Managing infant wheeze (post-viral wheeze)

Witnessing your small child fighting for breath can be a harrowing experience. Wheeze affects huge numbers of pre-school children but there's very little information out there for stressed, desperate parents who don't want to just hang on until their children 'probably grow out of it' (which is essentially the medical position on wheeze) and want to find some way to relieve their symptoms now.

Our youngest daughter first developed wheeze shortly after turning two years old. Over a few months during the autumn and winter of 2020 she suffered repeated episodes which grew in severity. In December of that year she was hospitalised for nearly four weeks, was intubated and spent over two days on a ventilator. This terrible experience of powerlessness as she nearly died propelled me into a years-long search to understand and hopefully cure her condition.

I am very pleased to say that she is now in excellent health and suffers only occasional and mild episodes of wheeze. Her episodes gradually decreased in frequency and severity. She no longer needs daily puffs from her brown inhaler (inhaled corticosteroids) though we do sometimes bring it back into play when she has colds or her sinuses are inflamed.

While our interventions have been varied, considered and almost ceaseless since the winter of 2020 I do think that ultimately her growth and development has been the decisive factor. Children mostly do just grow out of it as they get bigger.

That said, if you're living through your child's journey with wheeze, you want to be able to act to reduce the severity and frequency of their episodes. What follows is not medical advice and is not intended to replace the advice of your child's medical professionals but it will empower you to greater understanding of the condition and give you some things to try at home to help your wheezing infant.

What is (viral) wheeze?

I don't have a straightforward answer on this one. I think it's poorly understood by Western medicine, as is the case with most chronic conditions. We can describe what's happening physically when a child is suffering from wheeze but putting a finger on what's causing it is very difficult.

Physiologically speaking, the child is unable to take full natural breaths in an identical manner to asthma sufferers. The small airways of the lungs (bronchioles) are surrounded by smooth muscle, similar to that which surrounds our digestive tract and which produces the peristaltic movements which push food through the body from throat to anus. When this smooth muscle around the bronchioles contracts the airways get narrower. This airway narrowing is made worse by inflammation and excess mucus. The wheezing child is then unable to fully empty their lungs and replace the old air trapped inside with new air.

 

Picture credit: NIH Image Gallery via Flickr

You may have noticed that your wheezing child is barrel chested when they're in the midst of a severe episode of wheeze - the ribcage is elevated because they can't fully breathe out and return their lungs to full capacity. Instead they're breathing with only a small fraction of their lung's normal volume.

Adrenaline, one of the stress hormones, causes the smooth muscle surrounding the airways to relax so that more air can get into and out of the lungs. This is why the blue inhaler is so effective - drugs like salbutamol are beta2 adrenergic receptor agonists which mimic the effect of adrenaline on the smooth muscle cells and get them to relax very quickly. These kinds of drugs, which relax the airways, are known as bronchodilators.

Why humans have this smooth muscle around their small airways is not entirely clear. It's presence seems to be an evolutionary hangover from small aquatic mammals which need to constrict their lung capacity when diving so that they don't get the bends (decompression sickness). This mammalian dive reflex kicks in as soon as the nervous system senses wetness around the mouth and nose - we'll come back to this later.

Inflammation, the other big factor in reducing the ability of the lungs to draw in and expel air, is controlled by steroids - particularly the steroids produced by the adrenal glands situated above the kidneys. The brown inhaler delivers corticosteroids like beclomethasone dipropionate directly to the lung tissues. Oral steroids like dexamethasone and prednisolone deliver much higher doses to the entire body, which is why they're used in more severe episodes.

The classic pattern of our daughter’s wheeze episodes would be as follows. First she would cough for two or three days. Coughs are short, sharp contractions of the muscles used to exhale. They forcefully expel air from the lungs. For our daughter, dry, hacking coughs were the first warning sign that she was struggling to get air out of her lungs. The coughing would get worse at night, stopping her from sleeping. Over the course of two or three nights she would get progressively more tired and her muscles of respiration would start to fatigue. Then her breathing would start to become laboured and we’d become anxious about when was the right time to take her into A&E for a course of oral steroids.

Sometimes she’d recover from these episodes without steroids so we never wanted to give them to her unless it was definitely necessary. Systemic corticosteroids have always been linked with slowed growth in children and our daughter was already very small for her age. Prolonged steroid use also suppresses the immune system which is needed for dealing with the colds and infections which might trigger wheeze episodes.

They did always work though - within an hour of getting an oral dose of steroids the tightness in her chest would go and her breathing would relax. The cough would return a bit later as a hearty, phlegmy cough to clear the mucus from her lungs and though she’d look pale and wan for a few days afterwards, we knew we were out of the woods for at least a little while again.

Viruses, allergies, inflammation or something else?

We’ve never been able to say with any certainty what was causing our daughter’s episodes of wheeze. They did often seem to follow minor viral infections (colds and flu viruses) but not always - the Covid virus for example barely touched her. She did seem to suffer from episodes more frequently at the onset of pollen season. The frequency of her episodes decreased markedly when we started managing allergens, including eliminating dairy from her diet, but this change coincided with starting her on the brown inhaler, so it's hard to say which was the decisive factor. (These days she's mostly off the brown inhaler, eats loads of cheese and chocolate and is doing fine.)

Another hypothesis about infant wheeze which was published in 2023 by Professor Gary James Connett of the National Institute for Health Research in Southampton suggests that the mammalian dive reflex mentioned earlier may malfunction in children who have suffered pre-natal trauma (stress during pregnancy), kicking in when the child has sinusitis or a wet nose due to a viral infection, or due to some other kind of stimulus that was present at the first episode.

