Clinical summary
Assessment of respiratory disease in children considers the character and timing of the cough, triggers, respiratory rate, retractions and auscultation findings together. In asthma follow-up, device technique is the most critical yet most frequently overlooked determinant of treatment effectiveness.
Croup (laryngotracheobronchitis)
Croup arises from viral swelling of the region just below the vocal cords. The typical picture is a sudden onset at night of a barking cough, hoarseness, and a harsh sound on inspiration (stridor).
Most croup episodes are mild. However, stridor heard at rest, marked retractions, agitation or bluish discolouration require urgent assessment.
Bronchiolitis and RSV
Bronchiolitis is a viral infection of the small airways, most often caused by RSV, typically in infants under two years of age. Starting with a runny nose and mild fever, it may progress with wheezing, rapid breathing and reduced feeding.
Treatment is largely supportive: maintaining feeding, nasal clearance, and monitoring for respiratory distress. Antibiotics are not effective in viral bronchiolitis and unnecessary use provides no benefit.
Wheezing
Wheezing is a whistling sound produced by narrowing of the airways. Because airways are relatively narrow in young children, wheezing is common during viral infections and is often transient.
Key questions in assessment: how many episodes have occurred, what triggered them, do symptoms increase at night, are they exercise-related, is there a family history of asthma or allergy, and how did previous treatments work?
Recurrent respiratory infections
It is expected that a child newly starting nursery will have several upper respiratory infections per year. However, severe infections, effects on growth, recurrent pneumonia or an unexpected frequency of antibiotic courses may warrant further assessment.
Childhood asthma
Asthma is characterised by chronic airway inflammation and recurrent narrowing. Diagnosis is not made by a single test; history, examination, triggers, symptom patterns and — at an appropriate age — lung function testing are assessed together.
The goals of follow-up are to reduce attacks, eliminate night-time symptoms, and prevent limitation of school, play and sport. For that reason, symptom control and device technique are reassessed at every visit.
Inhaler and spacer use: why technique matters
In asthma treatment, delivering the medication with the right device and the right technique is as decisive as the medication itself. Studies show that a significant proportion of families make at least one critical error in device use. Incorrect technique can mean the medication never reaches the lungs, symptoms remain uncontrolled, and doses are escalated unnecessarily.
Device education steps used in the clinic
- Selecting an age-appropriate device and spacer/mask
- Step-by-step demonstration by the physician
- The parent (and, where appropriate, the child) repeating the technique while it is observed and corrected
- Explaining mouth care after use and device cleaning
- Providing a written plan for what to do during an attack
- Reassessing technique at follow-up visits
When is urgent assessment needed?
Seek care without delay
- Rapid or laboured breathing; retractions below the ribs or in the neck
- Bluish discolouration around the lips or tongue
- Breathlessness while speaking or feeding; inability to complete a sentence
- Stridor heard at rest
- Marked lethargy or difficulty waking
- Wheezing that does not respond to reliever inhaler treatment
- Fever or respiratory distress in an infant under 3 months
Related content
Frequently asked questions
Does every wheeze mean asthma?
No. Transient wheezing triggered by viral infections is common in the first years of life and most cases do not progress to an asthma diagnosis. Assessment considers episode frequency, triggers, night-time symptoms, family history and treatment response together.
Is a spacer really necessary?
A spacer is recommended for children using a metered-dose inhaler. Without one, a large proportion of the medication remains in the mouth and throat. A spacer markedly increases the amount reaching the lungs.
What is the difference between bronchiolitis and asthma?
Bronchiolitis is an acute small-airway infection usually caused by viruses such as RSV, most often in infants under two years. Asthma is a chronic condition with recurrent airway narrowing and inflammation.
Do asthma medications affect a child's growth?
Inhaled treatments used at guideline-recommended doses are considered far safer than uncontrolled asthma itself, which causes disturbed sleep, school absence and restricted activity. Dose and duration are kept at the lowest effective level through regular review.
This content is provided for general information purposes and does not replace individual medical assessment, diagnosis or treatment.
