Wheezing in children

Last updated: August 1, 2022

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This article provides an overview of conditions causing wheezing in children. While acute wheezing in children may suggest a common cold, an acute asthma exacerbation, viral bronchiolitis, foreign body aspiration, anaphylaxis, acute bronchitis, or croup, recurrent or chronic wheezing may indicate a diagnosis of asthma, double aortic arch, primary ciliary dyskinesia, cystic fibrosis, tracheomaicia, or left-sided heart failure with cardiomegaly.

For more information on each specific condition, see the respective articles.

Differential diagnosis of acute wheezing in children
Disease

Age

Characteristics Diagnostics
Common cold
  • Children < 6 years of age have an average of 6–8 common colds per year. [1]

Acute asthma exacerbation

Viral bronchiolitis
  • Primarily affects children < 2 years of age during winter [4]

Foreign body aspiration (FBA)

  • Primarily occurs in children < 3 years of age [5]
Anaphylaxis
  • Occurs at any age
Acute bronchitis
  • Most common in children < 5 years of age [6]
Croup (laryngotracheobronchitis)
  • Peak incidence: 6 months to 3 years of age [7]
Differential diagnosis of chronic or recurrent wheezing in children
Disease

Age

Characteristics Diagnostic findings
Asthma
Double aortic arch
  • Congenital; manifests in first weeks of life [8]

Primary ciliary dyskinesia

  • Median age at diagnosis: 5.3 years [9]

Cystic fibrosis

Tracheomalacia

  • Congenital; symptoms usually manifest at 4–8 weeks of age [11]
Left-sided heart failure with cardiomegaly
  1. Benjamin I, Griggs RC, Fitz JG. Andreoli and Carpenter's Cecil Essentials of Medicine E-Book. Elsevier Health Sciences ; 2015
  2. Most Recent Asthma Data. https://www.cdc.gov/asthma/most_recent_data.htm. Updated: February 27, 2017. Accessed: April 19, 2017.
  3. Mirabelli MC, Beavers SF, Chatterjee AB, Moorman JE. Age at asthma onset and subsequent asthma outcomes among adults with active asthma. Respiratory Medicine. 2013; 107 (12): p.1829-36. doi: 10.1016/j.rmed.2013.09.022 . | Open in Read by QxMD
  4. Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev. 2014; 35 (12): p.519-530. doi: 10.1542/pir.35-12-519 . | Open in Read by QxMD
  5. Wang K-P, Mehta AC, Turner JF, Jr. JF. Flexible Bronchoscopy. John Wiley & Sons ; 2012
  6. Fleming DM, Elliot AJ. The management of acute bronchitis in children. Expert Opin Pharmacother. 2007; 8 (4): p.415-426. doi: 10.1517/14656566.8.4.415 . | Open in Read by QxMD
  7. Lowen AC, Mubareka S, Steel J, Palese P. Influenza virus transmission is dependent on relative humidity and temperature. PLos Pathog. 2007; 3 (10): p.1470-6. doi: 10.1371/journal.ppat.0030151 . | Open in Read by QxMD
  8. Shah RK, Mora BN, Bacha E, et al. The presentation and management of vascular rings: An otolaryngology perspective. Int J Pediatr Otorhinolaryngol. 2007; 71 (1): p.57-62. doi: 10.1016/j.ijporl.2006.08.025 . | Open in Read by QxMD
  9. Kuehni CE, Frischer T, Strippoli MPF, et al. Factors influencing age at diagnosis of primary ciliary dyskinesia in European children. European Respiratory Journal. 2010; 36 (6): p.1248-1258. doi: 10.1183/09031936.00001010 . | Open in Read by QxMD
  10. Accurso FJ, Sontag MK, Wagener JS. Complications associated with symptomatic diagnosis in infants with cystic fibrosis. J Pediatr. 2005; 147 (3): p.S37-S41. doi: 10.1016/j.jpeds.2005.08.034 . | Open in Read by QxMD
  11. Yang D, Cascella M. Tracheomalacia. StatPearls [Internet]. 2022 .

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