To ask about toddler with asthma

[CherryBlossom100]

Hi everyone. I’m posting for traffic as worried about my 1 year old daughter.
She has been coughing throughout the night for around a month now and after each nap. Big hacking coughs that wake her up.
I took her to my gp last week who was very dismissive and said her chest was clear.
The hacking cough has continued so I took her to the out of hours gp this weekend who said it’s asthma and gave an inhaler.
I’ve been using it when the coughing fit starts but it doesn’t seem to help at all.
What should my next step be?
I’ll go back to my dr but she isn’t always the most helpful. It would be useful if I knew what to push for.

DD is quite distressed back the coughing attacks and it’s disrupting both our sleeps.
Do we need a preventative inhaler too or a nebuliser? Anything I can do to help? I have a humidifier in the bedroom. There’s a strong family history of asthma but mine is only very mild so not sure how to help. Thank you.

You need to speak to the GP or practise asthma nurse. My toddler is under the care of the hospital and has been since 10 months old. A salbutamol inhaler should ease respiratory distress and you should have been advised how many puffs to give. Preventative inhalers can be prescribed as can a medication called Montelukast which is particularly effective in under 5's. Nebulisers aren't routinely used now, the view being that if a child is that ill they should be being admitted to the ward.

I would go back to the GP. Mine were rubbish and said they wouldn’t diagnose asthma until my son reached 5. A couple of hospital admissions later, one quite serious, and the consultant issued preventative inhalers - made a big difference and no admissions since. Worth a mention DS was also prescribed Montelukast - he had terrifying nightmares when taking it so we stopped. I didn’t put two and two together at first but when I looked in to it others had similar issues and worse.

www.asthma.org.uk/advice/child/

Asthma Uk have loads of information about childhood asthma - we found it really helpful when DS was younger.

Our GP wasn’t very helpful at first and he had a few emergency admissions to hospital. They took it much more seriously then and he was assigned an asthma nurse at the practice after being discharged from consultant care.

The inhaler shouldn’t be used every time she coughs. I would see the GP and push for a referral to the asthma clinic and a paediatric respiratory specialist. They will give proper advice about using the inhaler and when to use it. It may not be asthma- my DD (3.5) has had 25 lung infections and antibiotics each time plus 10 hospital admissions. Turns out it isn’t asthma- she has underlying lung issues and aspirates liquids into her lungs every time she was drinking. Plus her tonsils are too big and may need removed

Please keep pushing with your GP. We went back and forth with DC1 for what felt like months before it was taken seriously.

As a PP mentioned, Montelukast can be really effective in toddlers with persistent coughs. DC1 has been on it for a while now and they no longer cough at night at all.

www.enherts-tr.nhs.uk/gps-professionals/files/2010/04/Paediatric-Wheeze-Discharge-Plan-OVER-2-YEARSGP.doc

Example of the inhaler plan we had to follow

Try and film one of the coughing attack’s.

I would be dubious of an OOH dr diagnosing asthma is a child so young having only seen them once to be honest. That’s not to say that’s not the issue but medical professionals don’t generally diagnosis asthma so young without a lot to back up the diagnosis.

They dont normally diagnose before age 2. My 1 year old got a preventer and blue inhaler about 10 or 11 months old but he was referred to the consultant for a consistent wheeze and cough. I'd go back to your gp and ask for a referral as they are so young x

If you use the blue pump more than 10 puffs and 10 times and it doesn’t improve go to a&e! Have they shown you how to use the pump properly, no one showed us and we was doing it wrong. 1 puff then hold the mask on for 10seconds then repeat as needed.
My son has had a couple of ambulance dashes and a stay in hospital for asthma. Hospital say they can’t diagnose it in under 5s but my gp has said it’s definitely asthma and given a brown pump.
Film the coughing. If her skin is being sucked under her ribs when she’s breathing or sucked into collar bone then she needs to go a&e if the pump doesn’t work.
I’ve found a lot of medical professionals very blasé about his asthma, once I saw 3 doctors and they all told me it was a chest infection or hayfever, a few hours later I was on the phone to 999 and taken straight into resus. The hospital was surprised no one had sent us and he was in quite a bad way by then.

