6 Signs of Severe Asthma in Infants and Small Children

A problem with infants and small children is they can’t speak for themselves. They feel asthma symptoms, but they can’t tell you how they feel. This is where it comes in handy that asthma shows signs that are visible to vigilant parents, grandparents, babysitters, teachers, and guardians. Here are six signs of severe asthma in infants and small children.

Retractions.  During normal breathing, the chest is relatively motionless, and the stomach goes out during inhalation. Airway obstruction, which occurs during an asthma attack, causes people to use accessory muscles, or muscles that are not normally used. These are used in an attempt to suck in more air. Because small children have more flexible chests than adults, their chests cave in, or retract, when accessory muscles are used. As you watch them closely, you can observe a “seesaw motion,” where the chest moves in and stomach moves out during inhalation. 1,2 This is a clear sign that the child is short of breath, and that a severe asthma attack is occurring. You can watch a video showing retractions here.

Nasal Flaring. When a child is in respiratory distress, the nares move outward (become dilated) during inhalation. This is a natural mechanism to reduce the resistance to airflow during inhalation, thereby making it easier to draw air into the lungs. 2 Nasal flaring is only seen in adults during aerobic exercise as a means of reducing airway resistance. It is not seen in children or adults during normal breathing at rest. For this reason, it is a good indicator that an infant or child is in respiratory distress. 3 You can watch a video showing nasal flaring here.

Grunting. Children with obstructed airways, who are working hard to suck in air, have a tendency to exhale against a partially closed glottis causing a grunt. This is a natural mechanism that applies added pressure during exhalation to prevent the lower airways from completely collapsing during exhalation, making them easier to reopen during inhalation.2Think of a balloon that has never been used. If you try to blow it up, it takes a great deal of effort the first time. The second time you go to blow it up it’s easier to do. Grunting, in effect, mimics the effect of blowing up a balloon for the second time. It makes sure airways stay partially open so that the next breath comes easier. Either way, grunting is a clear sign that a child is in trouble.  You can watch a video showing grunting here.

Peripheral Cyanosis.This is a bluish discoloration of the lips or fingertips. It means that the lungs are doing a poor job of getting inhaled oxygen to the bloodstream. In this case, blood is being shunted from the lips and fingertips to vital organs, such as the heart, brain and lungs. This is a clear sign that the asthma attack is severe.

Tachypnea,  This is the technical term for rapid breathing. It can be indicative of a variety of problems with infants (fever, pain, asthma, anxiety, etc.), although, when observed with the other signs of asthma, it can be another sign that the asthma episode is severe. 1,2,4

Anxiety. Children who are unable to breathe will be anxious and confused just as an adult who is unable to breathe. Good signs of anxiety are tachypnea and lack of desire to eat.

Conclusion. Any parent of an asthmatic child should be aware of these six signs of severe asthma. All of these are clear signs that a severe asthma attack is occurring, and that quick action is needed to end the attack. You should refer to your child’s asthma action plan, and seek medical attention for your child immediately.

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View References
  1. Egans Fundamentals of Respiratory Care, 6th edition, page, page 1006-1007
  2. Egans Fundamentals of Respiratory Care, 11th edition, page 1224, Link Here
  3. Sills, James R. “The Comprehensive Respiratory Therapist Exam Review,” 6th Ed. 2016, page 31, Link Here
  4. http://www.fpnotebook.com/lung/exam/Tchypn.htm