Advice on asthma symptoms at 13 months

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My Ds is 13 months old and has had asthma like symptoms on and off since September, including 4 visits to paeds A&E after being referred by GP . It gets worse whenever he has some sort of virus and since he started nursery in October its been fairly constant. Every time we go to A&E we are told to give him 10 puffs of his salbutomol inhaler every 4 hours, this works for about an hour after, although still wheezy he is able to play for a bit and eat and drink.

This time he has had a respiratory rate of 70 since Tuesday and has been on his 4 hourly inhaler since then. Yesterday in A&E we were told he was too young for steroids and it was just a case of keeping on going with the inhaler, even though its such a short term option and obviously exhausting (he hates his inhaler) They also asked if he had inhaled anything as his wheeze was still so bad even after his inhaler. I told them he hadn't and that the inhaler has never fully stopped his wheeze.

I was just hoping wondering if anyone had any tricks or experience of ways to help him??, we have a DRs appt. tomorrow to check on him but I dont think theres much else they can do to help him other than monitoring him.

I would ask to talk to someone who knows what they are talking about!

DS has been on inhaled steroids since about 11 months, and had oral steroids for the first time at around 4 months old.

Have you tried letting him play with the spacer for the inhaler? Pretend to take it yourself and make it seem something 'normal'. I have heard other people saying they pretend the spacer is a trumpet.

If he has had problems for so long I would be pushing to try a steroid inhaler (normally the brown one clenil first).

Thank you for replying, that's the sort of info I need.

We've tried giving it to his favourite teddy and me and my DH, which he finds great fun and will put it to his face. its just keeping it there while he breathes in that's the issue. trumpet is a good idea though will try that tomorrow.

The paediatrician mentioned the brown inhaler yesterday, I had previously been told they wouldn't give it too him until he was 2 and "officially diagnosed" with asthma. Seems to be a bit of confusion there so can ask tomorrow thank you.

Did you find that certain things made your DS worse?

Yes you can't formally diagnose asthma in such a little child but essentially if you treat the symptoms of asthma as if they were asthma and they get better then it's probably asthma, regardless of how old they are.

Inhaled steroids can be given from birth and should be trialled in a child with persistent wheeze especially one who has had repeated hospital admissions.

I'd be asking your GP about starting an inhaled steroid as well as a possible referral to a paediatric respiratory consultant.

Agree completely with what Sidge said.

You need to talk to someone with specific paed respiratory experience.

A formal diagnosis at that age is rare, DS was diagnosed at 12 months but only because he had more serious problems. The lack of a formal diagnosis shouldn't mean he doesn't get treated though.

With him a lot of his problems come with illness, although exercise and dust have both been identified as triggers.

Thank you everyone, you've given me some things to think about and be able to ask about. I find that my GP doesn't seem to feel comfortable with sending me off just giving him his inhaler, hence the repeated visits to A&E. Feel like Id like to know what to ask rather than be sent off again waiting for the next time it flares up and we end up in hospital again...

When ds2 had had 3 emergency admissions due to viral-induced wheeze by 18mths we were automatically referred to a respiratory paed.

Is there an asthma nurse at your practice, they tend to be far more clued up than gps (IME)...

"Is there an asthma nurse at your practice, they tend to be far more clued up than gps (IME)..."

Funnily enough I agree with you weblette

:) Sidge just seen your profile. Our nurse is an absolute gem - always completely up-to-date, she's just done her 'prescribing' course (and got no extra money - typical .

Our asthma nurse is fantastic, I happened to bump into her once in the corridor after the gp had told me Ds had a throat infection but his chest was fine - as soon as she saw him she suggested I took him to a an e - 5 days later we came home!

When you do one puff, do you wait for him to breathe 10 times before doing another puff in the spacer?

With my patients, I generally sing (badly) a song, like row row row your boat.

Puff
Row row row your boat
Puff
Gently down the stream
Puff
Merrily, merrily, merrily, merrily
Puff
Life is but a dream
Puff
Row, row, row your boat
Puff
Gently down the stream
Puff
If you see a crocadile
Puff
don't forget to scream
Puff
ARGHHHHH!
Puff

Then give lots of praise and cuddles!

It's difficult in young ones, but actually, if they cry and scream it's fine because they really open up their lungs to get the medicine in! Not ideal in the long term though!

Good luck.

I agree with everything that has already been said. We have similar ongoing problems with a and e admissions etc and usually only a nebuliser sorts my d's out, followed by steroids ( prednisolone sp???) he has had several courses and is only 2 and a bit, but his wheezing problems started at 8 months. Several people recommended a humidifier in the bedroom, bug I never tried it, so can't comment.