Following for the advice you get. My almost 2 year old as had a few instances of her skin being sucked under her ribs as MammaMia19 describes and has been to hospital for it. We have been given an inhaler but they have said it's not asthma and they won't refer us for further tests.

Thanks. I’ll film it tonight. Her breathing is fine during the day except nap time.
I was using two puffs at once into the spacer and keeping on for 10 seconds but she was wriggling quite a lot to get the mask off.
I only used the inhaler once. The coughing spell lasts for around 4am until 5am every night but she can breath normally between the coughing fits. I’m never worried that she isn’t getting enough oxygen, just that the coughing is quite intense and hurting her.
Thank you for all the info. I’ll go back and get another appointment with the gp. Might need to change surgery as we waited over an hour after our appointment time last week and she only spent two minutes before ushering us out.

Does your dd have any symptoms of hayfever? My ds had his first asthma attack at this time of year when he was around 18 months. We had been fobbed off by the gp a few times before hand as a viral wheeze.

He took a bad turn one night so we took him to a&e where he was admitted and diagnosed with asthma before being discharged the following day.

Hayfever is an asthma trigger for him and we've found by keeping on top of the hay fever it controls his asthma symptoms most of the time.

The pollen is incredibly high this year, I would definitely try her with some antihistamines, piriton syrup is available over the counter.

If it’s just at night- ask the GP to check for reflux, how large the tonsils are, sleep apnea etc. To be honest, I wouldn’t use the inhaler until you’ve had an asthma clinic show you. When I had to give it to DD they showed me different ways to restrain her to make sure she was getting the full effect, checked my technique was right (the angle of the pump) etc

I have hay fever too but she doesn’t seem to have any symptoms. No runny nose or eyes.

Oh and if she needs 10 individual pumps (with 10 inhales with each pump) and there is no change- straight to A&E

If she's not short of breath and just coughing then it may not even been asthma. As I said above my eldest has suffered since 10 months, lots of hospital admissions and at 5 years old still has consultant led care. Her younger brother also coughs on a night and is very phlegmy but is never wheezy/short of breath/working hard to breathe. His cough is related to issues with post-nasal drip and his tonsils, but I was initially concerned about asthma given his sisters history.

Reflux is another illness which can cause night time coughing.

So definitely speak to GP, but don't rule out other possibilities too.

I am asthmatic and not a toddler but I honestly do not think it’s good advice to give 10 pumps of salbutamol to a small child when she has not been diagnosed or reviewed since seeing an OOH GP and you aren’t sure if it’s an attack or just a cough iyswim. 10 pumps of inhaler ruins me for hours and hours I would only do this if you have an asthma plan or advised by 111 on the phone if you are worried she cannot breath

Can you hear a whistle or wheeze at all?

I really recommend a wedge hog too to help with sleeping abit more upright

My DD has a nasal drip and she coughs like this sometimes. She has very blocked ears, sinuses etc terrible hay fever and needs her ears syringed a lot. She gets sore throats too. I had her checked for asthma but they did not think she met the criteria

Yes. She has a wheeze and you can feel a rattle if you put a hand on her back. Sounds the same as my breathing when I wheeze but I don’t ever cough with my asthma.
Just feel like my dr isn’t taking it seriously. The ooh dr was the first that listened to my worries.
She was in hospital for a mri (unrelated) when the night time coughing first started and the dr said that her chest sounded wheezy and considered cancelling the mri as she had to be sedated. He thought it was due to the bronchitis that she’d had a few months previous leaving her chest weak. Her cough has got worse since then.

My asthma seems to sometimes sound wheezy but my chest is medically sounding clear, my mucus accumulates right at the top of my lungs and the stickiness of it all has nowhere to go so I will cough it up. My tight cough sounds and feels really tight, not productive iyswim?

My 2 year old was the same and we were dismissed until I filmed one night time episode. We got an inhaler to give before bed and before physical activity. It's made a huge difference. Now we only really have to give it if she's gotten herself in a hysterical state tantrum!
I hope you get somewhere soon x

Thanks pookie. Don’t worry. I won’t be giving her lots of puffs. The blue inhaler makes me feel really dizzy and weird when I take it so avoid it unless really necessary.