From the Guidelines
For a 6-month-old child with wheezing, treatment should begin with a short-acting beta-agonist like albuterol (salbutamol) administered via a metered-dose inhaler with an infant spacer and mask, as recommended by the most recent guidelines 1. The typical dose is 2 puffs every 4-6 hours as needed. Each treatment should involve holding the mask over the baby's face for 6 breaths per puff. If the wheezing is severe or not responding to albuterol, seek immediate medical attention as the child may need oral steroids, oxygen support, or hospitalization. Some key considerations for young children include:
- Inhaled corticosteroids are the preferred long-term control medication for initiating therapy, with benefits outweighing concerns about potential risks of a small, nonprogressive reduction in growth velocity or other possible adverse effects 1.
- The decision to start long-term daily therapy depends on issues regarding diagnosis and prognosis, including the frequency and severity of wheezing episodes, and the presence of risk factors for developing persistent asthma 1.
- For children whose asthma is not well controlled on low-dose ICS, few studies are available on step-up therapy in this age group, and the studies have mixed findings 1. Keep the child well-hydrated with frequent small amounts of breast milk, formula, or water. Elevating the head of the crib slightly and using a cool-mist humidifier in the room may provide additional comfort. Avoid exposure to irritants like cigarette smoke, strong perfumes, or known allergens. Wheezing in infants this young often results from viral bronchiolitis (commonly RSV), which causes inflammation and mucus production in the small airways. While most cases resolve with supportive care within 1-2 weeks, it's essential to have a healthcare provider evaluate any wheezing in a baby this young, as they may need closer monitoring or additional treatments based on the underlying cause and severity. Monitor response to therapy closely, because treatment of young children is often in the form of a therapeutic trial, and treatment should be stopped if a clear beneficial effect is not obvious within 4 to 6 weeks 1.
From the Research
Treatment for Wheezing in Infants
- The treatment for wheezing in a 6-month-old infant can involve the use of inhaled corticosteroids, such as fluticasone propionate 2 or budesonide 3.
- A study found that inhaled fluticasone propionate at 50 and 125 mcg twice daily for 6 months significantly improved respiratory symptoms in young children with asthmatic symptoms without causing significant side effects on growth and bone metabolism 2.
- Another study showed that nebulized budesonide is associated with faster clinical improvement and reduction in hospital stay period in infants with acute wheeze 3.
- Daily inhaled corticosteroids are also recommended for preschoolers with asthma or recurrent wheezing, as they appear to be more effective than leukotriene receptor antagonists in improving symptom control and decreasing exacerbations 4.
- However, parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children is not widely recommended due to limited evidence and potential adverse effects 5.
Medication Options
- Inhaled glucocorticoids, such as beclomethasone, can be used as a regular treatment for frequent wheezing in preschool children 6.
- A combination of a bronchodilator and a glucocorticoid can also be used as a prn treatment for wheezing in preschool children 6.
- Montelukast, a leukotriene receptor antagonist, can be used as an alternative therapy for preschoolers with asthma or recurrent wheezing, but daily inhaled corticosteroids are generally preferred 4.