Flixotide to prevent chest infections in baby?

[Prometheus]

My DS is 14 months old. Every time he gets a cold it seems to go onto his chest and the doctor prescribes a nebuliser with Ventolin.

With winter approaching, the doctor has suggested he use an inhaler of Flixotide twice a day to lessen the chances of future colds giving him a chest infection. I live in Belgium where doctors tend to over-medicalise so I'm not sure what to do.

Flixotide is a cortisone and the list of common side effects (such as oral thrush and discolouration of the mouth area where the cortisone would touch his skin) seem very common (more than 1 in 10 it says on the leaflet).

I don't know how to weigh up the dangers of repeated chest infections over the winter causing him long term lung problems or asthma versus the daily use of a cortisone that is normally used to treat asthma and serious bronchial infections.

Does anyone have any experience of Flixotide and can advise? Thank you!

Your DS sounds like my DS so I am watching this with interest. DS is 13 months, had a bad cold at 7 months and was also treated in an extremely over-medicalising country (Romania). Ventolin, Flixotide and cortison intraveneously in hospital, two courses of different ABs after relapse after first one. (Ah yes and nebuliser with adrenaline which second opinion doc back home said should never have been given.)

Whole thing made me feel very uneasy and yet he was very poorly at the time and I'm not such an alternative medicine person to contradict what the doc says! Roll on to now and DS still has a bit of a cough, sounds wheezy the moment he gets a slight cold and I am dreading the start of this winter's coughs and sneezes caught from his big sister. And I am still in overmedicalising Romania so reluctant to take him to a doc here or the medical sledgehammer will be wielded over again. But then my delay might be why it got so bad the last time???

All these steroids scare me and a doc in the UK told me this is classic Eastern Europe as they are cheap. But I also know Germany is faster to prescribe things like this than the UK, at least this is the impression I get.

Sorry to hijack, you have my sympathy. By the way is there a link between repeated chest infections and developing asthma? Friend of mine was diagnosed with repeated chest infections as a child and it wasn't until she was quite old they decided it was actually asthma. We were pondering whether nowadays (old git emoticon) it would be diagnosed much earlier as asthma? That thought has gone through my mind in relation to DS. Good luck.

As far as I am aware, Flixotide will not prevent chest infections - it will ease any symptoms from a chest infection, helping him to breathe more easily, but it's a corticosteroid, and these do not have any anti-infective properties. Perhps the benefit from it will be that it will reduce the breathing restriction caused any cold/chest infection but it wouldn't prevent it.

Asthma, BTW, is difficult to diagnose in an infant - the 'definitive' diagnostic tests rely on the subject being able to complete breathing manoeuvres, and an infant just cannot do this. A doctor will give a primary diagnosis of asthma on a small baby on the 'index of suspicion' (i.e. it looks like asthma, it behaves like asthma, it responds to treatment like asthma so it probably is asthma).

NB: am not a doctor, just a scientist. Probably best to wait for one of the properly-qualified bods to come along

I agree that flixotide will not prevent infection. Flixotide is used to reduce inflamation in the airways. The risk of oral thrush is usually reduced by rinsing the mouth out after use although I have no idea how you would do that with a child that age.

Thanks for the comments. romaniabound - your DS sounds very similar to mine. My DS caught a very bad cold/bronchiolitis at 6 months when he started creche and since then, every cold has gone on his chest.

He is developing a cold now (just started sneezing and generally under the weather) and already on day one I can hear his chest starting to wheeze.

Our doctor said that flixotide was the only way to prevent chest infections (?) and the other option would be to undergo some very invasive tests when he is around 2 years old.

I do think if we lived in the UK the advice would be very different.

My DS was originally diagnosed with bronchiolitis here in Romania too but they changed their mind to and fro between doctors and a friend GP in the UK thought it was unlikely it was bronchiolitis and that if it was, they had treated it wrong .

He also said at the time I should not let them near him with any more steroids because it would take him longer to get over the chest infection.

My DS is this evening coming down with the cold his sister got over the weekend. He is sounding chesty already. He is a huge strapping big bonzo of a baby and yet seems quite a fragile wee thing when his cough starts up. Hope your DS has an OK night!

Just a few points. Flixotide reduces narrowing of the tubes in the lungs and may prevent chest infections because reducing inflammation ensures better air entry and poor air entry in all ages can lead to chest infections.
Wheezing in small children (under 1) can be caused by bronchiolitis which in turn can be caused by by a virus know as RSV although not babies with bronchiolitis are RSV positive. The primary treatment is supporting the child maintaing oxygen saturations with oxygen, ensuring adequate but not excessive fluid intake and sometimes nebulizers/inhalers. Many children who've had bronchiolitis will not go onto to develop asthma.
Most paediatricians are reluctant to diagnose asthma in under ones although they are likely to suspect a child has asthma if they have repeated admissions for wheezing and are wheezy when they do not have a cold.
As the mother of a severely asthmatic child there are no invasive tests necessary to diagnose the condition. My DS had four episodes of pneumonia requiring admission to hospital and three admissions for bronchiolitis hospital again and he wheezed in between admissions all before he was 12 months old. The only remotely invasive diagnostic test he has ever under gone was to exclude cystic fibrosis.

Thanks for all the advice. DS now has a fully blown cold, chesty cough and is wheezing. He doesn't wheeze when he is cold-free - at all. This is one of the reasons why I am reluctant to give him a twice-daily puff on the Flixotide over the coming winter with the aim of reducing the likelihood of wheezing when he does catch a cold.

I gave him a puff of Ventolin this morning (left over from last cold) to clear his chest a bit.

romaniabound - I don't even know for sure that it was bronchiolitis that DS had when he was 6 months old. The doctors here said it was 'un peu de bronchite' and they say the same thing when he gets a cold and wheezes. I can't help think that in the UK the GP would simply advise calpol and lifting the head of the cot etc. rather than ventolin and steriods.

Flixotide would be very unlikely to do your DS any harm it's only in longterm high dose use do problems arise and then only if not monitored correctly children on long term high doses of inhaled steroids are usually monitored by paediatricians rather than practice nurses/GP for this reason. On the other hand wheezing in babies can become serious resulting in admission to hospital and in the worse cases admission to Intensive Care for ventilation (it's rare but it happens). Even mild wheezing is distressing for babies and reduces their ability to function in normal every day life.
In my experience most doctors have your child's welfare at heart and don't just prescribe medication for the sake of it. In the UK plenty of under ones are treated with steroids and nebulizers and have no long term side effects. As a general rule of thumb you can take 5 - 6 short courses of high doses oral steroids without having any serious effect. On the other hand those steroids may reduce the need for much more aggressive intervention.

I meant to say 5-6 short courses of high dose steroids a year
are unlikely to cause any serious side effects.

Thank you happygardening - my doctor wants DS to take the steroids all winter (i.e. from now until Feb/March) which is one of the reasons I'm slightly worried - 2 puffs a day on a steroid inhaler for 5 months.

Anyway - DS's cold has now turned into 'un peu de bronchite' once more. Not slept for 3 nights, temp of 39 degrees and really chesty . We have more ventolin, amoyxcilin, antibiotics ear drops (slight ear infection) and antibiotic nose drops