Tips for surviving respiratory illness season.

[Tiredmumma221]

We survived most of last winter and then got hit with over a weeks stay in hospital for bronchiolitis in May this year just before his 1st birthday.

Since then my little boy has been prescribed a blue and brown inhaler as his cough stayed around. Since the weather has got colder he has been up most nights coughing and needing his blue inhaler. We've been back and forward to the GP who thinks he's probably got asthma but he's too young to diagnose.

I'm dreading winter setting in, he goes to nursery full time so I know all the germs are on their way.

Any tips from the seasoned pros out there.

Are you under a respiratory clinic or nurse at the hospital? If not ask your GP to refer you. They should put a wheeze plan together for you. The main thing is to be religious about the brown inhaler use - this is the one that has the big impact. If he's needing his blue inhaler most nights then it sounds like he needs his treatment plan reviewed as his breathing isn't under control.

My dd was hospitalised with RSV twice in her first year and need the inhalers many times in her second winter. Towards the end of last winter I decided to take her to a cranial osteopath, the osteopath found tensions in the rib cage which she released and since then she has still had colds but none have needed inhalers or hospital treatment.
I will never know if she had just grown out of it or if the osteopath managed to make it easier for her body to clear virus’s from her chest but if you are desperate it could be worth a try.

I cannot say this enough times as have been through this every year with now 4 year old DS who is treated as asthmatic but can’t have formal diagnosis. When I say he has spent weeks in hospital every winter, been on hdu etc etc, the only thing that has made a life changing difference is montelukast. He had allergy testing which all came back clear and his only asthma trigger is respiratory illnesses. We have just passed the year mark of no admissions touch wood. He’s been on montelukast since January.

He isn't under anyone at the hospital. The GP is quite unbothered and keeps telling us the same thing that he's too young for a diagnosis.
He's been on the brown inhaler since the end of August and that has helped. But is still coughing himself awake at least twice most nights. He's not too bad in the day.

Thanks for this advice. What age did your DS go on it?
I will ask the GP (if we can ever get an actual appointment)

He might be too young for a formal diagnosis (my son is the same) but that doesn't mean it's a fictional problem. It will be classified as a viral wheeze but the mechanism is the same as asthma, just the main trigger will be getting a cold rather than exercise. He has breathing issues and the GP needs to take it seriously. I'd ask for a referral. As the PP said, montalukast is an option if he's still having issues, or you may be able to increase his brown inhaler. You should also know what to do if he starts sucking in at his ribs or base of his throat, has rapid breathing, or his oxygen saturation levels drop (we have a pulse oximeter at home) so if they haven't given you a care plan for that you need to push for one.

Thanks for this info. It's really helpful to know that I should be pushing for more. It's on his GP notes as a viral wheeze, but we don't have a care plan or anything.

When he was in hospital in May his SATS were pretty low and he ended up needing high flow humidified oxygen for several days and the needed regular low flow and struggled to get off it when sleeping.

We had a pulse oximeter, but it doesn't seem to read very well. Do you have any recommendations for a good one for small children?

He was three. The asthma nurse at the hospital requested a prescription from gp and now they do it every month with (so far 🙏🏻) no issues. X

We've got this one at the moment Kinetik Wellbeing Finger Pulse... https://www.amazon.co.uk/dp/B07NV9WFNT?ref=ppx_pop_mob_ap_share

Try to warm his finger up a bit beforehand, and he'll need help keeping his hand very still. Don't put his finger all the way in - it'll be too little to get a good reading like that. Stop just before the end.

But with the oxygen levels, remember that kids compensate really really well by upping their breathing rate and using extra muscles to force air in...right up until they don't and they get tired and it comes crashing down. So if he is sucking and breathing fast but his sats look fine, take him up to A and E anyway. If his levels are low he obviously also needs to go if he's struggling.

Thanks, this is really helpful.

That's exactly what happened to him. He was starting okay for ages and we were admitted on to the ward and then he crashed really fast.

My friend told me to video him when he's calm and breathing normally so I know what his baseline is.

We were told after his last bought that because of how poorly he got it's likely to happen again.

So far he's been okay, I just know the germs in nursery are picking.

I agree, if you're needing the blue inhaler most nights, it's not under control and he needs to be reviewed. Are you doing all the other cough tricks you can given his age? There's a fairly nasty cough doing the rounds where we are – it's had DD1 awake more than once, and she doesn't have viral wheeze. It was 'just' coughing.

