Diagnosing asthma in young children?

[strongmouse]

My young grandson has had a cold and cough. (He has had one lot of anitibiotics for an ear infection.) A couple of times now he has had a rattling chest when he laughs of becomes energetic. You can feel it in his lower chest. However at a recent check up the GP said his chest is clear.

I read that it is possible for children to have intermittent asthma when they laugh or exercise if their asthma is uncontrolled. However, he has not been diagnosed with asthma. Any ideas or is it best just to wait and see how he is?

[Minushabens]

It's increasingly common nowadays for local NHS Trusts (is that what they still call them?) to have policies of not officially diagnosing asthma until around 8 years-old. However, NICE guidelines also say that children presenting with "asthma-like" symptoms should be treated as if they have asthma. This all seems like a load of nonsense to me, but it's the way of the world. However, it might explain the GP's reticence to start talking about asthma.

My own (14-month-old) grandson frequently has a rattly chest & I worry a lot about it, but likewise, his GP never seems overly worried even though my daughter has mentioned the very strong asthma gene on my side of the family. There was some interesting research from Norway a year or two back that showed all the potential factors that increased the risk of developing childhood asthma starting in early pregnancy. I can't track it down but will share a link if I do. It might be worth diplomatically sharing with the GP if your worries grow. I remember that one of the things that was mentioned was keeping on top of chest infections.

[strongmouse in reply to Minushabens]

Thanks Minushabens. Taking a practical approach seems to be that unless there is something obviously concerning then a 'wait and see' is possibly best. I am not a great fan of overprescribing, but on the otherhand don't like the idea of something being missed which should be either investigated or treated!

Good to know that I am not the only 'concerned grandma'!

[Minushabens in reply to strongmouse]

I know what you mean & my worry is that asthma will 'trigger' for some reason in him & then it's too late. I know tots get rattly chests all the time, but you're right, you can't help but worry!

[HowNowWhatNow]

To continue: the logic is that lots of small children who have asthma like symptoms as toddlers grow out of their ‘asthma’ by 5 or 6. However, they are in a very vulnerable place while they have the symptoms, because the effects of their asthma symptoms pre-5 is just the same as it would be post-5, and these children also can’t tell you what is going on!

My daughter is two and I find the non- classification pre-5 absurd. The number of chats i’ve had with nurses and doctors in A and E. Them “so does she have asthma?’”. Me “No, I mean she has all the symptoms but doctors just don’t call it that in her age group”

If anyone from Asthma Uk is reading - please can you lobby for better awareness of what asthma symptoms are know as pre-5 and think of another way of calling it. “Fluid asthma”?

“Junior asthma”?

[strongmouse in reply to HowNowWhatNow]

Thanks Geogeor, sorry to hear your daughter has this problem. At the moment my grandson seems fine but it was concerning as the GP seemed only to think about 'infection' rather than any other issue.

Of course I am do not wish to overmedicate young children and I understand that many grow out of it as their immune systems mature, but it does seem an area which is under researched and under acknowledged. We know that asthma is on the increase, not least because of higher pollution. (Good to see The Times recently tackling the issue and calling for new laws for Clean Air).

I second your call for better awareness and research.

[HowNowWhatNow in reply to strongmouse]

My daughter had a very serious case of bronchiolitis when she was 7 weeks old. And this predisposes children to asthma-like symptoms in the run up to their 5th birthday, and to asthma for some thereafter. The risk is especially high if you have bronchiolitis badly enough that you are admitted to hospital / need help breathing when there, which she did.

This may reassure you somewhat - if your grandson hasn’t had any chest infections yet.

My daughter is 2.5 and has had numerous worrying viral illnesses, mostly involving her tonsils, and has had chest infections a few times too. I find keeping a short note of her symptoms (on my phone, is how I do it) to be really helpful, both for when we see the doc and for spotting triggers. And i’d recommend your daughter / you do the same, just in case you have further problems down the line.

[HowNowWhatNow in reply to HowNowWhatNow]

And I think that spotting chest infections ain’t easy. When my daughter was in A and E in Feb, she was seen by about 7 doctors in close succession, maybe more, including a few consultants. And the only thing that picked up her chest infection was the X Ray machine - no doctor heard it. Saying that, all of the other general symptoms of illness / weakness (not eating etc) pointed to there being something up.