Have you been considering sleep training your little one, but not enthused about letting your baby cry it out or leaving the baby unattended? The Pick Up, Put Down method of sleep training might be a good one to consider. This method was made popular in the book “Secrets of the Baby Whisperer” by Tracy Hogg. According to her, this method should be understood as the “middle of the road” method to sleep training a baby.

A baby who sleeps well is definitely happier, parents who get some rest are not only happier but more effective. The Pick Up, Put Down (PUPD) method is great for parents who don’t mind a slightly slow process. It requires you to come back to your baby several times until it’s settled down. 

In This Article

• What is Pick Up, Put Down (PUPD) Sleep Training Method?
• When Can You do Pick Up, Put Down Sleep Training Method For Your Baby?
• How Does Baby Pick Up, Put Down Training Method Work?
• How Long Does PUPD Technique Take to Work?
• Advantages of Pick Up, Put Down Sleep Training Method
• Disadvantages of Pick Up, Put Down Sleep Training Method
• Top 5 Tips to Introduce Pick Up, Put Down to Your Baby
• FAQ’s

What is Pick Up, Put Down (PUPD) Sleep Training Method?

The PUPD sleep method is gentler than most other sleep-training techniques because in this, the parent or the caregiver never leaves the baby to cry it out alone. In this method, you would put your baby down once asleep, be it in the crib or the bassinet, or the bed. This training method works on the basis of teaching the baby to self-soothe and then fall asleep on their own.

However, if and when the baby begins to cry, you would pick them up and soothe them, helping them settle and then placing the baby back down. This is repeated whenever the baby fusses or cries. Since the baby is never left to self soothe feeling like it’s abandoned, it’s known to be one of the gentler sleep training methods.

When Can You Do Pick Up, Put Down Sleep Training Method For Your Baby?

Sleep training, according to sleep therapists, can be started once the baby starts sleeping a few hours at a stretch or between 4 to 8 months of age. A baby’s sleep cycle begins to regularize only around 6 months of age. However, your own judgement about your baby is the most accurate. Every baby is different and has its own personality. It’s also best to speak to your baby’s pediatrician to before starting this method. This way you will be sure that you and your baby are ready to take the plunge.

Remember, some older babies may find this method too stimulating or disruptive. PUPD method is best for younger babies.

How Does Baby Pick Up, Put Down Training Method Work?

The PUPD sleep training method is quite simple. You can do it even at 2 am when your fussy and crying baby wakes up from your deep sleep. You will need loads of perseverance and patience and an acceptance that the training could take a while.

Here is how the PUPD Sleep training method works.

1. Create a Bedtime Routine

Start with creating a proper bedtime routine for your baby both in terms of a wind-down routine and timings. For most sleep-training methods, following the familiar and usual bedtime routine is very important as the baby associates sleep time with the routine.

2. Put Your Drowsy But Awake Baby to Sleep

As your baby gets drowsy and is almost ready to sleep, place them in their crib or bassinet. Let them fall completely asleep on their own. Though it may take some time initially, they will learn to doze off to sleep on their own.

[Read : 8 Ways You Can Teach Your Baby To Sleep In A Crib]

3. Shush-Pat

Once your baby quietens and looks settled, then you could exit that area or the room. However, if the baby doesn’t settle and starts to fuss, then after waiting a little bit try shushing and patting the baby to soothe them.

4. Pick Up the Baby

If the baby is not calmed and is still upset or crying, then pick the baby up and offer comfort.

5. Put the Baby Down

Once the baby stops fussing or crying, it’s best to quickly put the baby down even if the baby is fussing while being kept. You could try to place one hand on the baby to reassure of your presence.

6. Redo and comfort

If the baby cries again, try and pause to see if the baby will settle down. If not, then repeat the method until the baby is asleep.

How Long Does PUPD Technique Take to Work?

The PUPD method can take a week to three weeks to work. The time taken to work depends a lot on the baby – its personality, its responses – and on the parents – on how consistent they are. You should be able to maintain consistency in their sleep routine as well as the PUPD method. Any break during the initial weeks can bring the process back to square one and you may need to try again.

The first few nights of introducing this method to your baby are extremely long. You may need to continue picking and placing the baby every 10-20 minutes. However, within a week you’ll begin to see changes and some responses.

Advantages of Pick Up, Put Down Sleep Training Method

Here are some of the advantages of PUPD sleep training method for babies.

1. Gentle on the Baby

One of the biggest advantages of this method is that it gives the baby time and space to adapt to a new way of sleeping gently.
For babies, knowing that the parent is always available to reassure them is a huge mental comfort. A relaxed calm baby is more open to learning new things.

2. Well-Structured Method

A parent can be in the same room as the baby the whole time – a thing that’s of comfort to most parents as well. This is a well-structured method, unlike a similar other method called Sleep Fading training method, which is also more rigid than this one.

