From the Guidelines
For an 8-month-old infant experiencing wheezing, treatment should be guided by a pediatrician and may involve the use of bronchodilators such as albuterol (via a nebulizer or inhaler with a spacer and face mask) at a dose of 2.5mg per treatment, given every 4-6 hours as needed 1.
Key Considerations
- If the infant has a history of eczema or allergies, or if the wheezing is recurrent, a pediatrician may prescribe a short course of oral corticosteroids like prednisolone at 1mg/kg/day for 3-5 days to reduce inflammation 1.
- Inhaled corticosteroids are the preferred long-term control medication for initiating therapy in infants with recurrent wheezing, and should be titrated to as low a dose as needed to maintain control 1.
- Maintaining a humid environment and ensuring the infant stays hydrated can help alleviate symptoms.
- It's essential to monitor the infant's condition closely and seek immediate medical attention if symptoms worsen or if the infant shows signs of distress, such as difficulty breathing or feeding.
Additional Recommendations
- For infants with persistent wheezing despite treatment, airway survey via flexible fiberoptic bronchoscopy may be suggested (conditional recommendation, very low quality of evidence) 1.
- 24-hour esophageal pH monitoring may also be considered for infants with persistent wheezing that is not relieved by bronchodilators, inhaled corticosteroids, or systemic corticosteroids (conditional recommendation, very low quality of evidence) 1.
From the FDA Drug Label
The safety and effectiveness of albuterol sulfate inhalation solution have been established in children 2 years of age or older
- The safety and effectiveness of albuterol sulfate inhalation solution in children below 2 years of age have not been established 2 2. The treatment for wheezing in an 8-month-old infant is not established based on the provided drug labels.
From the Research
Treatment for Wheezing in an 8-month-old Infant
The treatment for wheezing in an 8-month-old infant is a complex issue, and the approach may vary depending on the underlying cause of the wheezing. According to 3, wheezing in infants is often episodic and associated with upper respiratory infections, and there is no evidence for an overall beneficial clinical effect of nebulized a2-agonists in acute severe wheezing episodes or acute bronchiolitis in infants.
Diagnostic Approach
The diagnostic approach for wheezing in children involves historical data, physical examination, and targeted diagnostic testing, as suggested by 4. The history should include family history, age at onset, pattern of wheezing, seasonality, suddenness of onset, and association with feeding, cough, respiratory illnesses, and positional changes.
Treatment Options
The treatment options for wheezing in infants are limited, and the choice of therapy depends on the severity of symptoms and the presence of co-morbidities, as noted by 5. Inhaled steroids are considered the most effective treatment, and the initiation of therapy is recommended in children with at least 3-4 episodes or after one severe exacerbation.
Management Plan
A management plan for recurrent wheezing in preschool-aged children should include monitoring and planned interventions, as recommended by 6. The primary care physician should discuss the risks of developing asthma with parents and employ specific questions for features present during the intervals between acute episodes. Close monitoring and the use of the Asthma Predictive Index can help guide rational management.
Key Considerations
- Wheezing in infants is often episodic and associated with upper respiratory infections 3
- Inhaled steroids are considered the most effective treatment for recurrent wheezing 5
- A management plan should include monitoring and planned interventions 6
- The diagnostic approach should involve historical data, physical examination, and targeted diagnostic testing 4