Viral-induced wheeze factsheet

Introduction

Viral-induced wheeze is a common breathing problem in children under three. It happens when a child has a viral infection and gets a cough or cold. The airways in the lungs become narrow and fill with mucus, making it hard for your child to breathe properly and causing a wheezing sound when they breathe out.

Viral-induced wheeze can also be known as:

reactive airways disease (RAD)
preschool wheeze
childhood asthma.

Viral infections are the most common cause of wheeze, but it can also be caused by:

bronchomalacia – immature or floppy airways
asthma – a breathing condition diagnosed in older children
living in an environment where there is cigarette smoke.

Signs and symptoms

Viral-induced wheeze will often start with cold and flu symptoms, including:

cough
sneezing
fever
increased snot and mucus.

Your child may then develop further symptoms and show signs of working harder than usual to breathe.

These can include:

wheezing – a whistling sound when breathing out
faster breathing
flaring their nostrils when breathing in through the nose
retractions - when skin pulls in around the chest, neck, and ribs in an upside-down V-shape while breathing
bobbing their head back and forth
leaning forward on their arms while sitting.

If your child has wheezing or trouble breathing for the first time and doesn't have an asthma action plan, call your local doctor or go to the nearest emergency department.

Diagnosis

Your local doctor can diagnose viral-induced wheeze. They will:

do a physical check of your child’s signs and symptoms
listen to your child's chest to hear them breathe
watch for signs that your child is working harder than usual to breathe.

Treatment

Treatment of viral-induced wheezing will depend on:

how severe your child’s symptoms are
whether this is the first time your child has had breathing difficulty
what caused the wheeze to develop.

Reliver medications and oral steroids

Your child’s doctor may prescribe medicine that will open the airways and reduce inflammation.

These can include:

reliever medications - bronchodilators that are breathed in using an inhaler and spacer, like Ventolin® or Asmol®
a short course of oral steroids taken as a syrup, like Redipred® or prednisolone.

The doctor will discuss treatment options with you and create a plan for future wheezing episodes. Antibiotics won't work for viral-induced wheezing as a virus causes it.

Treatment in hospital

Children who are very young or have more severe symptoms may need to be treated in hospital.

Treatment in the hospital aims to:

give breathing medications frequently, more than every three hours
check oxygen levels and give extra where needed
support with feeding and fluids.

Your child will get breathing medication and an action plan before going home from the hospital.

You will need to make a follow-up appointment with your local doctor within a week of leaving the hospital to check your child's recovery.

Managing wheeze at home

Children who have an action plan and have had an episode of viral-induced wheeze before may be managed at home if their symptoms do not get worse.

You will need to:

follow your child’s action plan
give their medication as directed
check that their breathing is not getting worse
call your local doctor if you are concerned.

Share your child's action plan and medication instructions with their other caregivers, and keep your child away from cigarettes and other smoke at all times.

Management

When to seek help

Call your local doctor or go to your nearest emergency department if your child continues wheezing in-between doses of reliever medication, or they have:

fast breathing
fast heartbeat
retractions - tummy and ribs sucking in when breathing
grunting noise when breathing out
breathlessness that stops them from speaking properly.

Call Triple Zero (000) for an ambulance if your child:

has trouble breathing
has a blue, green, white, or grey colour around the lips, tongue, gums, ears, and fingernails
gets worse very quickly.