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Dear Dr. Wong: Our daughter is 15 months old. In the last few months, she has been sick a lot after she started going to daycare. Every time, she started with a cold, and this invariably progressed into a bad cough that lasted for weeks. She would finally get better, and then pick up another cold and get sick again.
The last time she coughed so much that she vomited up mucus and became lethargic. I was thinking about taking her to emergency room. Fortunately, I was able to reach a nurse practitioner who suggested that she might be somewhat dehydrated from vomiting and advised me to nurse her for longer periods of time. After a few hours of nursing, she perked up and gradually recovered.
I grew up with pretty severe asthma, and her cough reminded me of my cough when I was young. I am much better now, although I still have exercise-induced asthma, and I use an inhaler from time to time. How can I tell whether my daughter has asthma or not?
Answer: I am very glad that your daughter improved after she got more breastmilk from you. When she was sick and coughing, she was breathing faster, coughing and vomiting up mucus. All of these can contribute to dehydration that made her lethargic. You did get good suggestion from the nurse practitioner.
Because of the COVID-19 pandemic, many children stayed home and had few contacts with other children. Once the pandemic rules were relaxed, children started going to school and daycare. Respiratory viruses naturally circulate among children who have little exposure and immunity to common respiratory viruses, including rhinoviruses that cause common cold, influenza viruses and respiratory syncytial virus (RSV), not to mention the COVID-19 virus and others.
When your daughter was exposed to any of these viruses, she would develop cold-like symptoms with stuffy and running nose, sore throat, fever and cough. Most children are sick for a few days with each cold, their cough is usually not too severe. Some may develop complications like ear infections, sinus infections or pneumonia.
It is not easy to tell if a young child has asthma. As you may already know, asthma is a genetic condition; usually one or both parents have a history of asthma. Adults can take a lung function test; those with asthma have narrowing of their bronchial tubes. These bronchial tubes can relax after taking a bronchodilator inhaler. However, it is very difficult to do this test in young children. A few centres can perform a modified lung function test in young children for research purposes only.
Some of the symptoms of asthma in young children include a prolonged and severe cough when they get colds. Very often, their cold symptoms can last for weeks, and they can cough and vomit up mucus. Sometimes parents can hear a wheezy noise when they breathe. If it is severe, these children can breathe very rapidly, and parents may see their chest sucking in between the ribs or under the ribcage. These are all signs of respiratory distress.
Not infrequently, doctors cannot tell whether a child has asthma or not when they are young. Listening to the chest with a stethoscope may not tell anything. Sometimes physicians have to rely on the patterns of cough when they are sick, as well as how frequent and how long each of these episodes lasted. They may prescribe a course of inhaled bronchodilator and steroid to see how the child responds.
Since you have a history of asthma, it is possible for your daughter to develop asthma. You may want to eliminate some common indoor triggers, like dust mites, moulds and certain household pets. You can also watch whether she starts to cough when she runs, even when healthy. Asthma symptoms are also more common in spring and fall.
In the meantime, if she has not received influenza or COVID-19 vaccines as yet, you should consider immunizing her against these viruses. Both of them can get her quite sick, whether she has asthma or not.
Dr. David Wong is a retired pediatrician in Summerside and recipient of 2012 Distinguished Community Paediatrician Award of Canadian Paediatric Society. His columns are in The Guardian on the last Tuesday of every month. You can see a collection of his previous columns at askdrwong.ca. If you have a question for Dr. Wong, please mail it to Prince County Hospital, 65 Roy Boates Ave., Summerside, P.E.I., C1N 2A9.