I give this hypothesis a lot of credence: our daughter’s episodes were often accompanied by sinusitis. I have also found that an anticholinergic antihistamine, which suppresses the activity of the vagus nerve which carries the dive reflex, can help to relieve mild early symptoms (though of course this could be because antihistamines reduce inflammation associated with allergies!) She was delivered by caesarean section at 38 weeks and her initial episode coincided with her toilet training period, a stressful time for toddlers.

 

Though it could well be the case that wheeze takes different forms in different children and that this is just one typology.

What parents can do to help manage infant wheeze

This list is not exhaustive and I must stress again that it does not constitute medical advice. I am not a doctor and would never suggest that you ignore the advice of your child’s medical professionals.

These are things that you can try that are non-invasive and won’t cause any harm. They’ll give you a feeling of being proactive, which will reduce your stress and that can only have a positive effect on your health and the health of your child. The role of anxiety in chronic respiratory disorders cannot be overstated - if you can keep yourself calm then you can help keep your child calm and that’s going to help massively.

That said, don’t get fixated on any these interventions. Your child will almost certainly have more episodes. None of them will be directly caused by anything you did or neglected to do. Focus on what you can do to make your child more comfortable now, to reduce the severity of the current episode and the one after that. Don’t kick yourself for not preventing this one.

Keep a journal

Start keeping track of the date of every symptom, every medication administered, every doctor or hospital visit and if possible, what the weather was like that day, what the child had been eating, what they did on the previous days.

At first this may seem pointless, but a year down the road if your child is still having episodes and there’s any pattern to spot, you’ll be able to spot it. With luck, you’ll also be able to see the effect (or lack of effect) of any interventions you make like dietary changes and allergy management. If nothing else, you’ll be able to talk confidently to doctors and nurses about your child’s symptoms, frequency of attacks and medical interventions.

Take your child to a naturopath

We started seeing Charlotte Tiffany a few months after our daughter’s major hospitalisation and it was a real turning point in the journey. NHS doctors have no choice but to treat your child as a basket of symptoms. A naturopath will see the whole person and the family surrounding them, they’ll listen to you, they’ll have a whole different view of chronic disease to Western medicine and they’ll prescribe dietary changes, lifestyle changes and possibly herbal supplements.

It’s so important to have a trusted ally in this journey who sees you and hears you.

See a counsellor or therapist

On the same note, episodes of wheeze can be traumatising. Finding someone to talk to about it can help you manage your anxiety around your child’s condition so that it doesn’t become a barrier to being helpful. I had a lot of guilt to let go of before I could be a really effective carer for my daughter - I couldn’t have done that without talking to a therapist.

Don’t buy processed food

I am convinced that industrial seed oils like sunflower oil (vegetable oil), rapeseed oil and palm oil cause inflammation and should be avoided. These oils are in almost all processed food. Don’t cook with them - use coconut oil instead. It’s more expensive but the health benefits are worth it. (Try not to cook with olive oil either - it breaks down into toxic compounds under high heat - just use it for flavour.)

Loads of fresh fruit and veg

Get as much fresh fruit and veg into them as you can. They’re packed with antioxidants which help combat inflammation, with essential minerals for aiding smooth muscle relaxation (magnesium and calcium) and repairing the lung tissue damage resulting from wheeze episodes. Fruit and veg also delivers a lot of vitamin C which (as well as being a powerful antioxidant) boosts immunity to help prevent the colds and sinus infections that can often trigger episodes.

Use essential oils

We’ve had an essential oil diffuser is our children’s bedroom since early 2021 and I think it’s really helped, particularly with stuffy noses which so often precede our daughter’s episodes of wheeze. Tea tree, lavender, rosemary, ravintsara, orange, peppermint and eucalyptus have all proven effective. Just make sure you don’t add too much essential oil as that can be counterproductive.

Learn how to breathe consciously and then teach your child

Few of us really know how to take full, natural, relaxed breaths. Most of us have a restriction in our breathing somewhere - either we breathe too much with the chest or throat, or we breathe into the chest and belly in the wrong order, or we fail to relax our abdomen or pelvic floor.

A full, natural, easy breath should start in the belly with relaxed abdominal muscles and a relaxed pelvic floor so that there’s loads of room for your diaphragm muscle to push your organs down and expand the chest cavity. Then your ribcage should expand outwards before swinging up. An outbreath reverses the order.

Of course, it’s not easy teaching a one year old or two year old to do this - especially if they’re already in an elevated state due to a wheeze episode. But it’s likely that their condition has led them to breathe too much into the chest, which itself is anxiety provoking due to the effect it has on the sympathetic nervous system. If you start introducing the idea that when they breathe in their belly should go out, and when they breathe out their belly should go in, and that slow, deep breaths can help relax them, and keep reinforcing the idea, eventually it will pay dividends. As they become more conscious of their breathing and how they can use it to influence their energetic state, they’ll feel more empowered and less anxious about their wheeze episodes.

Try gentle massage

During wheeze episodes the respiratory muscles can get severely overtaxed which leads to chronic tension persisting between episodes and contributing to the severity of subsequent episodes. Some gentle massage therapy can help them to relax and heal as well as having a positive effect on the whole nervous system of your child (and yours as well). You’ll need to go gently - children get irritated by massage very quickly - but often just laying a warm hand on the affected muscles for a minute or so can have a hugely positive effect.

Muscles to pay attention to are located all around and under the rib cage, the abdominals, the mid and upper back and the neck - particularly at the sides and front of the neck though this is a difficult, tender area to massage so go extra carefully. You can sneak these massages in while cuddling in front of a book or the TV.

I hope this post has been helpful. If you have any questions please don’t hesitate to get in touch by email: hello@jamiemassage.co.uk