Hope things get better for you soon and sending sympathy vibes, because I know it's very tough on the parents too

I agree with everyone and just want to say - push for more support - I wish I had. Ds is 5 and only just diagnosed after years of all this crap including pneumonia which couldve been prevented if hed had the flu vaccine for asthmatics.

Really push for them to help you, never feel like a pain even if it means going back twice in one day.

Thank you for everyones advice. Ended up back in A&E on Sunday as DS's breathing worsened. In the end we were given oral steroids which seemed to have helped straight away. Makes me really angry though as we were told last week that he had to be 2 before we could try oral steroids and then 5 days of suffering later he was given the. Anyway just very relieved hes on the mend. Thank you so much for all your support.

Thats a great tip charlie we try counting so he knows its nearly over but at 13 months a song would probably make more sense to him.

Weve also been asked to sign up for a research trial on viral induced wheeze in children under 6 so hoping it is another form of advice to go to in times of need.

Thank you!

We are in a similar situation again with 13 mth old ds & I sympathise. Think we are on 8 hospital admissions.ds is seen by the asthma nurse & general paeds.he has been on brown inhaler & singulair since nov.Nothing seems to work when he has a virus tho & he is usually admitted struggling to breathe.we also have a neb at home.after the last admission I have pushed for him to be seen by a paediatric respiratory consultant (we dont have 1 locally) as enough is enough!so at the moment we are waiting for an appt at a more specialist hospital..the trial sounds interesting.do you have any more info?

Gosh gingerroots that sounds like hard work. Weve just started DS on brown inhaler to try and not let it get so bad but I worry that it wont do much when he gets a virus. The issue is that he ends up breathing so fast that he cant actually get any inhaler in.

The research trial is being done by south central children's research. they're trying to find the best cause for treating wheeze. They're using montelukast which is already used in some children with wheeze and we basically have to give him it as soon as theres any sign of a cold or virus , once a day for 10 days. Its 50/50 whether DS will receive the medication or a placebo but they just wanted a urine sample and saliva swabs which DS was more than happy to give. I googled WAIT research trial and heres the official details www.icms.qmul.ac.uk/chs/pctu/current_projects/wait/25693.html

Thank you for the info.ds is already on singulair/montelukast ( I forget which is the brand & which is the actual drug) but again it seems to do nothing for him.good luck with the trial, hopefully it will help your ds. I am hoping that the great ormand st referral will have some better ideas for our ds as local treatment hasn't been very proactive to say the least. Good luck!

Oh no ok, hoping it helps my DS but I guess well see. Good luck with your referral, hope someone can help. Its horrible seeing your children so poorly x

gingerroots who are you being refered to at great ormond st? ds sees dr suri there and he is fantastic. It has really improved ds's asthma he is starting to be a normal child and not one having nebs and steroids all the time.
If you are going on the NHS make sure you have a whole free day and there can be very long waits. We waited two hours before. They are fantastic there all the staff are really freindly.

Glad you are getting more help.

We have struggled with this for two years. DD is two and a half. She has always had the oral steroids when we have been admitted and has started on the Clenil at home since October. Unfortunately, when things get bad it's only the Neb that sorts it.

I am currently on the chase for a referal and direct pass to the ward as Sunday night it took 2 1/2 hours to get to use the Neb in A&E.

We do have a DX now, so I'm hoping we will get more help and support.

In, fact I just started a thread about getting a referal etc!

I am just so tired all the pushing that has to be done just to get the right actions.

Hello everyone. My DS was prem and we have a respitory paed who does lots of research on these areas.

His views are

1. Brown inhaler - 2ce a day every day. Five breaths, and that if they scream it doesn't work at all. He has done a research paper on it apparently where they measured the amount of drug in the urine aftewards! We count, sing or if all else fails try Cbeebies. It took for ever to stop DS screaming as he became frightened of it. Apparently you have to stop that before you can be sure that he is inhaling properly.

1. Montelukast every day.

1. Salbutomol, up to 10 puffs hourly in the case of an attack. When its through a sapecr the risk is always it makes the little ones hyper but nothing else and you can never be sure what they are getting.

1. If that doesn't work interspace atrovent

1. then consider either oral steroids or actually antibioitics (clarithromycin which is also an antiinflamaroy and helps prevent secondary infections taking hold making the astham work)

This is his standard package, and says if you think salbumotol/ventolin works the rest of it is working (probably) even if you can't see a difference Once you can get the inhaler in.

He gave me odds of 50% for DS being in hospital again this winter and so far its stopped that, we have only had one scary night

ps we have had this pattern and drug regime since DS was 13 months corrected age. Paeds view are that inhalers start working from about 12 months and if the inhalers work so do everything else