Viral Wheeze

Key points about viral wheeze in children

• viral wheeze often starts with a cough or a cold
• in most cases, you can care for your child at home
• if your child is having difficulty breathing, take them to your family doctor, or an after-hours clinic, or the hospital
• smoking increases the risk of viral wheeze in children - don't smoke in the house or car or anywhere around your child

What is viral wheeze?

Wheezing is a musical, whistly sound that children make, usually when breathing out. It can also happen when they breathe in. The sound comes from the chest, not from the nose or throat.

The wheeze often starts with a cough or a cold caused by a virus.

Cough and wheezing are common when young children have colds and chest infections.

Who gets viral wheeze?

• viral wheeze is common - almost 1 in 3 children have viral wheeze at least once
• viral wheeze most often happens in children under the age of 3 years
• children who are around people who smoke are more likely to get viral wheeze
• viral wheeze is more common in premature babies or babies who have had bronchiolitis

Why does viral wheeze happen?

The viral infection may cause a narrowing of the small airways or an increase in mucus production in your child's lungs. Viral wheeze is more common in children under the age of 3 years as their airways are smaller.

The wheeze may return each time your child has a cold and can occasionally last for some weeks.

If my child has viral wheeze, does it mean they have asthma?

No, wheezing does not usually mean your child has asthma. It is often difficult to tell whether very young children have asthma, as they have narrower airways and tend to get a lot of colds.

More than half the children with viral wheeze will grow out of it as their airways grow and develop. Some children with frequent viral wheeze may go on to develop asthma. This is more likely if:

• there is an allergic condition such as asthma, hay fever or eczema, in your family
• your child has eczema, hay fever or allergies
• a mother smokes during pregnancy

What are the signs and symptoms of viral wheeze?

Viral wheeze often starts as a cold, with a runny nose. Your child might also have:

• a fever
• a cough
• fast breathing
• extra noises when breathing in or out or both

What is the treatment for viral wheeze?

Most children with viral wheeze get better by themselves without any treatment.

Antibiotics do not help with viral wheeze.

Doctors may give a blue inhaler to some children with viral wheeze. The same medicine is used for asthma. It's sometimes called a reliever or a puffer. This medicine helps open the airways to allow air to move in and out of the lungs more easily.

If the doctor gives my child a reliever inhaler, how do I use it?

You will need to use the reliever inhaler with a plastic tube called a spacer and a mask. Ask your doctor or nurse to show you how to use these properly.

If your doctor has given your child a reliever inhaler:

• give 2 puffs of the reliever inhaler, one puff at a time, using the spacer and a mask, every 4 hours
• for each puff of the reliever inhaler, your child will need to take 6 breaths through the spacer and mask

If your child is still not improving:

• you can give up to 6 puffs of the reliever inhaler every 4 hours

You need to take your child to your family doctor, or an after-hours clinic, or the hospital:

• if you need to give the reliever inhaler more often than every 2 hours - for example, every 60 or 90 minutes
• if there is no improvement 30 minutes after giving 6 puffs of the reliever inhaler

When should I seek help for my child with viral wheeze?

Check out the signs that your child is struggling to breathe

When do I need to see a doctor?

You should see your family doctor or go to an after-hours medical centre urgently if your child:

• is sucking or pulling in under the ribcage when breathing
• is sucking or pulling in between each rib when breathing
• has increased use of the muscles around their neck when breathing
• has flaring of the nostrils - the nostrils move out as your child breathes
• is so breathless they can only speak a few words at a time
• looks pale and unwell
• may have choked on something - they suddenly start to cough and have not been unwell

Even if you've already seen your doctor, if your child's breathing difficulties get worse or you are worried, take your child back to the doctor.

When should I dial 111?

Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if your child:

• has blue lips and tongue
• has severe difficulty breathing
• is becoming very sleepy and not easy to wake up
• is very pale
• is floppy
• has breathing that is not regular, or pauses in breathing

How should I care for my child with viral wheeze at home?

• encourage plenty of fluids and let your child eat if they want to
• children with viral wheeze may not be able to drink as much as usual - offer smaller amounts more often
• give your child as much rest as possible
• don't smoke in the house or car or anywhere around your child
• if your child is miserable and upset, you can give paracetamol - you must follow the dosage instructions on the bottle; it is dangerous to give more than the recommended dose
• keep them home from school or daycare until they have recovered

What will happen to my child with viral wheeze if they need to go to hospital?

Help with breathing and getting enough fluids

Children with more serious viral wheeze may need to go to hospital. Sometimes children need help with their breathing. This might include extra oxygen through small soft plastic tubes that fit into your child's nose.

If your child is not drinking enough, they may need feeding through a nasogastric tube (a tube through the nose into the stomach) or fluid through an intravenous drip (into a vein).

Other medicines

Your child may need other medicines that they breathe in, or sometimes medicines through a drip.

How can I prevent my child getting viral wheeze?

Smoke-free environment

Make sure your child's environment is smoke-free. If you want to give up smoking:

• call the free Quitline Me Mutu on 0800 778 778 or text 4006
• check out the website Quitline
• ask your health professional

A warm house

Keeping the house warm and well-insulated will also decrease your child's risk of developing viral wheeze.

See the KidsHealth page on keeping your home warm and dry