheezing (Other Than Asthma)

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

  • 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 Body (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 under 3 months. Don't use.
    • Age 3 - 12 months of age. Give 1 ounce (30 mL) each time. Limit to 4 times per day.
    • Age over 1 year of age. 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 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 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.
    • Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops.
    • 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 child care 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

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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Copyright 2000-2018. Schmitt Pediatric Guidelines LLC.

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