Viral Induced Wheeze

What is viral induced wheeze?

Viruses, such as a cold, are common infections. Viruses can irritate the small breathing tubes in the lungs making them swell – this makes the breathing space smaller. When this happens it may make it harder for your child to breath.  You may hear a whistling noise when they breathe out, this is called a wheeze.
 

Can I prevent it?

You can’t stop your child catching a virus. Inhalers like the ones used for asthma can help to manage your child’s symptoms.

Your child may be prescribed a blue inhaler called salbutamol.  This relaxes the muscles around the breathing tubes, opening them up and making it easier for them to breathe.

If you smoke, try to stop as cigarette smoke can irritate airways. Antibiotics will not help a viral infection.
 

Is it asthma?

No it isn’t. Asthma is a long term condition that affects the small breathing tubes in a similar way to viral induced wheeze. However, there are usually many things that cause the small breathing tubes to become swollen, not just viruses. Most children with viral induced wheeze will grow out of it.

Related topics: asthma, bronchiolitis and RSVcough and coldsCovid-19difficulty breathing

 

If your child has any of the following:

  • Too breathless to talk/eat or drink
  • Has blue lips
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite giving them 10 puffs blue (salbutamol) inhaler
  • Breathing very fast or breathing that stops or pauses
  • Working hard to breathe, drawing in of the muscles below the rib, unable to talk or noisy breathing (grunting)
  • Becomes pale, blue, mottled and/or unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched, continuous cry or extremely agitated
  • Has a fit (seizure)
  • A temperature less than 36oC or temperature 38oC or more if baby is less than 3 months
  • Develops a rash that does not disappear with pressure and seems unwell (see the 'Glass Test')
Ring 999 immediately for help. Give 10 puffs of blue (salbutamol) reliever inhaler every 10 minutes until ambulance arrives

Keep child in upright position and reassure them

You need urgent help.

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

If your child has any of the following:

  • Having their blue (salbutamol) inhaler 2 puffs every 10 minutes via spacer and symptoms still there at 4 hours
  • Cough or wheeze/tight chest during the day and night
  • Too breathless to run/play/do normal activities
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips, tongue or looking pale
  • Not had a wee or wet nappy in last 12 hours
  • Sleepy or not responding normally
  • Crying and unsettled
  • Not drinking
  • A temperature 39oC or above in babies 3-6 months
  • Temperature of 38oC or above for more than 5 days or shivering with fever(rigors)
  • Getting worse or you are worried about them
Immediately contact your GP and make an appointment for your child to be seen that day face to face

Give two puffs of their blue inhaler and wait ten minutes.

You can repeat the two puffs every ten minutes up to a total of six puffs. You can repeat this as often as every four hours if needed

If your child is needing six puffs as often as every four hours, keep going, but you must see a doctor within the next 24 hours (This can be your GP or your local out of hours service)

If your child has none of the above:

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

Additional advice is also available for families for help cope with crying in otherwise well babies

Self Care

Give two puffs of their salbutamol (blue) inhaler through a spacer up to four hourly

You can do this for a few days but if your child is not getting better, make an appointment to see a doctor

Carry on looking after your baby or child at home. If you are still worried about your child , ring NHS 111 or visit 111.nhs.uk

 

This guidance has been reviewed and adapted by healthcare professionals across North East and North Cumbria with consent from the Hampshire development groups.

Choose appropriate sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath).

 

 

  1. Shake the inhaler well and remove cap.

  2. Fit the inhaler into the opening at the end of the spacer.

  3. Place mask over the child’s face or mouthpiece in their mouth ensuring a good seal

  4. Press the inhaler once and allow the child to take 5 slow breaths between each dose or count to 10

  5. Remove the inhaler and shake between every puff. Wait 1 minute between puffs.

    Repeat steps 1 – 5 for subsequent doses
    Plastic spacers should be washed before 1st use and every month as per manufacturer’s guidelines

Videos on inhaler technique.

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  • Keep your child well hydrated by offering them lots to drink
  • Most children with coughs and colds do not require treatment with antibiotics. 
  • If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.
  • Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help.
  • Try using saline nose drops or spray if your baby has a blocked nose.
  • For children over 2 years, vapour rubs (containing camphor, menthol and/or eucalyptus) may help children sleep better.

How Can I Treat Viral Induced Wheeze?

  1. Follow the wheeze plan as soon as you think your child is starting to get a cold.
  2. It is important that you use a spacer to administer the inhaler and use the correct technique
    • Shake the inhaler well and put in the hole at the end of the spacer
    • Place the mask over your child’s nose and mouth
    • Press the inhaler once to release a “puff”
    • Encourage your child to breathe in and out at a normal rate for a count of ten – you will see the valve on the spacer moving
    • Repeat this until the required number of puffs have been given
    • Do not force your child – if they are crying the inhaler will not be effective
    • Ask your nurse for advise if giving your child their inhaler is difficult - make it fun with silly songs/games
    • It is important to let your child rest and ensure they drink plenty of fluids

Where should you seek help?

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

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

If you’re not sure which NHS service you need, call 111. 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?

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:

  1. Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
  2. 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?

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

Some primary and secondary schools may have an allocated school nurse, however this can vary depending on the area  – telephone your child’s school to ask for the contact details of your school nursing team.

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

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

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
  • 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.

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.

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

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?

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.

Sound advice

  1. Visit a pharmacy if your child is ill, but does not need to see a GP.
  2. Remember that if your child's condition gets worse, you should seek further medical advice immediately.
  3. Help your child to understand - watch this video with them about going to the pharmacy.

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

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?

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