Is early childhood asthma possible in an infant?

Question

Hello doctor,

I would like to kindly request a second opinion regarding our two-year-old daughter's health. She began attending childcare several months ago and thoroughly enjoys it. However, since then, she has experienced two significant episodes of illness that have raised some concerns for us.

Since starting childcare, she has fallen ill on two separate occasions, a few weeks after joining and again a few months later. In both instances, the doctor diagnosed her with a respiratory infection that progressed from viral to bacterial and prescribed the following treatments:

Steroids, Prednisolone suppositories
Ventolin inhaler, administered several times daily over two weeks.
Zithromax, Azithromycin antibiotics, 2.5 ml daily

Each episode began with a sore throat and reduced appetite, then a cold, and finally a persistent cough and wheezing. We have been advised that this is a common consequence of exposure to other children in childcare settings.

Notably, this is now the third time overall that she has been prescribed Ventolin. The first episode occurred approximately nine months before the most recent illness.

Given this background, we would appreciate your views on the following:

Could these recurring symptoms indicate early signs of asthma?
Is it normal for a two-year-old to have been prescribed Ventolin on three occasions within the span of less than a year, or should we be concerned?
Are there any further investigations or precautions you recommend?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Thank you for your detailed and thoughtful summary regarding your two-year-old daughter's recent health concerns. As a parent, it is entirely natural to be concerned about repeated illnesses in a young child, particularly when treatments involve medications like steroids, inhalers, and antibiotics.

Based on the information you have provided, I will address your specific questions regarding the possibility of asthma (a chronic respiratory disease causing airway inflammation, mucus buildup, and muscle spasms), the appropriateness of Ventolin (Salbutamol) prescriptions at her age, and what further steps might be advisable.

Given that your daughter's symptoms have occurred primarily during illness and not outside of it, from what you have described, she may currently fall into the category of transient early wheezers. These are children who wheeze during infections but are less likely to develop chronic asthma later.

However, if she continues to have more frequent episodes, particularly with wheezing or nighttime coughing, asthma becomes more likely. In clinical practice, it is not unusual for toddlers with virus-induced wheeze to be prescribed Ventolin (Salbutamol) multiple times a year.

Reducing exposure to environmental triggers can make a significant difference, especially if your child has sensitive airways. These measures include avoiding tobacco smoke, both direct and secondhand, using dust-mite-proof bedding and vacuuming frequently, considering a HEPA (high-efficiency particulate air) air purifier, and minimizing exposure to pet dander and strong fragrances.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.