Causes of Wheezing That Can Lead to Child's Symptoms

While asthma can be one of the causes of wheezing in your child, wheezing can also be caused by a number of other conditions and infections. The exact causes of wheezing will vary depending on your child's age. In fact, the younger your child the greater the chance that wheezing is due to something besides asthma.

It is important to make sure that you get your child's wheezing looked at. Wheezing is never normal and all that wheezes is not asthma. Many times wheezing may be a reaction to an acute short limited illness. However, wheezing is also a symptom that occurs in many different diseases.

If you or another child has a rescue inhaler it is important not to just treat the symptoms. While this may be appropriate in an acute emergency where you are seeking immediate medical care. It is not appropriate chronically. The concern is that you may actually be making the symptom and not treating or identifying the underlying cause of the problem.

Similarly, it is not appropriate to begin treatment with a controller medication until meeting with your healthcare provider and determining if it is advisable. Finally, while there is some availability for over the counter medications that treat wheezing, use of these should only be for the acute, short limited time frame, if at all. I do not recommend over the counter products for my patients and feel that everyone with wheezing need to be under the care of appropriate professional healthcare personnel.

Your healthcare provider will likely order a number of different tests, especially if it is your child's first time wheezing. These may be simple things like a pulse ox or chest X-ray, but could also include pulmonary function tests if your practitioner is not sure exactly what is going on.

Doctor listening to child's lungs
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What Wheezing Sounds Like

Wheezing occurs when a child breaths out.

If your child is wheezing, make sure that you get it checked out by her healthcare provider.

Take note, though, that what you think may be wheezing may actually be a different breathing pattern — in particular, what's known as inspiratory stridor. In this inspiratory stridor video, notice how the sound is different and occurs when the infant breathes in. You may also notice the baby's chest going inward, which is called a retraction.

Upper Airway Obstruction

  • Enlarged adenoids or tonsils: These are less common in infants and more common in preschool children. They often produce snoring.
  • Croup: Croup is commonly mistaken as wheezing by parents of 6-month to 3-year-olds. Rather than a true wheeze, you are actually inspiratory stridor. Parents often describe this as a 'croupy' or 'barking' cough that typically accompanies the stridor.
  • Inhalation (aspiration) of foreign body into the lung: This is most common in toddlers beginning to explore their environment who are still put everything in their mouths. Aspirating objects is not very common before reaching the toddler stage.
  • Tracheomalacia: A weakness of the windpipe's walls, this is most common in infants and, like croup, causes inspiratory stridor.
  • Vascular ring or congenital stridor: Likewise, the sounds created from these conditions are often confused with wheezing but are most commonly inspiratory stridor; the windpipe becomes compressed by the abnormal blood vessel.
  • Pertussis: This is a series of coughs followed by an inspiratory whoop.

Lower Airway Obstruction

  • Bronchiolitis caused by RSV virus and other viruses
  • Gastroesophageal reflux
  • Tracheoesophageal fistula
  • Inhalation of foreign body into the lung
  • Bronchopulmonary dysplasia or BPD
  • Mycoplasma pneumonia

Chronic Illnesses

  • Congenital heart disease - While not a respiratory illness, congenital heart disease can lead to congestive heart failure and pulmonary edema that causes wheezing. Sometimes this will occur in infants around a month old with a ventricular septal defect, the most common congenital heart defect. These kids are often initially misdiagnosed with bronchiolitis.
  • Cystic fibrosis
  • Immunodeficiency
  • Tuberculosis
  • Direct compression of lung tissue from enlarged lymph nodes or conditions such as Hodgkin's disease; this most commonly occurs in teenagers and young adults.
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By Pat Bass, MD
Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.