• 90°

Dr. Magryta: wheezing in young children

Dr. Magryta

Winter is here and we are seeing an increased volume of children with viral related wheezing disorders. Bronchiolitis, a term that means inflammation of the bronchioles, is a viral associated illness that causes significant lung inflammation in children under the age of three years old. It is one of the leading causes of hospitalization in this age group.

This illness is usually benign and self limited as the cough and wheezing fade away over a few days to a week without intervention. However, it can also be scary as some children will present with cough, fever, wheezing and further respiratory compromise over time. Some high risk individuals need to be aware of this disease, including: premature or low birth weight newborns, children with immune system defects, cardiac disease, chronic lung disease and/or severe neurological disease.

Respiratory syncytial virus (RSV), rhinovirus, parainfluenza, influenza, adenovirus and metapneumovirus are the major pathogens that cause this disease. RSV is the most common and serious player in this group as it spreads rapidly between children and carries the highest risk and rate of serious wheezing associated disease. Deaths per year are in the hundreds in the United States.

The tricky part of diagnosing this illness early is realizing that it starts as a common cold before progressing to a lower respiratory tract disease with wheezing and shortness of breath as the hallmark worsening symptoms. Paying close attention for these signs of lower respiratory illness can save a life.

These viral diseases are easily spread via droplets of a cough or nasal secretions. Quarantining young ones and effective hand washing are very important in the prevention of disease. If your child does get ill, bring them to your provider as soon as they show signs of lower tract disease with wheezing, shortness of breath, tugging in their ribs, nasal flaring or fast breathing rate.

Your doctor will likely provide a breathing treatment with a medicine called albuterol which can help in a minority of cases that are asthma related. Children with a family history of asthma are likely to benefit from this medicine and warrant a trial. Other medicines like steroids and antibiotics have no place in treating viral disease and should not be used as the recent scientific literature has proven.

I am often asked the question, “does this mean that we are looking at asthma in the future?”
All things that wheeze are not asthmatic nor will be so. Based on the work of Fernando Martinez, we now understand that children with wheezing concerns can be broken out into 4 categories of disease. From his 2005 paper, “The prevalence of atopy and wheeze by age 16 yr was similar for never and transient wheezers and for persistent and late-onset wheezers. Both transient early, and persistent wheezers had significantly lower FEF25-75 (-259 ml/s, p < 0.001, and -260 ml/s, p = 0.001, respectively), FEV1 (-75 ml, p = 0.02, and -87 ml, p = 0.03, respectively), and FEV1:FVC ratio (-1.9%, p = 0.002, and -2.5%, p = 0.001, respectively) through age 16 yr compared with never wheezers. Late-onset wheezers had levels of lung function similar to those of never wheezers through age 16 yr. There was no significant change in lung function among subjects with any of the four phenotypes, relative to their peers, from age 6 to 16 yr.” (Morgan et. al. 2005)

Simply put, if you wheeze below the age of three with viral infections and not in between illness events and you do not have a family history of atopy/asthma, then the odds are very low that you will end up with asthma. If you have a primary relative with asthma, your risks go up. If you have this relative and you wheeze in between viral infections, your risk is even higher over time.

From a micronutrient and disease prevention model, it is clear that vitamin D and zinc are important in the prevention of disease. As with all immune related diseases, vitamin D and zinc are critical for maintaining a robust and normal immune response to disease. Maintaining normal vitamin D levels in a newborn’s body is critical. To that end, it is recommended that all breast fed babies receive 400IU of vitamin D daily. Zinc containing foods are a necessary addition to the daily dietary fare for all mother’s that are nursing and children that are eating whole foods. Zinc sources.

Exclusive breastfeeding is also critical in order to provide passive antibodies that can prevent illness in the first place throughout the first year of life where the risk is highest.

Aside from the risk of death from this disease, there are some other interesting risks post illness. Children with low vitamin D levels and/or a family history of allergic type diseases are at higher risk for developing later asthma. We also know from the Amish study that children that have little exposure to natural animal based bacteria are at higher risk for allergic type disease.

Take home points:
1) Exclusively breastfeed
2) Maintain adequate vitamin D and zinc levels
3) Get exposed to animal dust of farms/farm houses and household pets
4) Wash hands and avoid people with viral colds when your children are young to prevent infection
5) After 6 months of age, children should eat as healthily as possible to keep all micro nutrient levels normal.  No kid friendly foods please!
6) Seek immediate medical help if your child is wheezing, having difficulty breathing, is short of breath or has you concerned
7) Avoid smoke and other airborne pollutants that can reduce immunity and inflame the lung tissue
8) Keep your child hydrated with adequate volumes of breastmilk or supplemental water when older
9) Run a vaporizer with sterile normal saline for mucous thinning and cough reduction
10) Provide chest physical therapy to loosen mucous in the bronchioles – Youtube video on chest PT: https://www.youtube.com/watch?v=MGrsdLzhhvE/

Dr. M

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at newsletter@salisburypediatrics.com

About Post Lifestyles

Visit us on Facebook: https://www.facebook.com/SalPostLifestyle/ and Twitter @postlifestlyes for more content

email author More by Post



David Freeze begins cross-country cycling journey in San Diego


Community remembrance events to focus on lynchings of the past, need for justice today


August issue of Salisbury the Magazine is now available


After 10 days, three hospitals, one diagnosis, Kassidy Sechler will return home


COVID-19 surging as North Carolina set to ease restrictions


Blotter: Police ask for help finding robbery suspect


Three Rivers Land Trust finalizes deal to double size of nature preserve in Spencer


Spin Doctors announced as headlining band for 2021 Cheerwine Festival

Ask Us

Ask Us: Readers ask about Hoffner murder case, ‘Fame’ location


Cornhole tournament at New Sarum Brewery brings out Panthers fans, raises money for charity


Blotter: Salisbury man charged for breaking and entering, burglary tools


Senators race to overcome final snags in infrastructure deal


Child killed in Monroe drive-by shooting; 1 arrested


Rowan County Chamber of Commerce’s Dragon Boat race returns after year hiatus


Marker commemorating Jim Crow-era lynchings in Rowan County, racial injustice required years of work


Identified Marine was a Salisbury native, served in WWII


Rowan County sees COVID-19 cases coming more quickly, remains in middle tier for community spread


Cleveland plans to build walking trail, community barn quilt mural

High School

High school athletics: Male Athlete of the Year Walker in league of once-in-a-generation players


Young entrepreneur learns lesson of responsibility by raising quail, selling eggs


Historic McCanless House sold, buyers plan on converting home into events venue


Library’s Summer Reading Week 10 has virtual storytime, last chance to log hours


Positive COVID test knocks DeChambeau out of Olympics


College football: North grad Delaney ready for next challenges at Johnson C. Smith