Healthcare - Health Tips - Children and Teens

by Dr. Donald Daeke, Emergency Services
Evans Army Community Hospital, Fort Carson, Colo.

There is a whole family of illnesses that can cause respiratory problems and wheezing. The lungs and respiratory passages have only limited means of responding to irritation. These consist of mucous production and narrowing. The narrowing develops as a result of swelling of the lining and constriction of muscle cells that encircle the respiratory passages.

The result is a narrowed passage, full of fluid and mucous, that causes inhalation to take extra effort. The effect is magnified in children because the diameter of their respiratory passages is much narrower.

This is one reason why children sometimes seem to "outgrow" asthma. They still get the mucous secretion and swelling but have much more space to work with to accommodate it. Therefore, they do not get noticeable wheezing when they are older but may notice some tightness in breathing.

In young children, respiratory distress may represent either "croup," which is swelling in the upper airway, above the trachea in the larynx, or "reactive airway disease," which is swelling and mucous formation in the trachea and below.

Croup

With croup, the child will have a high-pitched, barking-type cough. Breathing in may sound harsh and raspy. The child will seem to have to work hard to breathe in, and may suck in the skin between the ribs and above the clavicles. He will probably look frightened.

Croup is caused by a virus. The virus causes the cells lining the upper part of the airway passage to swell. The harder the child coughs or works to suck air in, the more the swelling worsens, making the croup worse.

Parents often notice that when they take the child out into the cool night air, the problem gets much better. This is because, similar to putting ice on a sprain, cool air shrinks swelling, relieving the problem. Similarly, breathing cool mist also relieves the swelling, and the moisture helps, especially in dry climates. Calming the child also helps to relieve the child's struggling and thus the swelling.

What to do at home:

• Stay calm.
• Take your child into the bathroom and get into the shower with him or her. Turn on the shower and hot-water faucets to make steam. The saturated moisture in this environment is very soothing to the lung tissues. If the mist seems to upset the child, then stop and calm the child. Cool air can also reduce swelling. It is helpful to take the child outside in the cool air or keep the child's bedroom window open at night. Getting overheated without the moisture can make croup worse.
• Sit with the child and let him/her breathe in the steam.
• Do not leave the child alone.
• Have someone start a vaporizer in the child's room.
• When breathing is easier (10 to 15 minutes), give him/her a popsicle. Later give the child more clear fluids to drink. This will help to keep the throat and airway moist and cool.
• Avoid milk and thick liquids. These will make your child's phlegm thicker and make him/her cough more.
• Do play activities such as coloring and looking at books together, to help him/her stay calm and quiet so that he/she can breathe more easily.

When to take the child to the emergency room:

• If your child's breathing does not improve after trying the home treatments for 15 to 20 minutes.
• If the child's breathing problem gets worse.
• If he/she continues to have retractions between the ribs or in the hollow of the neck.
• If he/she begins to drool.
• If he/she has trouble swallowing.
• If he/she becomes restless and cannot sleep.
• If a bluish color is seen around the lips.

Asthma

Asthma is a condition of the lower respiratory passages in which mucous secretion and swelling occurs in the lining cells, and the muscle cells around the airway passages constrict (spasm). Wheezing and mucous accumulation result. In children, the first few episodes are usually called reactive airway disease since these may be isolated events reacting to a viral infection. The term asthma is reserved for when the episodes become recurrent or persistent.

Several things can be inciting causes or "triggers" for these episodes. Some of these include smoke, allergies, viral infections, exercise or fatigue, drugs, weather, and environmental factors.

It is important to recognize that the process of mucous secretion can come on gradually and may not be apparent at first. People with asthma can have subtle symptoms at the beginning of an attack and not recognize what is happening. By the time wheezing becomes noticeable, the patient has already accumulated large amounts of mucous in the airways and lungs, which then cannot absorb oxygen. Early treatment is very important to prevent the episode from getting out of hand.

Several medications are used to treat asthma. These include bronchodilators like Albuterol, which work by dilating the constricted muscle cells in the airways. Other medications work by decreasing the inflammation or irritation of the lining cells that causes them to swell and secrete mucous. These medications are called anti-inflammatories, and include inhalation steroids like Flovent or oral steroids like prednisone. These medications are often used on a long-time preventative basis, as they can prevent the reaction to the trigger factors. Cromalyn is another medication that is used by inhalation and can prevent the reaction. Some of these same medications and treatment techniques are used for both asthma and croup.

(Reprinted from the Fort Carson Mountaineer)

Health Tips from Army Medicine
February 2003