[Read : Room Sharing With Your Baby]

3. Apt For Younger Babies

If your baby is too young and you want to start sleep training them, PUPD may be a good place to start with. Since it is gentle on the baby and gives them time to adjust and adapt, it is less stressful for young babies.

Disadvantages of Pick Up, Put Down Sleep Training Method

While Tracy Hoggs called it the “middle of the road” method, many people criticize this approach, calling it confusing for the babies and frustrating for both parents and the babies. Here are some of the disadvantages of the PUPD sleep training method.

1. Draining For Parents

This is an extremely draining method. It could take a toll on the parents in the beginning. In the initial days, when the baby wakes up — it could even take more than two hours to settle the baby. According to therapists, it could involve more than 100 pick ups to soothe and settle the babies.

2. Can be Confusing

For some parents, it’s very confusing to decide when to pick the baby up and soothe, them and when not to. It is also confusing to figure out the point when the baby is settled enough to be placed back.

3. Difficult in Households With More Than One Child

For parents with more than one kid, it’s hard to keep up with this method as it requires the parent constantly — something that’s not possible in multi-children households.

Top 5 Tips to Introduce Pick Up, Put Down to Your Baby

If you are trying out the PUPD sleep training method for your baby, here are some tips to make the process easier for you.

1. One of the most important tips is to ensure that your baby is on a good sleep routine and is going to bed daily at a similar time and age appropriately.
2. The parent or the caregiver planning to attempt the training should be well-rested. This method is physically demanding.
3. Do the pre-sleep routine before you begin the method.
4. Make sure that you have some help while doing this method. It is a taxing method and that could often lead to parents not being consistent.
5. If your baby is unwell or is recovering from an illness, no sleep-training method should be tried out on your munchkin.

To sum up, the Pick Up, Put Down sleep training method is a good “gentle” way of sleep training. While it may be physically extremely demanding, it’s also one method in which neither you nor your baby will be in any anguish. It’s not a cry-proof approach, but when the baby fusses or cries, it has a parent close by and gets picked up, giving both the reassurance they needed. Depending on what works for you, your baby and your family, a sleep-training method should be selected. The one you select should be the one you can do consistently. That’s the only way to success with any sleep training.

FAQ’s

1. Does the Pick Up, Put Down Sleep Training Approach Work?

The success of this method depends largely on your comfort with the method and the baby’s personality. But with consistency, patience and confidence, it could work and teach your baby how to sleep on its own in a gentle way.

2. How Long Does Pick Up, Put Down Take to Work?

While it may be difficult to estimate an exact time frame, most studies suggest that 3 weeks may be an ideal time frame. Remember that each baby is different, so is their constitution and behavior. Sometimes if the baby falls ill, you may have to do away with the training and start over. So, all these effects have a bearing on the time taken.

3. What if the PUPD Method Does Not Work?

If even after a week, you see no progress or change in how your baby soothes itself, then it might be a good idea to look at other sleep-training methods. Or you can give the trial a rest for a couple of weeks, set a proper sleep schedule and routine for your baby and try again.

Read Also: Ferber Method of Sleep Training Babies by Dr. Srikanta J T

When a child struggles to catch their breath, it can be scary for not just the parent but for anyone and everyone. Breathing comes naturally to all living beings. A child should breathe normally and freely when they are playing or just carry on with their activities. They should not struggle or make a noise when they breathe in or out.

Wheezing is not an uncommon phenomenon in children. Many children have wheezing. Some get well in a few years and for some; they just learn to live with it. Just because a child is wheezing, doesn’t mean they need to have asthma. All wheezes are not asthma in children. Come, let’s find out more about wheezing in children.

In This Article

• What is Wheezing in Children?
• Signs and Symptoms of Wheezing in Children
• What is Asthma in Children?
• Signs and Symptoms of Asthma in Children
• How to Tell if My Child’s Wheezing is Asthma or Not?
• When to Take Your Child to The Doctor?
• Can Childhood Asthma be Cured?
• FAQ’s

What is Wheezing in Children?

When a child’s airway is too small, they struggle to breathe normally. It can result in a high-pitched whistling sound as they breathe out, called wheezing. If you pay close attention, the noise will come from their chest rather than their nose, which happens when they have a cold or a nose block.

Some of the reasons for wheezing in children can be

• Lower respiratory infections including infections such as RSV (Respiratory Syncytial Virus).
• Choking, when your child has something stuck in their nose or airway.
• Swelling in the mucosal lining due to severe cold or allergic reaction.
• Bronchospasm or swelling due to irritation in the airway.
• Inhalation of foreign particles that can either block or irritate the nasal lining.
• Excess secretion of mucous.
• Croup or an infection to the upper airway that can cause swelling in the windpipe and bronchial tubes.
• Gastro-oesophageal reflux or acid reflux that rises from the stomach and affects the throat. It can be a medical condition by itself or due to indigestion.
• Secondary smoking, meaning a constant exposure to parents or other adults smoking around them.
• Seasonal infections due to exposure to something in the environment that is seasonal. This type of wheezing will subside once the weather changes.

