Steroids for Asthma in Babies

If your infant is wheezing, you might wonder if she has asthma. Unfortunately, it might be difficult to get a solid diagnosis from a doctor -- yet you want to ensure your child receives whatever treatment he needs. Here's what you need to know while you and your pediatrician try to determine what's best for your baby.

Symptoms

• Asthma is a chronic lung problem that swells and tightens the airways and produces excess mucus. Symptoms include wheezing, coughing, shortness or breath, and chest tightness. In an infant, you may notice flaring nostrils, a bluish tinge around his lips, and increased collapse of the stomach while breathing. Coughing (often becoming worse at night) may be the only symptoms in mild cases of asthma.

Diagnosis

• Asthma is notoriously difficult to diagnose in children 5 years of age or younger. For older children and adults, a lung function test is typically given in which the patient takes a deep breath and blows out into a measuring device. However, this isn't possible with infants and small children.

  Other conditions may produce symptoms similar to asthma. For example, if a baby has a respiratory tract infection, her already-small airways can get swollen and full of mucus (the two major symptoms of asthma) much more easily than an adult's or older child's would.

Other Diseases with Asthma Symptoms

• In addition to respiratory tract infections, bronchiolitis, croup, and respiratory syncytial virus (RSV) can produce asthma-like symptoms, but usually with a fever. (Babies who develop these illnesses may also be more likely to develop asthma later in life.) More rarely, cystic fibrosis can cause wheezing, as well numerous other symptoms, and premature babies with insufficiently developed bodies may also wheeze.

Treatment

• Your doctor will usually try to rule out other causes of your baby's symptoms but may begin treatment for asthma to be on the safe side. The most common treatment for asthma is an inhaled bronchodilator. This can be administered through an oxygen-mask like device, or as a liquid.

  If your child's asthma is severe, a corticosteroid (also called a steroid, but different from the type of steroids that athletes use to enhance performance) pill may be given for up to 5 days. However, these can only be taken by toddlers - not infants.

  If your child needs frequent bronchodilator treatment, or is an infant in need of steroid treatment, his doctor will put him on a long-term preventive medication that will reduce the need for frequent inhaler treatments. For children, cromolyn sodium and -- for more difficult cases - inhaled steroids are often given daily.

  Sometimes the drug montelukast (which is not a steroid and is better known as an allergy medication) can be taken to reduce airway and lung inflammation in children over 2.

Side Effects of Steroids

• Steroids are anti-inflammatory drugs and most are man-made versions of cortisone, which is produced naturally in our bodies. They work by reducing swelling in the airways.

  Steroid treatments for asthma are generally considered safe when used as prescribed. However, long-term side effects are possible, including fungal infections (also called thrush, which is common if the mouth isn't rinsed after taking steroid medications), hoarseness, weight gain (due to increased appetite), nausea, or rapid heartbeat and agitation or hyperactivity. Many of the symptoms can be treated simply by lowering the dose of the medication.

  Although one study suggests steroids don't work well for infants, more research needs to be done in this area, and pediatricians continue to use steroids for the worst cases of asthma.

  Some worry long term use of steroids can stunt a child's growth and damage her bone density, and scientific studies can be found to support or disprove this claim. One study showed that a child may grow more slowly in his first year of using steroids for asthma, but continued steroid use will not make him a shorter adult. Still, the evidence is still not considered solid on either side.