Wheezing in Children

What is wheezing?

Wheezing is a high-pitched, whistling sound that happens when a child breathes out (and sometimes when they breathe in). It is caused by air passing through narrowed or inflamed airways in the lungs.

Wheezing is a common symptom in young children and can be associated with many conditions. While asthma is a frequent cause in older children, wheezing in babies and preschoolers is often due to viral infections or other structural or developmental airway differences.

Causes of Wheezing in Children

Wheezing is a symptom, not a diagnosis, and may be caused by a range of conditions:

1. Viral Respiratory Infections (e.g. Bronchiolitis)

Most common cause in babies and toddlers under 2 years old
Typically caused by viruses such as RSV, rhinovirus, or influenza
Airways become swollen and filled with mucus, leading to cough, wheeze, and difficulty breathing
May occur as a one-off episode or recur with each viral illness

2. Pre-school Wheeze (also called Viral-Induced Wheeze)

Affects children aged 1–5 years
Wheeze is triggered by viral infections, cold air, or other irritants
Many children outgrow this by the time they start school
These children may not necessarily go on to develop asthma

3. Toddler Asthma

A chronic condition involving inflamed, sensitive airways
Common in older children, or those with a personal or family history of eczema, hay fever, or asthma
Triggers include viral infections, exercise, cold air, allergens, and smoke
Symptoms include recurrent wheezing, cough, chest tightness, and breathlessness

4. Structural Airway Problems (e.g. Bronchomalacia, Laryngomalacia)

In younger infants, especially those who have always wheezed from birth
Airways are softer or more flexible than usual, collapsing slightly with breathing
Symptoms are often worse with activity, crying, or feeding
Usually improve with age

5. Inhaled Foreign Object

Sudden onset of wheeze, cough, or choking, especially if it affects one side of the chest
Most common in toddlers who may accidentally inhale food or small objects
Requires urgent medical evaluation

6. Other Less Common Causes

Allergic reactions (including anaphylaxis)
Reflux-related wheezing (acid reflux irritating the airways)
Chronic lung conditions (e.g. cystic fibrosis, primary ciliary dyskinesia)
Heart conditions

What Are the Symptoms of Wheezing?

Whistling noise when breathing, especially on exhaling
Fast breathing or shortness of breath
Coughing, often worse at night or with colds
Chest tightness or discomfort
Use of chest or neck muscles to breathe (visible effort)
In severe cases: blue lips, lethargy, or difficulty speaking or feeding

When to Seek Medical Help

Call 999 / emergency services if:

Your child is struggling to breathe or has blue lips or face
They are too breathless to talk or feed
They suddenly develop wheeze after a possible inhaled object, sting, or food

Contact your GP or respiratory paediatrician if:

Wheezing is persistent or worsening
Your child is needing reliever medication every 3 hours or more
You are unsure whether this is asthma or something else

Diagnosis of Wheezing

The cause of wheezing is often based on:

Clinical history and examination
Response to inhalers
In older children: lung function tests (spirometry, FeNO)
In persistent or atypical cases: chest X-ray, CT scan, bronchoscopy, or specialist referral

Treatment Options

Treatment depends on the cause of the wheeze:

1. Relievers (e.g. Salbutamol, Ventolin®)

Help open up the airways
Used during wheezing episodes
Given via inhaler and spacer (and mask if needed)

2. Steroids

Oral steroids (e.g. Prednisolone) may be used in more severe episodes
Inhaled steroids (e.g. Flixotide®) may be prescribed for children with frequent wheeze to reduce airway inflammation

3. Avoidance of Triggers

Avoid tobacco smoke exposure
Treat allergic rhinitis or hay fever
Reduce exposure to known allergens or irritants

4. Pre-School Wheeze Action Plan

A written plan from your doctor to guide you on what to do when your child is unwell, including when to use inhalers or seek help.

Caring for Your Child at Home

Use reliever inhaler as prescribed with a spacer
Encourage small, frequent sips of fluids
Use a cool mist humidifier or warm steam if recommended
Avoid smoke exposure completely
Keep a record of symptoms and response to medication

Will My Child Grow Out of Wheezing?

Many young children with viral-induced wheeze improve as their lungs grow
If your child has frequent wheeze or associated allergic conditions, they may be more likely to go on to develop asthma
Early recognition, monitoring, and treatment can help reduce the impact on daily life

Follow-Up and Monitoring

Children with recurrent wheezing should be reviewed regularly
Follow-up is especially important after an emergency visit or hospitalisation
Your child may benefit from input from a paediatric respiratory specialist if symptoms are frequent, severe, or not improving with standard treatment

Need Support or Further Advice?

If you’re concerned about your child’s breathing or wheezing symptoms, please contact your GP, or respiratory specialist. Early management can make a big difference.

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