It is important not to confuse a wheeze with breathing difficulty caused by a blocked nose or cold. A runny nose or blocked nose can make it difficult to breathe as well as cause noise during breathing. Wheezing is more severe and recurrent than just a nose block.

Signs and Symptoms of Wheezing in Children

It is quite common to fear the worst when a child is unwell. Wheezing can be easily mistaken for asthma. Wheezing is in fact a strong symptom of asthma. So, it is important to distinguish your child’s wheeze. You need to identify if it is asthma or a viral wheeze.

A viral wheeze will present itself when your child has a severe cold or chest congestion. A severe cold, nose block, runny nose, fever, or various other triggers can cause:

• Whistling like noise starting from the chest, when your child is breathing out
• Tightening feeling in the chest during exhalation
• Shortness of breath

What is Asthma in Children?

Asthma in children is similar to asthma in adults. It is a condition where the child is unable to breathe freely. Exposure to certain triggers will cause inflammation of the child’s airways and even lungs.

It can be difficult to determine if the breathing difficulty your child is experiencing is just a wheezing episode, choking, or asthma. Periodic and long-lasting wheezes are typical symptoms of asthma.

The exact cause of this severe respiratory problem is not known. It could be environmental triggers, genetics, or a combination of both.

[Read : Asthma in Toddlers: Symptoms and Treatment]

Signs and Symptoms of Asthma in Children

A cold or cough is very common in young children. Asthma is more than just a cold. Some of the symptoms you need to watch out for are:

• Frequent coughs that seem to worsen with a cold or viral infection.
• Excessive cough due to exercise or exposure to cold air.
• Cough that seems persistent and doesn’t go away.
• Wheezing or whistling sound during exhalation.
• Shortness of breath or difficulty in breathing freely.
• Tightening of the chest during exhalation.
• Delay in recovering from a respiratory infection.
• Regular or frequent wheezing without a cold or viral infection.
• Difficulty or trouble sleeping due to breathing issues.
• Rapid breathing.
• Difficulty in eating and swallowing is sometimes accompanied by grunting.
• Feeling tired and weak due to insufficient breathing.
• Low energy during sports or play; the child might even refuse to play.
• Allergic reaction to pollen, mold, and other environmental factors.

[Read : Common Indoor And Outdoor Allergens in Children]

How to Tell if My Child’s Wheezing is Asthma or Not?

So, your child is having difficulty breathing. You hear that tell-tale whistling sound when your child breathes. Could it be asthma or is it just a regular wheeze? Here is how you can differentiate between the two:

• If the wheezing occurs only during a viral infection, cold, or fever and subsides as the infection clears out, indicates a viral wheeze.
• If the wheezing occurs frequently, without any trigger, it indicates a problem in the lungs. Doctors don’t generally diagnose breathing trouble as asthma until the child is at least a year old. It takes about a year for their airways to fully develop. Only after this can a doctor check for narrow passages that are resulting in breathing issues. For some children, a confirmed diagnosis is not possible until they are 5 years old.

When to Take Your Child to The Doctor?

If you notice the following in your child, rush them to a doctor or at least call your doctor immediately. Following medical advice is important here.

• Your child is unable to breathe or has difficulty breathing.
• The breaths are irregular or rapid.
• Noisy cries even when not crying.
• They turn blue due to a lack of oxygen.
• Unable or refuses to eat or drink.
• Tired more than usual.
• Fever along with breathing difficulties.
• If they are choking on something and you are unable to dislodge the foreign item.
• Foreign particles stuck in the nose, causing breathing difficulties.

If your child suddenly has an asthma attack due to some triggers in their environment, follow the procedure your doctor has taught you. If it is a severe attack, it is advisable to get it checked even if you are able to get everything under control.

Can Childhood Asthma be Cured?

Unfortunately, not all children with pediatric asthma can be cured. For some children, asthma can get better and clear itself by the time they are 5 to 11 years old. In most cases, even this is due to an effective asthma action plan that the parents and the doctor come up with, based on various symptoms and triggers in the child.

Once the doctor and the parents are able to identify the triggers and control them effectively, they can frame a long-term plan.

The doctor will prescribe maintenance medications such as:

1. Inhaled Corticosteroids

These are anti-inflammatory drugs that doctors prescribe for long-term use. They help in controlling asthma and ensuring a wheeze does not become an asthma attack.

2. Leukotriene Modifiers

These can be used individually or in combination with other medications for asthma. A possible side effect of this medication is psychological reactions. If you notice your child is having a psychological reaction to the drug, rush them to the doctor immediately.

3. Combination Inhalers

These inhalers use a combination of Corticosteroids in inhaling form and long-acting beta-agonist (LABA), to reduce the risk of severe asthma. However, the LABA should always be given in a combination only and never alone as it can worsen the asthma attack.

