Vad ska du göra om ditt barn har pipande andning?

Vad orsakar pipande andning hos barn?

At least 2 av 5 barn have at least one episode of wheezing before they are 6 years old. When my patients think of pipande andning in their children, they almost always assume it's due to astma .Det finns faktiskt många andra orsaker till pipande andning – och ibland, som vi ska se senare, är det som låter som pipande andning hos ett litet barn kanske inte alls pipande andning.

Väsande andning är ett ljud som uppstår när luft andas ut (eller mer sällan in) genom förträngda luftvägar. Eftersom barns luftvägar är mindre än vuxnas blir de lättare så pass trånga att det uppstår väsande andning. Vid astma är luftvägarna förträngda eftersom musklerna som omger dem drar ihop sig. Även slem eller andra sekret som delvis blockerar luftvägarna kan orsaka väsande andning. Detsamma gäller inflammation i luftvägarnas slemhinna. Mer sällan kan ett föremål som har andats in fastna i luftvägarna.

Virusinfektioner

The most common reason for wheezing in children is infection with viruses such as the ones that cause the förkylning. Detta kallas ”virusutlöst pipande andning”. Många barn med virusutlöst pipande andning blir inte andfådda eller påverkade och återhämtar sig snabbt utan några bestående besvär.

Krupp is a viral infection most common in children aged between 6 months and 3 years old. Classically, it gives rise to a barking cough, caused by inflammation of the vocal cords in the larynx. It can also cause andnöd and it may sound as if your child is wheezing.

Bronkiolit is also caused by a virus - in this case usually the bronchiolitis means inflammation of the bronchioles. It is usually caused by a virus called the respiratory syncytial virus (RSV). It's most common in babies aged 3-6 months and is much less common in toddlers and older children. Along with cold symptoms, babies often develop wheezing, rapid breathing and sometimes difficulty breathing.

Tecken att vara uppmärksam på

Oavsett orsaken till andningsbesvären finns det vissa tecken att vara uppmärksam på om ditt barn väser eller hostar.

Om ditt barn får dessa symtom, sök omedelbart medicinsk rådgivning.

Spelar åldern någon roll när det gäller pipande andning?

There is some good news for parents of wheezy babies and toddlers. Perhaps counterintuitively, as a rule, the earlier the child gets wheezy for the first time, the more likely they are to grow out of it quickly. There appears to be something of a upphör vid ungefär 2 års ålder: de flesta barn som först söker vård för pipande andning före denna ålder slutar ha symtom i mitten av barndomen

Kan mitt barn ha astma?

In adults, there are various reliable tests for diagnosing astma. Dessa inkluderar:

• Spirometri - a simple breathing test that measures the amount and speed of air flowing in and out of your lungs.

• Reversibilitetstest – om och hur mycket din andningskapacitet ökar efter att du har inhalerat läkemedel som vidgar luftvägarna.

• Test av fraktionerad utandad kväveoxid (FeNO) – ett mått på mängden kväveoxid i utandningsluften.

• Mätning av maximalt utandningsflöde - measurement of how hard you can blow out using a portable monitor you can use at home. This isn't as reliable as the other measures above but can be useful to monitor your asthma.

Unfortunately, it's almost impossible to get reliable readings from children aged under 5, which means your doctor will have to rely on their symptoms and examination to make a diagnosis. For instance, while almost all children get intermittent cough, wheeziness and/or symptoms brought on by exercise, 3 av 4 av dessa barn don't have asthma.

Att upptäcka tecken på astma hos barn

If you're concerned your child has asthma, speak with your GP. If their assessment suggests a high probability that your child has asthma, they'll prescribe inhalationsläkemedel and review them to see how they responded.

När bör jag oroa mig för min astmatiska barns pipande andning?

There's no doubt that having a child with asthma is a concern, and that children can become unwell rapidly. Children younger than 5 years old with asthma are mer benägna att behöva akut vård than any other age group with asthma.

Part of the problem is that younger children in particular can't förklara sina symtom in the way adults can. If your child has asthma, it's natural to be on the lookout for symptoms - especially since you should have been given advice on what treatment to offer if your child is wheezy.

Vid ett astmaanfall, blir slemhinnan i bronkiolerna (de små luftvägarna) inflammerad och musklerna runt bronkiolerna drar ihop sig. Detta orsakar andnöd och pipande andning.

Hopefully, if your child has asthma, you'll have been given an astmahandlingsplan, explaining what to do if your child is wheezing or breathless. But knowing if your child is wheezing is not as straightforward as it sounds. In younger children in particular a whistling sound often comes from the upper airways, including the nose, rather than from the lungs. In practice, parents and their doctor or nurse disagree about whether wheeze is present in över hälften av konsultationerna.

If you're not sure how to identify if your young child is wheezing, a validated device such as the Omron Wheezescan uses an algorithm based on over 600 children with asthma symptoms, to tease out the difference between the sound of wheezing and other lung sounds.

Väsande andning är förstås bara ett av tecknen att vara uppmärksam på. Läkaren eller sjuksköterskan hjälper dig att identifiera utlösande faktorer som innebär att du bör ge ditt barn luftrörsvidgande läkemedel. Om ditt barn uppvisar något av de ”tecken att vara uppmärksam på” som nämns ovan ska du alltid söka akut vård.