Not convinced with GP's diagnosis - toddler 22 months - asthma, cough, eczema

[Zoink]

So my 20 month old has had a cough for a whole month now. With the cough she also has some sort of eczema. GPs have said:

Ringworm
Chicken pox
Eczema
Hay fever
Asthma

We have cream that clears up the skin on their chest and back but it just comes back. At the top of the neck it now looks like tiny whip marks

Their cough mostly at night, where we will wake at least once with a coughing fit (in fact, she now sleeps through them as they're so regular). I don't think it's a tickly cough bc I think she is coughing up phlegm.

I feel it is an allergy. Would that makes sense? Can gave Piritin which made no difference and we inhaler does nothing. The dr basically said give her Calpol. But why? She's asleep and coughing?!

Who can we go and see private if needs be?

(We have changed washing now to eco-eggs and I've monitored food and I can't see a link to that either).

Night time cough sounds like nasal drip so yes could be an irritant response ? House dust mite?

Re milk; if age appropriate formula - plant based options can help to bridge the gap. If you do follow an exclusion diet, keep a detailed record and it must be absolutely strict. Parent of DC with eczema, asthma, hayfever…. multiple food allergies diagnosed at around 13 months in a specialist allergy clinic. By time we got there, after several months of working things out, we had a food diary, symptoms, pictures to support observations, strict diet and re-introduction produced symptoms. It wasn’t easy… but essentially changed everything for the better. GP and paediatrician did not agree; got sent to the allergy clinic to show me I was wrong.

You can also record the night time cough.

Following as in similar situation

Sounds very like what we had with my DD at a very similar age. But it went on even longer. Eczema patches were improved by switching washing powder and using a variety of prescription creams. I would stop the shake and vac. My DP has asthma so it’s in the family but they won’t diagnose in such a young child. She never had wheeziness but did have the night time cough. Had an X-ray to check for obstructions. Found the inhaler quite difficult to give even with the tube. In the end piriton did seem to clear it up for her and has worked again since after a prolonged cough a year later. We left London and my feeling is reduced pollution or different pollen has made a difference.

I agree asthma is likely and to stop shake and vac. Also any air fresheners. On medication, mine had montelukast tablets to take as a preventer as it’s not a steroid and so better for very young children. You could ask about that? One DC started on them age 6 months, the other age 4 (asthma appeared different ages). It worked really well and stopped the night time coughing completely as well as drastically reducing daytime asthma attacks.

By the way, the cough at night may be the asthma getting out of control. If they have no idea when the paediatrician appointment will be, push for an appointment that takes place in the morning as soon as possible. If she is mostly coughing at night, that is the best time to check her of oxygen levels are ok

@KarmaNoMore hi! Thanks! She's never been breastfed so she stopped formula aged 1! She eats broccoli every day! So that won't be hard! Will give It a go

We know a lot more about the causes of asthma now and you might want to read this medical paper on the microbiome role in asthma
www.ncbi.nlm.nih.gov/pmc/articles/PMC6337651/ and this one www.ncbi.nlm.nih.gov/pmc/articles/PMC5707699/ and there are so many more.

I would suggest you read Dr. Erica Sonnenburg The Good gut book
( she has also done several interventions at conferences which you can find on YouTube such as this one) and then a deep and honest look at your child's diet and try to swap any processed / refined food for a natural one, in order to increase fibre intake.

You need to try to take control of asthma in its earliest stage because an asthma attack is one of the most frightening thing to experience. Watching my son unable to breath sent me into the deepest fear I didn't even know existed.

Fixing your DD's gut will regulate her immune system and help control these overreactions such as asthma and eczema in addition of course of using a preventer and having a Ventolin in the house (and in the car, school bag, swimming bag, every single one of my my handbags, .... I had ventolin everywhere for a while) .

And attacks can occur outside as well. One of the worst my son had was when we were walking on the beach in Manly. Luckily the lifeguards intervened very quickly and the ambulance arrived in a matter of minutes . Without them, my son would have died that afternoon.