4. Theophylline

A daily medication that can help open up the airways. However, doctors don’t prescribe this medicine as frequently as they used to.

5. Biologics

In case of severe asthma, the doctor might give the Nucala injection every four weeks. It can help children above the age of six when combined with their asthma maintenance plan.

Any breathing issue in a child is concerning. While wheezing can be temporary and occasional, asthma is a more severe kind of infection. You need to find a good doctor who can help your child with their asthma and come up with an effective maintenance plan.

If your child is having difficulty breathing normally, don’t immediately fear the worst or assume it to be asthma. Get a medical opinion after taking the tests concerned. It could be a wheeze that needs just a simple medicine and nothing long-lasting.

[Read : Biologics For Autoimmune Diseases]

FAQ’s

1. Does Wheezing Mean Asthma?

No, all wheezes are not necessarily asthma. A child can have a simple viral wheeze due to a cold or a nose block. A viral wheeze can return every time your child gets a cold.

2. What Causes an Asthmatic to Wheeze?

A blockage in their airway can make it difficult to breathe. This can be due to severe colds, environmental triggers, or even coughs.

3. What is The Difference Between Asthma And Wheezing?

Wheezing is a strong symptom of asthma. While wheezing is less severe and can be seasonal, which will go away on its own; asthma is more severe. Asthma is recurrent in nature and does not have a permanent cure.

Read Also: Breathing Problems In Children – Causes And Symptoms

When your child coughs or struggles to breathe, the face does not show much more than just the struggle. You are left wondering and panicking about what could be going on the inside. With the advancement of science, doctors can now see the inside of your child’s lungs if they are sick and need proper diagnosis and treatment. Bronchoscopy for children is one such procedure that helps doctors diagnose the underlying issue correctly and ensure the right treatment.

If your child has rashes or is hurt, you are able to see it with your eyes and assess how bad it is and what type of treatment it requires. You can determine if some basic first aid at home is sufficient or if you need to go to the doctor. Similarly, a doctor will determine the health of your child’s lungs with Bronchoscopy.

In This Article

• What is Bronchoscopy?
• What is Carried Out in Bronchoscopy For Children?
• How do You Prepare a Child For Bronchoscopy?
• How Long Does a Paediatric Bronchoscopy Take?
• Are There Any Side Effects to Bronchoscopy Tests For Children?
• Recovery Time After Bronchoscopy For Children
• Ineligible For Bronchoscopy
• FAQ’s

What is Bronchoscopy?

When your child has some issue in their lungs, the respective specialist – a pulmonologist will want to take a closer look at the lungs to understand what the real problem is. For this, they need to get up close to the lungs which cannot be done with naked eyes.

Bronchoscopy is an invasive procedure where the doctor will insert a thin tube with a camera and a light at the end. They will insert this tube through your child’s nostril or mouth and go down all the way to the lungs. This tube is called a bronchoscope.

Through this bronchoscope, the doctor will get a better look at the lungs and the air passage. They can determine the source of the problem, which is essential for a proper diagnosis. In most cases, the bronchoscope is a flexible tube that will bend and turn in your air passage without trouble.

However, if your child is experiencing any type of bleeding in their lungs or the air passage, the doctor will use a stiff tube. Even if something is stuck in the child’s air passage, a stiff tube will be used.

Do not worry, a bronchoscopy will not hurt your child or cause any pain as the lung tissue has no pain fibres. It can cause lung inflammation and coughing but the doctor will prescribe medicine for it, and it will subside in a short span of time.

What is Carried Out in Bronchoscopy For Children?

Bronchoscopy involves the following steps

1. In a bronchoscopy procedure, the doctor will sedate your child’s throat and mouth before beginning the procedure.
2. They will then insert a thin tube with a light and camera attached at the end. This tube will go through the nostrils, through the windpipe all the way to the lungs.
3. The camera helps get a closer look at the lungs and air passage.
4. In case of damage, the doctor can identify the exact spot with the help of this instrument. Bronchoscopy is the most preferred procedure to dislodge anything from the airways too.
5. The doctor will obtain some tissue or mucus samples; dislodge foreign objects from the throat (kids are notorious for putting everything into their mouth).
6. It helps to treat certain lung issues.

A doctor will perform this procedure if your child has:

• A persistent cough that is not subsiding with any medications.
• Trouble breathing.
• Has had an infection or multiple infections.
• Abnormal CT scan and X-ray that could indicate an issue.
• Swallowed something they were not supposed to, which is now lodged in their throat.

A bronchoscopy helps doctors in the following ways:

• To diagnose a problem in the lungs.
• Identify an infection in the lungs.
• Do a biopsy of the lung tissue.
• Remove mucus, tumour or a foreign object that may be blocking the airway.
• Put in a stent to hold the airway open.
• Treat lung issues like collapsed or bleeding lungs.
• Take a closer look at the lymph nodes near the lungs.

