Wheezing as an Asthma Symptom in Children

Wheezing is one of the common childhood asthma symptoms and is often the reason many parents seek care for their kids. You will hear a high-pitched whistle sound as your child breathes through their mouth or nose. While most commonly heard while breathing out, wheezing may also occur when inhaling. Wheezing occurs because of the lungs narrowing as a result of inflammation, making it more difficult for air to flow through the lungs.

Male nurse explaining inhaler to boy
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Parents often describe wheezing in very different terms and may not have heard the term or of asthma before. Parents may describe wheezing as:

  • "Whistling sound in the chest."
  • "High pitched sound."
  • "Breathing hard with the chest sucking in and out."
  • "Rattling in the chest."
  • "Rattling and coughing."
  • "Crackly sound in the chest."
  • "Squeaky."
  • "Gasping for breath."
  • "Noisy breathing."
  • "Can't describe it but I can feel it in his back."

The above descriptions make one see that wheezing can be described in very different ways. However, not all wheezing is necessarily because of asthma and a number of other non-asthma conditions, such as a foreign body in the lung (e.g. coin or small toy), secondhand smoke, or GERD, are common causes of wheezing in kids.

What Does It Mean If I Hear Wheezing?

Do you ever hear this sound when breathing? This is what wheezing sounds like when a healthcare provider listens to your child's chest with a stethoscope. Wheezing is never normal and should not be ignored. Wheezing is one of the classic symptoms associated with asthma in children. After taking a clinical history your healthcare provider may make a diagnosis of asthma if your child also has these symptoms:

  • Chronic cough, especially at night
  • Chest tightness
  • Shortness of breath

It is also very important to understand that not hearing noises does not mean your child is not having problems. If your child is uncomfortable, not hearing any extra noises could mean that your child is having a severe problem and not moving very much air at all. This would be a reason to seek care immediately do to a severe asthma attack.

Importantly, children often do not talk about their asthma symptoms. While an adult is likely to say something like "I have been wheezing more" or " I have been using my rescue inhaler more than normal," a child is unlikely to make these sorts of statements. A child is more likely to say something like "I do not feel well" or some other non-descriptive statement.

When Should I Contact a Healthcare Provider?

  1. If the wheezing is new
  2. If wheezing is not new, but getting worse
  3. You are concerned about what is happening with your child

If your child's wheezing is a new problem and your child does not have a diagnosis of asthma, your child should definitely see a healthcare provider as many different things can cause wheezing.

When you visit the healthcare provider, you will be asked many questions about your child's history, symptoms, and if the symptoms are associated with any of these triggers. Triggers are things that "set off" your child's asthma. You can learn how to identify and avoid these common triggers to help get better control of your child's asthma.

If your child is already being treated for asthma and still wheezing significantly, your child's treatment may not be working or your child may not be taking the treatment correctly. When your child's asthma is under good control, your child should not wheeze. Improving communication with your child's healthcare provider and asking for a health information prescription may help you gain the information and skills you need to get better control of your child's asthma.

If your child uses an Asthma Action Plan, make sure you follow the instructions for wheezing. If you don't have one, you need to make discussing one with your child's healthcare provider a priority.

When a child with asthma develops recurrent wheezing at the start of a respiratory infection, recommendations issued by the National Institutes of Health in December 2020 state they should be started on a short (seven to 10 days) course of daily inhaled corticosteroids coupled with a short-acting beta agonist rescue inhaler as needed to swiftly relieve wheezing.

1 Source
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  1. Cloutier MM, Baptist AP, Blake KV, et al. 2020 focused updates to the asthma management guidelines: A report from the national asthma education and prevention program coordinating committee expert panel working group. Journal of Allergy and Clinical Immunology. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003

Additional Reading
  • Medline Plus. A Wheezing

  • Patient Information- University of Maryland Medical Center.

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.