Asthma in Young Children (< 5 Years)

The diagnosis of asthma may be difficult to make in children younger than five who can't cooperate with pulmonary function testing and is especially difficult in infants. Making the long-term diagnosis of asthma in young children is not necessary as long as the symptoms of asthma are treated, avoiding irreversible airway changes if asthma is indeed present. There are several reasons to wait before diagnosing asthma in young children. The symptoms of asthma, especially wheezing, may occur with other conditions such as bronchiolitis. (Although children who experience bronchiolitis as infants may be more likely to develop asthma later in life). [Cassimos: 2008] Other causes of wheezing are more likely to be found in infants than in older children such as aspiration of a foreign object, underdeveloped lungs in premature infants, and cystic fibrosis. Also, most children with wheezing at a young age outgrow their wheezing by the time they are in school. [Allen: 2004]
If young children have the signs and symptoms of asthma, they should be managed similarly to older children, although with more frequent follow-up visits. Children in this age group should be prescribed controller medications as determined by the stepwise therapy recommendations, (with a spacer with all metered dose inhalers). If these controller medications are being used frequently, daily use of inhaled corticosteroids are recommended (with a nebulizer or meterered-dose inhaler with a holding chamber). As with older children, immunizations, asthma action plans, and environmental controls are also recommended. Exposure to cigarette smoke and environmental pollutants in infants is increasingly associated with asthma. For example, see [Piippo-Savolainen: 2004] and [Rodriguez: 2007]. Parental history of asthma and allergies makes a future diagnosis of asthma more likely. [Cassimos: 2008]

Authors & Reviewers

Initial publication: September 2008; last update/revision: September 2008
Current Authors and Reviewers:
Author: Medical Home Team

Page Bibliography

Allen, PJ and Vessey, JA ed.
Primary Care of the Child with a Chronic Condition.
Fourth Edition ed. St. Louis, Missouri: Mosby; 2004. -13 978-0-323-02364-1

Cassimos DC, Tsalkidis A, Tripsianis GA, Stogiannidou A, Anthracopoulos M, Ktenidou-Kartali S, Aivazis V, Gardikis S, Chatzimichael A.
Asthma, lung function and sensitization in school children with a history of bronchiolitis.
Pediatr Int. 2008;50(1):51-6. PubMed abstract

Piippo-Savolainen E, Remes S, Kannisto S, Korhonen K, Korppi M.
Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study.
Arch Pediatr Adolesc Med. 2004;158(11):1070-6. PubMed abstract

Rodriguez C, Tonkin R, Heyworth J, Kusel M, De Klerk N, Sly PD, Franklin P, Runnion T, Blockley A, Landau L, Hinwood AL.
The relationship between outdoor air quality and respiratory symptoms in young children.
Int J Environ Health Res. 2007;17(5):351-60. PubMed abstract