[Read : What To Do When Your Kid Swallows A Coin]

How do You Prepare a Child For Bronchoscopy?

If your child has repetitive lung infections or bleeding, your doctor will ask for a bronchoscopy. Usually, the attending doctor will only perform this test. The medical care team will give you specific instructions and prep your child for the procedure.

As a parent, it is essential that you prepare your child to go through with this procedure. It can be very difficult and scary for them. Here are some ways in which you can prepare them:

1. Intake

Do not give your child anything to eat or drink post-midnight before the bronchoscopy the next day.

2. Medications

If your child is on any medications, check with the doctor as to when you should stop their usage or if it won’t interfere with anything. Certain medications will have to be stopped days before the procedure. So make note of the duration required and stop accordingly.

3. Brief Them

Talk to your child and brief them about what is going to happen. It is after all their body and they have a right to know what is happening to them if they want to know. Tell them about the procedure and what to expect after the procedure.

4. Reassure Them

It can be scary for a child to allow someone to insert a tube into their nose. It is not a comfortable feeling either. Provide moral support and reassure them you will be close by, and they have nothing to fear.

5. Answer Questions

Your child will have several questions regarding the procedure. Even if they don’t make much sense or if the question is repeated multiple times, stay patient and answer them. They are just too scared to tell it out.

6. Meet the Doctor

If needed let your child meet the doctor who will be performing the procedure. In all probability, it will be the same doctor who has been assessing and diagnosing your child. Let them feel secure around the doctor and not fear them. This will make them cooperate during the procedure.

7. Before The Procedure

The medical care team will make note of your child’s vital readings. This can sometimes upset a child who is already in fear of the upcoming procedure. Calm them down and reassure them.

8. After The Procedure

Your child will be observed for many hours to rule out any complications. Only then will they be discharged. During this time, their throats can feel dry and numb. They need to wait until the numbness wears off, to even drink water. Inform them about this, so that they don’t start panicking and have a breakdown after the procedure.

9. Comfort Toy

If it is a small child and they like to hold on to a toy, you can give it to them. The medical care team might let them hold on to it before and after the procedure. This can be a little reassuring for them as they won’t be scared of feeling alone.

How Long Does a Paediatric Bronchoscopy Take?

The length of the bronchoscopy varies. It can last anywhere between 15 minutes to an hour. It all depends on what the issue is. If it is a simple washing, it won’t take too long. On the other hand, collecting samples or analysing the damage can take more time.

For small children, it may take some time as their airways will be very narrow and the procedure has to be done precisely. However, they cannot be put under anaesthesia for long.

Once the procedure is over, your child will be taken to the recovery room where the medical care team will closely monitor them. As your child wakes up from the anaesthesia, the staff will monitor their condition and let them go once they are fully satisfied, and the doctor verifies the same.

So, you will have to prepare your child for a “few hours” of treatment.

Are There Any Side Effects to Bronchoscopy Tests For Children?

Like any other procedure, bronchoscopy has its own set of risks. While some can be very minor, some can be more concerning but rare. Do not worry unnecessarily thinking about the side effects. If your child is suffering from a lung issue, it needs to be checked closely. Bronchoscopy is the only way to do it safely and quickly.

Some of the possible side-effects you can expect are:

• Bleeding: If a biopsy was taken, then there are chances for bleeding, however, this will stop soon on its own.
• Bronchospasm: Irritation of the airway.
• Laryngospasm: Irritation of the vocal cord.
• Infection: Does not happen regularly.

Recovery Time After Bronchoscopy For Children

Your child will need a few weeks to recover. Their throat has been invaded and checked. It will result in some hoarseness and difficulty while swallowing. Your child might find this very difficult and might have meltdowns or tantrums. Ensure you comfort them and consult the doctor if the problem persists after the recommended duration.

Your doctor will usually recommend something for hoarseness or cough. If they don’t ask them if one will be needed. Get the prescription beforehand as you may not be able to consult the doctor as and when you want. Also, you want to focus on your child’s healing. Getting things in order before the procedure can make the entire episode very smooth.

The doctor will ask your child to avoid any strenuous activities post the procedure so that they don’t strain their lungs and airways too much. Keep your child informed about this and ensure they don’t exert themselves for a few days, as recommended.

Get your child checked immediately if they experience any of these:

1. Fever that lasts more than a day
2. Pain in the chest
3. Breathing trouble
4. Coughing brings up blood

[Read : Breathing Problems In Children – Causes And Symptoms]

Ineligible For Bronchoscopy

Sometimes, a child may be ineligible for a bronchoscopy despite their lung issue. Some of the reasons that can make them unfit for the procedure are:

1. Narrow airway that is severe and blocks the trachea.
2. Very low oxygen levels – it is not advisable to administer anaesthesia to such patients.
3. If your child is coughing and gagging severely, the doctor may ask you to wait until they feel better to do the procedure.

