Farm Doctor: What to do when children have breathing problems

As many parents know, the autumn and winter months bring a surge of coughs, colds, and fevers, often seeming like a child is unwell every other week.

Winter is also the busiest time for children’s A&E departments, with many needing care for breathing problems.

When a child contracts a viral infection, they may develop a fever, cough, or runny nose.

See also: Farm Doctor: On the lookout for ticks and Lyme disease

In some cases, this leads to more severe breathing difficulties that require hospital admission for support.

While, in general, children are very robust, breathing problems can become serious, and it’s important to know when to seek help.

In this month’s Farm Doctor, Camilla Baker gives advice on how to spot breathing problems in children and what to do if symptoms appear.

What is bronchiolitis?

Bronchiolitis occurs when the small airways in a child’s lungs become swollen due to a viral infection, making breathing difficult.

It mainly affects children under the age of two, and a virus called RSV is the most common cause. Symptoms include a cough, runny nose, and rapid breathing.

“Breathing becomes faster, and you might notice the child using muscles between their ribs or in their tummy to breathe,” explains Camilla.

Children may also struggle with feeding and have fewer wet nappies than usual.

If a child is feeding less than half of normal or having less than half their normal wet nappies, they may need support with their feeding to keep them hydrated. 

While bronchiolitis typically lasts five to 10 days and usually improves without treatment, some children require additional support, such as high-flow oxygen, if their breathing becomes very laboured. 

What is croup?

Croup occurs when a child’s airway swells, resulting in harsh breathing and a distinctive barking cough, “sometimes sounding like a seal barking,” says Camilla.

As the airway is narrowed, the breathing can sound noisy. This is called stridor, which is a high-pitched sound when the child takes a breath in.

Your child may also have a runny nose, fever, and sore throat.

If the noisy breathing continues at rest or becomes severe, you should take your child to A&E.

“Croup can be scary for both the child and the parents.

“It is important to keep the child calm and not upset them as this can make symptoms worse,” says Camilla. 

If the loud breathing noise is present at rest, or if they are finding it hard to breathe, you should take your child to A&E for a review.

Steroids such as dexamethasone or prednisolone are used to reduce inflammation, making breathing easier.

Since croup is caused by a virus, antibiotics will not make a difference to the illness.

What is viral induced wheeze?

Viral induced wheeze is caused by swelling in the airways from a viral infection, resulting in wheezing, and is most common in children under five.

“Nearly one-third of all children will experience viral induced wheeze at some point,” Camilla says.

It’s more common in children born prematurely or those with eczema, hay fever, or exposure to cigarette smoke.

Symptoms include wheezing and difficulty breathing.

Treatment involves inhalers such as Salbutamol to help open the airways and sometimes a short course of steroids.

The child breathes this medicine in via an inhaler (normally blue) and this helps the airways to relax.

“If your child has a history of eczema or hay fever, or if there is a family history of asthma, they may also be given a short course of steroids,” says Camilla.

“The steroids help to further reduce the inflammation in the lungs.”

Camilla reassures parents that viral induced wheeze doesn’t mean the child has asthma, although a few may develop it later.

Symptoms of asthma include a wheeze even without a cough or cold, breathing difficulties or wheezing when running around with friends, and a regular nighttime cough.

If asthma is a concern, parents should consult their GP or asthma nurse for a review.