Preventers, inhalers, allergy medicines are a patch on the symptoms. You need to work upstream, and introduce a lot of bacteria with fermented foods (yoghurt, kefir but also miso, sauerkraut, ..) and a lot of vegetables, prebiotics and also remove food that makes bad bacteria thrive, so most foods kids love, processed and industrial food made with refined grains, processed oils and so on. Anything wrapped basically.

While you do your research (go on pubmed, not google) , buy a ventolin and a spacer, because you never know when it will escalate .

Of course , @Zoink talk to your doctor first, because if your DD has asthma symptoms more than twice per month, she needs a preventer asthma.org.au/about-asthma/medicines-and-devices/preventers/ but you don't want to be long term (years) on them, as long term side effects are quite serious, from osteoporosis to cataract as adult and behaviour problems and stunt growth as children.

My son is now a teenager and absolutely fine. No need of preventer or reliever (but when we go on a long flight, I have a ventolin in my handbag, and will probably always have it for as long as he travels with us).

Also try putting dust mote encasements on the mattress pillow and duvet in the bed where she sleeps. Dust mite allergies are very common and cause night cough (as they are closest to the source at night) and excema/skin rashes. If you encase everything and then she improves, you can then follow the plan to minimise them in the rest of the house

@PlanDeRaccordement

I agree asthma is likely and to stop shake and vac. Also any air fresheners. On medication, mine had montelukast tablets to take as a preventer as it’s not a steroid and so better for very young children. You could ask about that? One DC started on them age 6 months, the other age 4 (asthma appeared different ages). It worked really well and stopped the night time coughing completely as well as drastically reducing daytime asthma attacks.

Yes, Montelukast is 1st line treatment for prevention of asthma in young children, it targets the leukotriene receptors and blocks them, which is the main inflammatory marker for asthma, unlike Piriton which just blocks histamine and can exacerbate asthma but isn't often the inflammatory driver

@Corcoran
That's really helpful advice, the only note of caution I would add ( and this is if asthma is diagnosed) is to NOT rely heavily on the blue inhaler ( otherwise known as Salbutamol or Ventolin).
This should only used as a reliever as you rightly point out, needing it more than twice a week indicates established inflammation which needs to be treated. If this isn't treated by Montelukast or a mild steroid inhaler, and instead the cough or breathlessness is treated by giving too much ventolin, then what that does, is open up the constricted airways, masking the underlying cause, which is inflammation, which can and does lead to catastrophic asthma attacks and death.
The caveat to this is that it can be used in an acute setting, ie, before getting to hospital for proper treatment. It would be 6-10 puffs, depending on the age of the child, delivered via a spacer, with a mask (mask is essential).
That's why they withdrew sole asthma treatment with "Long- acting beta 2 Agonists, basically a long acting ventolin/Salbutamol inhaler.
This should only be used in conjunction with a preventer( usually brown/ dark red) inhaler.
OP, does your little one cough on exertion, ie when running around or in cold weather, especially going from indoors to outdoors?
Another very typical and persuasive symptom of asthma.
Sounds like you know this Cormoran, so I'm just typing it for the wider audience who may read this thread.
Having said all that, to have spare ventolin for school, handbags, swimming/activity bags is essential.

Sounds identical to my daughter. In our case, she did grow out of the cough rather than an asthma diagnosis. They called it pre school wheeze. She was given an inhaler at times and sometimes antibiotics. It was torture with the lack of sleep (mine).

The excema also improved a lot. It occasionally got infected too. So watch out for it getting angry and spreading.

She finally got allergy testing age 6 after a severe reaction. It's all the pollens, dust etc. She takes daily anti histamine.

I'm very careful with soaps, washing powder etc. And I'm supposed to do a lot more dusting! Anti allergy covers on bed and mattress. Try to keep her room fairly clear.

Ps. My dd had awful reflux too.

And after reading every comment above I just wanted to reiterate that you must ditch the shake and vac, probably forever. You need to be using the mildest, most sensitive of everything. Plus extra rinse on washing. No fabric softener.

