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Viral induced wheeze

Viral induced wheeze is a whistling sound from the chest that is due to the narrowing and swelling of the airways, caused by a viral infection (e.g. a cough or a cold). It can be associated with difficulty in breathing. The symptoms may recur each time your child has a cold.  Usually the child is well in-between the viral infections but the wheeze can last for some weeks after the infection. Children under the age of 5 years are more likely to be affected as their air passages are small.

Treatment of viral induced wheeze is similar to asthma with a salbutamol (reliever) inhaler. Your child may also have been prescribed a preventer medication if they have had recurrent episodes of viral induced wheeze.

 

Does this mean my child has asthma?

No, not necessarily. This is a different condition from asthma, although a few children do go on to develop asthma.

Children with asthma:

  • Are often wheezy, even when they do not have a cough or cold
  • Usually have a family history of asthma and allergy
  • Are generally more breathless than their friends when they run around or become wheezy on exercise.
  • Often have a regular night time cough

If you are worried that your child has asthma, you should make an appointment to see your GP or GP asthma nurse.

When should you worry?

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink 

  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)

  • Breathing that stops or pauses

  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)

  • Is pale, blue, mottled or feels unusually cold to touch

  • Difficult to wake up, very sleepy or confused

  • Weak, high-pitched cry or can’t be settled

  • Has a fit (seizure)

  • Has a rash that does not go away with pressure (the ‘Glass Test’)

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has a salbutamol (blue) inhaler, give 10 puffs of salbutamol now or follow your treatment plan

If your child has any of the following:

  • Breathing a bit faster than normal or working a bit harder to breathe

  • A harsh noise as they breathe in (stridor) only when upset

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Getting worse or you are worried about them 

  • Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)

  • Temperature less than 36°C in those over 3 months

You need to contact a doctor or nurse today

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If your child has a salbutamol (blue) inhaler, you can increase this to 6-10 puffs every 4 hours or follow your treatment plan

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

If none of the above features are present:

Watch them closely for any change and look out for any red or amber symptoms.

If your child has any other symptoms associated with their fever, you may want to look at the information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache or our other pathways.

Self care

Continue providing your child’s care at home. If prescribed, this may include your salbutamol (blue) inhaler.

If you are still concerned about your child, call NHS 111 – dial 111

What should you do?

At the start of cold symptoms (such as runny nose), begin your child on salbutamol (blue) inhaler 2 puffs every 4 hours as needed. This can be increased to up to 10 puffs at a time if your child’s symptoms are still significant. If your child is requiring increasing amounts of blue inhaler you should seek medical advice according to the table above.

1) It is vital that your child uses their inhaler and spacer correctly.

Your child’s wheeze will not be controlled if their medicines are not getting into their lungs.

Watch this video on how to help your child use their inhaler.

  1. Check the inhaler contains medicine and shake. Reliever inhalers have a maximum of 200 doses but will continue to fire when empty. 

  2. Remove the cap.

  3. Fit the inhaler into the end of the spacer.

  4. For spacer with mask, place the mask over the nose and mouth and ensure a good seal. For spacer and mouthpiece, place teeth around the mouthpiece and seal with lips. Most children over 3 years can use a mouthpiece. 

  5. Press the inhaler once and encourage the child to take 5 slow breaths or count to 10 slowly whilst they breath normally through the spacer.

  6. Shake the inhaler and repeat steps 4 and 5 if more puffs are needed.

See your practice nurse or doctor if you are not sure whether your child is using their inhaler properly.

To watch a video on encouraging children to use their inhalers effectively please click here.

 

2) Treatment over the next few days 

Over the next few days, your child will be recovering and hopefully will feel better.

They may still need their salbutamol (blue) inhaler if they have symptoms of chest tightness, a dry cough or shortness of breath.

If they have symptoms, you can give up to 10 puffs of their blue reliever inhaler and the effects should last for 4 hours.

If your child becomes increasingly breathless or the effects are not lasting 4 hours, you should follow the instructions outlined in the RED section.

In the event that your child has been started on steroid tablets, these should be continued once daily (usual treatment course is 3 – 5 days for prednisolone or 1 day for dexamethasone).

If you child normally uses preventative treatment(s), this should continue as normal.

If your child’s wheeze worsens in future, please follow the instructions outlined in red, amber, green traffic light table.

How long will symptoms last?

The wheezing episodes usually last 2-4 days but can be longer.

Where should you seek help?

For wear and tear, minor trips and everything in between

Self-care

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

 

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  • Doctors or GPs can treat many illnesses that do not warrant a visit to A&E
  • Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, you can call 111 or use 111 online.

Please note that 111 online is for people aged 5 and over. Call 111 if you need help for a child under 5.

An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services

For information on common childhood illnesses go to What is wrong with my child?

 

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  • Many visits to A&E and calls to 999 could be resolved by any other NHS services
  • If your child's condition is not critical, choose another service to get them the best possible treatment
  • Help your child to understand – watch this video with them about going to A&E or riding in an ambulance
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