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TREATMENT OF ASTHMA MILD ATTACK IN BABIES AND CHILDREN UNDER AGE OF TWO
Very young children present a special problem when they are wheezy, as they are too young to use any of the conventional inhalers. Many doctors will not recommend them until the age of 3, but I have found with care and patience most children will manage with them quite adequately from the age of 2 onwards. The situation has improved since research has shown there is no possibility of over-dosage, as people always feared. In fact the nebulizers have been shown to deliver up to 50 times the dosage of a conventional pressurized inhaler.
Asthma is uncommon below the age of one, and the reason for this is uncertain. It seems likely that it does take some time for irritability of the airways to develop, and perhaps there is some inherited protection from the mother in the first year of life.
If a baby does develop wheezing it is usually mild and often requires no treatment. However, if it becomes more severe then it may be necessary to give a bronchodilator, either Bricanyl or Ventolin in a syrup form by mouth. This obviously raises the possibility of side-effects, but in babies the dose needed to produce widening of the airways is very small, so it is unlikely that significant unwanted effects will arise. The main problem with medicines at this age is they are very slow to act and may take over an hour to produce any effect at all.
An alternative to medicine – especially in the 1-2 age group – is to use a conventional pressurized inhaler with an inverted paper or plastic cup on the end. Paul was 13 months when he had his first significant wheezing attack. It was not surprising, as both his parents suffered with it and were well versed in the use of the various inhalers. I advised them to give Paul some Ventolin every three hours using the following method. Firstly, a hole should be cut in the bottom of the plastic cup, big enough to fit the mouthpiece of an inhaler. The wide part of the cup is then placed over Paul’s face and nose and four puffs of the inhaler are given into the cup. This manoeuvre allows the spray to stay in the cup long enough to be inhaled a little at a time with each breath without much effort. Paul received instant benefit and his breathing became much more settled.
Alternatively, Ventolin can be given via a nebulizer as described on p. 86. The problem with this method in the very young is that they will not tolerate a mask strapped to the face or a mouthpiece in the mouth. However, it is usually possible to hold the mask near enough to the baby’s face for sufficient of the vapour to be inhaled. You will actually be able to see the baby breathing in the cloud of medication as it comes out of the nebulizer. This can be repeated as necessary, but four hourly is usually adequate. It is worth mentioning here that babies do tend to wheeze for longer than older children, although it often does not cause them any distress. Many is the time in the surgery where I have seen a baby with a slight wheeze who was nevertheless perfectly happy, and it was the parents who wanted something done. With some babies it is wise to allow the wheeze to settle on its own. This is not true, of course, in older children where it is important to bring the wheeze under control as quickly as possible.
I am normally a little reluctant to recommend alternative methods in treating asthma, as it is a condition which can deteriorate so rapidly. However, in young babies asthma is much milder and often responds well to homoeopathy. By using this it may well be possible to avoid the use of conventional medicine by mouth.
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