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If the pediatrician says that my toddler has “a wheezy chest, “does she have asthma?

Not necessarily. Some pediatricians will not even use the term “asthma” until a child is 2 years of age or older. Wheezing in infancy is never normal. It can, however, be divided into two general patterns: non-allergic wheezing and allergic wheezing (Table Patterns of Wheezing in Infants). In the first instance, wheezing occurs when the infant becomes ill with an acute upper respiratory viral infection. The infant’s airways grow larger in the preschool years, and the wheezing disappears as the toddler grows. In non-allergic wheezing, symptoms seen in infancy do not recur with subsequent upper respiratory viral infections. The “wheezy chest” is not an early manifestation of asthma.

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Table Patterns of Wheezing in Infants

Non-Allergic Wheezing
• Wheezing when sick with viral upper respiratory tract infection
• Allergies not present
• Wheezing disappears as the baby grows in the pre-school years
• The wheezing seen in infancy is not a harbinger of asthma
Allergic Wheezing
• Wheezing when sick with viral upper respiratory tract infection
• Allergies such as eczema, food allergy, or rhinitis are also present
• Wheezing with viral upper respiratory infections persists as the child grows
• The wheezing in infancy is a form of asthmatic response

Infants who exhibit the second, allergic, pattern also wheeze when infected with an acute upper respiratory virus. But because they fall into the allergic wheezing category, they are more likely to have “real” asthma that continues throughout childhood. They are also more likely to have diagnosed allergies such as rhinitis, eczema, or food allergies. Their airways will also grow larger as they become toddlers, but the wheezing persists. They have asthma, not a narrowed, “immature” airway as a cause of wheezing in infancy during upper respiratory viral infections.

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