Bronchoscopy for children is an invasive procedure though it does not involve any suturing. It is a simple procedure that won’t take much time and will help in a better diagnosis of the problem your child is suffering from. It may be scary for both you and your child, but it will be done in no time.

FAQ’s

1. What is the Most Common Reason For Bronchoscopy in Children?

One of the most common reasons for bronchoscopy in children is something obstructing their airway. It could be just mucus or something they swallowed.

2. Is a Child Awake During Bronchoscopy?

No, the child will be given anaesthesia before the procedure begins. For small issues, local anaesthesia will be given and for issues that will take a long time, general anaesthesia will be given. It also depends on the age of the child and the doctor’s usual method of treatment. The main aim here is to prevent your child from moving during the procedure and avoid any injury or damage.

3. Can a Child go Home After a Bronchoscopy?

Yes, they can. The entire procedure should not take more than an hour. However, if your child were to develop any complications or bleed after the procedure, the doctors will want to keep them overnight or longer, for observation and healing.

4. What is the Difference Between Bronchoscopy and Endoscopy?

An endoscopy is a medical procedure that involves a close assessment of the internal organs and parts of the body with a camera and light. Endoscopy is a generic term and there are several types of endoscopies for various parts of the body. Bronchoscopy is the analysis of the throat and airways that lead to the lungs.

Read Also: Lung Function Test For Children – What Can You Expect by Dr Srikanta J T

The minute your little bundle of joy arrives, you are filled with joy and excitement. You can’t get enough of them and want to keep checking on them to ensure they are ok. When you notice even the slightest thing off, you get worried, and you have a list of queries for the doctor. Tracheomalacia in babies is one condition that can be quite worrying for parents.

Newborn babies sleep most of the time. They wake up, cry, feed, and go off to sleep again. It is all they do for the first few weeks of their lives. Your ears are tuned to even the smallest noise that escapes from them. When you hear a weird noise as they breathe, your parental alarm goes off that something is wrong. Could they be struggling to breathe? Do they have a breathing problem? Could it be Tracheomalacia?

In This Article

• What is Tracheomalacia in Babies?
• Signs and Symptoms of Tracheomalacia
• Causes of Tracheomalacia in Babies
• Diagnosis of Tracheomalacia in Babies
• How is Tracheomalacia Treated?
• Surgical Options For Treating Tracheomalacia in Babies
• Outlook For Babies With Tracheomalacia
• FAQ’s

What is Tracheomalacia in Babies?

Tracheomalacia is a medical condition where a child’s airway or the windpipe collapses and falls in on itself. This usually happens if something presses on the windpipe, causing it to collapse or if the walls of the windpipe are weak.
Just a small part of the windpipe or the windpipe as a whole can be affected.

Now, when only a small part is affected, the collapsed part can move down the windpipe. The windpipe splits into two and goes to the lungs. When the collapsed part of the windpipe goes past this branching-off area, it is called Bronchomalacia.

Signs and Symptoms of Tracheomalacia

How do you know if your tiny baby has Tracheomalacia? Here are some signs and symptoms that can tip you off. These are usually noticed between the ages of 4 and 8 weeks.

• Breathing is noisy, especially if you change the baby’s sleeping position
• Noisy breathing while asleep
• Breathing issues that seem to get worse when the baby coughs, feeds, cries, or has a cold
• Stridor – a high pitched noise while breathing
• High-pitched coughing
• Wheezing or a rattling sound when breathing
• Repetitive or frequent infections in the lungs
• Apnea or Cyanosis
• Breathing difficulties

[Read : Chest Infection In Toddlers]

Causes of Tracheomalacia in Children

Tracheomalacia is a condition that happens due to the windpipe collapsing on its own.

Tracheomalacia can be classified into

1. Congenital Tracheomalacia

Tracheomalacia can be present right from birth but is not a common health condition you are bound to see in newborns. Babies born with this condition may experience a few other complications like acid reflux, developmental delay, or even a heart defect. This is not a very common issue and most likely will sort itself out as the baby grows older.

2. Acquired Tracheomalacia

When Tracheomalacia is the result of an injury or repeated infections to the throat, it is defined as type 2 Tracheomalacia. It can even be due to the prolonged use of a tracheostomy tube.

Diagnosis of Tracheomalacia in Babies

If you notice your baby is making noise when they breathe, you need to consult your doctor immediately. The doctor will listen to the baby’s breathing and ask for further tests to confirm a diagnosis. Some of the tests they can ask for are

1. Bronchoscopy

The doctor will insert a narrow tube with a camera down your baby’s airway, through the mouth. This will help them see the insides of the windpipe and trachea as the baby breathes, coughs and swallows.

2. Laryngoscopy

This procedure is very similar to Bronchoscopy but here the doctor will assess the voice box and the upper airway. It is usually done along with a Bronchoscopy.