FWIW, my DS now 22 has been on a steroid inhaler since he was 18 months old for asthma ( he actually has a combined steroid and long acting salbutamol as he has fairly established but v well controlled asthma). He is 6 foot 2 and recently has a bone density scan ( for work as part of private heath insurance which was provided) which was entirely normal.
The beauty of the inhaled route for administration of the anti inflammatory effect from the steroid is that it is v low dose and delivered locally, ie, straight to the airways, rather than taken by tablet and absorbed systemically, where the side effects are hundreds of times greater. It's like putting a bit of hydrocortisone on some eczema. Sometimes, a short course of steroids is absolutely necessary if the asthma attack is triggered, for example by a respiratory virus. But the benefits outweigh the risks in this situation.
Untreated asthma, or only treated with Ventolin can lead, in the long term, to what's called "remodelled airways". This is when inflammation has become entrenched in the airways, and rather than it being reversible constriction, scarring takes place, the airways thicken and become chronically and irreversibly constricted, as if you have smoked 20/day for 50 years, it resembles a COPD picture.
1,400 people die each year still, from asthma, but it is so much better understood now and since the introduction of inhaled corticosteroids in the early 60s, the deaths from asthma have vastly diminished. Poor compliance with treatment is the most common cause of preventable asthma deaths today.

Hi all,

Many thanks for all of your messages.

Today she has dry red patches but mainly down one side of her body. Now on her leg too!

I have replaced all household stuff with eco-cover, we now have the eco-egg for washing. I've ditched the shake and vac and the air fresheners.

I'm keeping a food diary, a coughing diary and also a skin diary.

I haven't done the elimination diet as people here have said because of nutrients etc. However, I have cut her food down to a select few ingredients as that may show me something. For example, I will alternate two cereals, two lunches and two dinners. She eats broccoli every day along with other fruit and veg, and then mainly fish. She doesn't often eat meat. So I'll be strict on that and keep an eye.

Once we have done a week of this, I'll then try the change in milk. I don't want to change too much too soon. Hopefully the paediatrician appt won't be too far away!

The GP gave her Infant Gaviscon in the meantime.

Good steps op. I'm pretty convinced with my daughter it's not diet related. Even the allergy nurse asked me several times if I was sure she didn't want to test for peanuts. She eats tons and is fine.
What gave us the reaction requiring a hospital visit was a scented rubber doll. She got testing in case it was latex, but it wasn't. She can't however wear any latex, m&s is good for latex free. Dd used to get bands of reaction around her sock and pants elastic until we switched.
The allergy nurse said piritize for life was likely. Her dad is similar.

But..... it's so much better than the peak of night coughing we had age 2. I remember it so well as I was pregnant. Her sister has no allergies, sensitivities or night time coughs. (Just a whole load of her own other issues).

So eventually you might get answers. But in our case it was slow steps.

Today she came up with a massive hive looking rash. Like stinging nettles. I watched it spread all over her legs and bum. Gave her Piriton which helped. Then this evening a temp of 38.4 and fast breathing (about 38 breaths per min). She hasn't eaten much food the last couple of days either, which isn't like her at all. Rang 111; they said they will call in five hours.

How is she? I took mine to hospital with that type of rash and they gave her steroids and antihistamines via injection (We were on holiday in spain).

Temp went down, rash faded. In the morning around the same time the rash appeared again. It's now evening and breaths per min is 53 per min, temp 35.8. She also is holding her breath a lot (might be bc she is bunged up)

Op, I don't want to scare you and, I'm not a doctor, but if it was me I'd want her seen immediately. Is your thermometer accurate? Try it on yourself. A low temperature like that and her other symptoms would be a concern. Together with the rash I'd be calling now.

In fact I'd be straight to hospital. Op I really am quite worried, please let me know how she is. The holding breath could be respiratory distress.

Her temp is now 36.8 and she is asleep. Her breathing is now 33 per minute. So she seems to be going back to normal!

My son had the rapid breathing at this age he was in my arms, he suddenly went floppy, well he was rushed to hospital there for two days. They diagnosed asthma we had a few more scares like this, in those days you could not buy a nebuliser for less than £400 which we could not afford. Please watch the breathing and phone nhs if you think it is serious. He did outgrow it but he had snotty nose often it was all related looking back allergic rhinitis, asthma.

Maybe look at primary immune deficiency.