From the Guidelines
Montelukast may be considered for a 15-month-old with upper airway symptoms, particularly if they have a history of wheezing or asthma-like symptoms, as it is FDA-approved for use in children as young as 1 year old for asthma management. According to the most recent and highest quality study, 1, montelukast is suggested for use in children with sleep-dependent persistent obstructive sleep apnea after adenotonsillectomy, indicating its potential benefits in managing upper airway symptoms. However, it's essential to note that montelukast is primarily used for asthma and allergic rhinitis, and its use in upper airway symptoms should be carefully considered.
For a 15-month-old with upper airway symptoms, first-line treatments would include saline nasal spray, gentle suctioning, adequate hydration, and possibly short-term use of antihistamines if allergies are suspected. If symptoms are severe or persistent, a pediatrician might consider other age-appropriate medications. The decision to use montelukast should be based on the individual child's symptoms, medical history, and response to other treatments, as well as careful monitoring for potential side effects, as recommended by 1 and 1.
Key considerations for using montelukast in young children include:
- FDA approval for use in children as young as 1 year old for asthma management
- Potential benefits in managing upper airway symptoms, as suggested by 1
- Need for careful consideration of individual symptoms, medical history, and response to other treatments
- Importance of monitoring for potential side effects, as recommended by 1 and 1
From the FDA Drug Label
SINGULAIR is indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients 12 months of age and older. The dosage for pediatric patients 6 to 23 months of age is one packet of 4-mg oral granules. Safety and effectiveness in pediatric patients less than 12 months of age have not been established For allergic rhinitis SINGULAIR should be taken once daily Safety and effectiveness in pediatric patients younger than 2 years of age with seasonal allergic rhinitis and less than 6 months of age with perennial allergic rhinitis have not been established
The patient is 15 months old, which is within the age range for the treatment of asthma and perennial allergic rhinitis. The recommended dosage for pediatric patients 6 to 23 months of age is one packet of 4-mg oral granules. Since the patient has upper airway issues, montelukast may be prescribed for asthma or allergic rhinitis. However, the specific reason for prescribing montelukast to this patient is not explicitly stated in the provided information 2 2.
From the Research
Montelukast for Upper Airway Obstruction in a 15-Month-Old
- Montelukast is a selective and orally-active leukotriene-receptor antagonist (LTRA) that inhibits the cysteinyl leukotriene 1 (CysLT1) receptor, and it is used in the treatment of asthma and allergic rhinitis 3.
- In children with obstructive sleep apnea syndrome (OSA), montelukast may be considered as a medical therapy option, especially in those with mild OSA, in combination with intranasal steroids (INS) 4.
- Upper airway obstruction in infants and children can be caused by various factors, including anatomical differences, infectious or congenital conditions, and acquired disorders 5, 6.
- The management of acute severe upper airway obstruction in children requires a detailed history, thorough physical examination, and assessment of severity, with supportive care and definitive airway management as necessary interventions 7.
- For a 15-month-old child with upper airway obstruction, montelukast may be considered as part of the treatment plan, especially if the child has a diagnosis of asthma, allergic rhinitis, or OSA, and under the guidance of a healthcare professional 3, 4.