DD2 does have viral wheeze, and with her the trick is to hit it hard with the blue inhaler as soon as her breathing starts to change. If I've caught it early, I give about half of the maximum puffs I'm allowed before taking her to A&E, but if I'm not getting on top of it, then we go up the scale pretty quickly. When needed, I will set an alarm to give more overnight (on a good night, I can do this without waking her).

Our local hospital aren't keen on home pulse ox for small children in part because of this (and in part because of tiny fingers and poor fit). They preferred to set respiratory rate and pulse rate thresholds, and if she hits those or she's retracting, to A&E we go. I must find out if they want to adjust the numbers for this winter, now that she's a year older...

Same as this - we can go up to ten puffs in one go, but if that doesn't sort it and he needs more within four hours we have to go to hospital. Our standard discharge plan is six puffs every four hours day and night for 48 hours which typically gets us over the hump of the virus and then things calm down. But you do want an agreement from them on how to proceed because right now it's not controlled and he is very likely to get it again when he inevitably gets a cold.
Also just a heads up - my son typically gets breathing issues at the back end of a cold rather than in the middle. So keep a close eye even when you think you're in the clear!

I'll get him to the gp again tomorrow and see what they say. Last time we went they said to give him his blue inhaler on worse nights before he goes to bed as well as his brown.

He's 17 months old, we we've been using the calpol plug in and his cot is propped and we use saline nasal drops.

Good plan. Don't let them fob you off (easier said than done I know!).

Last time we went, I asked how many times I could give DS his blue inhaler before he needs to be reviewed and the GP said that because DS doesn't have a diagnosis there isn't a set amount (which I know is rubbish).

Dd has asthma - dx age 4 but only after years of hospital stays starting pre age 2 including HDU admissions and proactive treatment. Accepted under hospital consultant care for resp by 2.5. Also thrived on montecalust (but had terrible nightmares so had to be discontinued). Finally (now turning 6) have her steady-ish on a combo of purple inhaler and blue - but I know overall she still requires as hoc steroids and they’d prefer this didn’t happen. At your son’s age I think she had oral steroids 8-10 times in a year (often post nebuliser/a&e, it sucked)!

Prevention tricks - thermal everything especially at change of season. DD will wear good brand tights under leggings/bottoms, ski quality jackets, wool jumpers, constant availability of gloves (cheap as we lose them but means there’s multiple sets in the change bag). Pyjama type socks. Making sure her feet don’t get wet. Thermal t shirt under her school uniform.

Slightly warm water if transitioning from a cold space to a warm one can help reduce her cough. We’ve practiced her inhaler technique, slowing her breathing with the asthma nurses and that’s really helped reduce the ‘number’ of blue (and linked a&e). She sleeps on two pillows when she does have a cough/cold (and one normally) and being propped up also helps. Like the previous mum, I do have to set alarms and administer overnight on occasion especially at this time of year.

BUT context background here being, far more than two wakes a night coughing. That’s what we now aim for.

Your friends tip for video when well is a good one. I have one I use to remind myself to compare when I think she is ‘catching’. But actually our biggest tell, is that her mood disintegrates and she goes from charming, to irritable, rude and shouts/sad - and it nearly always precedes an illness or asthma admission (which does nothing for the mum guilt!) but hey ho. I’m getting better at noticing.

Sending hugs, it can be scary. Especially when they are little. For the last few years I kept a hospital bag packed at this time of year - just with a pair of pj’s, a spare teddy, two books, some colors/easy small toys, spacer and both inhalers and some long life snacks (mainly for me, she won’t eat when poorly). I’m realizing this year I haven’t needed it! So that has to be a good thing. Keep at the GP and even if there isn’t answers hope you’ve a bit more of a plan soon.

OP can you ask for an asthma nurse referral? Ours are brilliant and dd has been under their clinics since 3 ish

Obviously you want advice tailored to your child, but for what it's worth, our threshold is also 10 puffs every 4 hours before we have to go in. That said, if DD2 is struggling whilst we're en route to A&E, then our instructions are 'give what you need to give' – keep her breathing as well as possible until we get to more intensive help.

Don’t dry wet laundry inside the home, it’s really unhealthy for the lungs for more than one reason

Oh, tip for the horrifically bitter steroids – chocolate coats the mouth so they don't taste it as much. Get the syringe ready, and have two little pieces of chocolate ready. First piece of chocolate, as soon as it's swallowed, then syringe (near the back of the mouth if you can), then second piece of chocolate.

Montelukast is not helping me this time. I picked a bug up, probably at the panto 10days ago and can’t get on top of it. I’m using my blue inhaler too much. I’m so fed up. Good luck with all the sick little ones.