3. Fluoroscopy of the Airway

An X-ray with a contrast material will show the movement of the cartilage inside the Trachea. This will help the doctor diagnose the source of noisy breathing

4. Esophagram

This is a type of X-ray test. The technician will take X-ray pictures of the oesophagus which will help the doctor with the correct diagnosis.

5. Endoscopy

In this procedure, a thin tube with both camera and a light will be inserted through the windpipe to get a closer look at the oesophagus, the beginning of the small intestine, and the stomach. This helps to check for acid reflux and the damage created by it.

6. CT Scan of The Chest

CT scan or Computer tomography of the chest is a special test using advanced X-ray equipment to further examine abnormalities seen in basic tests such as X-rays.

7. Pulmonary Function Test

As the name suggests, a pulmonary function test is a test that measures the functioning of the lungs by measuring parameters such as lung volume, lung capacity, rate of gas exchange, etc. These parameters will help the doctor diagnose the problem in the baby.

[Read : Lung Function Test For Children]

8. MRI

Magnetic Resonance Imaging of the lungs allows the doctor to diagnose the source of the problem by giving detailed pictures of the area of testing.

How is Tracheomalacia Treated?

Tracheomalacia is not always serious. In some babies, the condition can be very mild and drastically improve by the time the baby turns 2 years old. However, some babies and toddlers will require treatment. The treatment depends on how severe the condition and the symptoms are.

For Mild Symptoms

If the symptoms are mild, the baby can be given humidified air to breathe and a few antibiotics to treat infections. These along with careful feeding can help the baby get better and the symptoms can diminish by the time the baby becomes 2 years old.

For Respiratory Infections

If the newborn has respiratory infections, it can cause the Tracheomalacia to worsen when they cough. So, medications will be given to control the respiratory infection and to reduce the baby’s coughs and sneezes.

For GERD

If the baby has GERD or acid reflux, it can worsen the Tracheomalacia. So, the doctor will give medications to help with the reflux and control the GERD symptoms.

Some of the other common treatments to help improve Tracheomalacia symptoms are

• Medications to clear the airway
• Nebulisation with saline solutions to thin down the secretions
• Percussion and vibration (physiotherapy to the chest) to reduce mucus in the airway and reduce infections
• Exercises for pulmonary hygiene to reduce mucus in the airway
• BiPAP or CPAP to push air gently into the lungs

Surgery is generally not necessary for very small children as the condition will improve as they grow older. However, in severe cases where the child is unable to eat or breathe normally, surgery might be the only option. Some of these surgeries aim at opening the airway and holding the tissues that are falling and creating the block. Over time, the muscles within will get stronger and the symptoms will reduce.

[Read : GERD and Reflux in Babies]

Surgical Options For Treating Tracheomalacia in Babies

Some of the surgical options available for Tracheomalacia are

• Pexy Procedures, which help open up the airway by attaching the weak part of the trachea to other surrounding organs. Some examples of Pexy procedures include Aortopexy, Tracheopexy, Bronchopexy, Posterior Aortopexy, Posterior Tracheopexy, and Descending Aortopexy
• Tracheostomy where a small opening will be created in the front part of the neck. A small tube will be inserted through this opening to help with breathing.
• Tracheal Resection to remove all secretions to make the airway as normal as possible.
• Rotational Esophagolplasty
• Placing a Stent, a rarely suggested temporary option.

Outlook For Babies With Tracheomalacia

If your baby is having difficulty breathing, you will need to attend to it immediately. If you are not satisfied with the diagnosis, get a second opinion. But in most cases, doctors try to avoid surgeries as children get better with age. Getting help and following medical advice can help and make a big difference to both your child and your quality of life.

Babies born with Tracheomalacia might develop other issues as mentioned earlier. If needed, a specialist will have to be considered to treat those issues and help your child. Overall, it is a condition that can be treated and controlled with treatments and medications.

FAQ’s

1. Is Tracheomalacia Life Threatening?

In some cases yes. If the damage to the airway is severe and prevents the child from breathing or eating properly, it can cause severe problems. However, in most cases, symptoms will get better as the child reaches the age of 2.

2. Is Tracheal Tug an Emergency?

Yes, it is. It is a block to the upper airway and can cause respiratory distress, meaning prevent the child from breathing. The doctor will observe and decide on the next course of action based on the evaluation.

Read Also: Laryngomalacia in Infants – Symptoms, Diagnosis and Treatment by Dr. Srikanta J T

Substances that can cause allergic reactions are specifically called allergens. Allergens exist everywhere, inside the house and in the environment outdoors. They exist in different forms like pollen, dust, insect remains, and molds. When the human body comes in contact with the allergens indoor or outdoor, it involuntarily releases certain antibodies to fight them in children. This can lead to allergic reactions. Occasionally these indoor and outdoor allergens are proven harmful to children who are prone to allergies, especially in kids with allergic asthma and other inherited skin diseases like eczema. In this article, we discuss some common indoor and outdoor allergens in children.

In some children, allergens may cause seasonal or perennial allergic rhinitis. Allergic rhinitis includes a runny or itchy nose, sneezing within a few minutes of inhaling them, itching or irritation inside the nose and the roof of the mouth which may last for a few days or throughout the year. Certain allergies are seasonal and temporary, and they will pass with time. While some allergies caused by both indoor and outdoor allergens are long-lasting, harmful, and may lead to complications in Children. Allergy complications are mostly genetically inherited and require the attention of a doctor.

In This Article

• What Are Indoor Allergens?
• What Are the Most Common Indoor Allergens in Children?
• Indoor Allergy Signs And Symptoms in Children
• What Are Outdoor Allergens?
• What Are the Most Common Outdoor Allergens in Children?
• Causes of Outdoor Allergies
• Outdoor Allergy Signs And Symptoms in Children
• When to Seek Medical Advice
• FAQ’s

What Are Indoor Allergens?

Allergens that are found inside a house are called indoor allergens and include dust, dust mites, insects, pets, and indoor plants. All pets and pet fur may not necessarily be allergens, but the minute organisms that are present on their fur and saliva can be allergenic. Do we have allergens at home? Yes, it is common to find many allergens in every household. Children who are vulnerable to allergens can be sensitive to such indoor allergens. Household cleaning agents and chemicals can also can allergies in some children.

What Are the Most Common Indoor Allergens in Children?

Indoor allergies can be harder to avoid and are not seasonal. There is a list of indoor allergens that can trigger allergic reactions in children who are vulnerable to allergens.

1. Dust

Dust is a common complaint in every house. It can be a combination of various substances like pollen from indoor plants, insect remains, pet fur, spider webs at the corners of the roof, and molds that form due to the damp environment. Together this can trigger allergic rhinitis and can last longer than expected in susceptible kids. Household dust can be managed by frequent dusting and vacuuming. Some insect remains which are part of house dust can be airborne and trigger allergies when inhaled.

2. Dust Mites

Dust mites are the minute insects that prefer to shelter in humid environments. These are very small insects that we cannot see with the naked eye. They typically feed on the minute flakes of human dead skin. Dust mites grow in warm and humid temperatures. Maintaining a humidity-free house can help in keeping the dust mites away from your furniture and bedding.

3. Cockroaches

Cockroaches are the most common complaint in every household. Dripping water and wet environments are the reason for the presence of cockroaches at home. Their small remains like the antenna and the other small particles from their fore and hind legs can stay in the air and cause allergies when inhaled. Cockroach waste is also one of the common sources of allergic rhinitis.

4. Fabric Fibres

These are small particles that detach from clothing and can stay in the air for enough time to be inhaled. Such tiny particles can cause itching and irritation inside the nose. Detergent particles present on these fibres can also trigger allergic reactions in children.

5. Animal Waste

Pet waste or animal dander like fur, saliva, and animal waste comes under one of the indoor allergens and can lead to allergic rhinitis. It is important to keep the pets away from your bedding and furniture if your child is prone to allergies.

6. Indoor Plants And Molds

Indoor plants need constant watering, some may or may not need sunlight. Keeping plants in closed rooms and watering them can lead to the growth of molds because of the dampness. Keeping the environment dry and ventilated can help avoid the growth of molds.

[Read : Dog Allergies In Babies]

Indoor Allergy Signs And Symptoms in Children

An allergic reaction is a natural defence of the human body against foreign particles. Seasonal allergies can be common and regress with time, chronic allergies like perennial allergic rhinitis and allergic asthma can be an alarming situation and might need constant care.

Some symptoms of indoor allergies include

• Runny nose
• Stuffy nose or nasal congestion
• Dry cough
• Irritation or itching inside the nasal passage, inside the throat, and on the roof of the mouth
• Constant sneezing
• Wheezing or difficulty breathing
• Watery eyes

What Are Outdoor Allergens?

Outdoor allergens are substances from the environment that cause allergic reactions. These are seasonal and act as a source of seasonal allergic rhinitis in children vulnerable to allergens. Outdoor allergens are small particles that can float in the air. Inhaling these may lead to adverse reactions in kids who are prone to allergic asthma and other respiratory troubles.

What Are The Most Common Outdoor Allergens in Children?

The most common outdoor allergens are from plants, trees, and grass. There are different types of pollen grains, among them only some trigger allergic reactions.

1. Pollen

Pollination is a fertilization process in trees, plants, and weeds. During spring and autumn, the amount of pollen in the air rises to a point where children start to inhale it and this becomes the main source of seasonal allergic rhinitis or hay fever.

It’s not just plants, trees, weeds, and grass that can also produce seasonal pollen for fertilization. Certain trees also release pollen, some throughout the year and some seasonal, which can be the reason for allergies. Some such trees include

• Coconut tree
• Eucalyptus tree
• Papaya tree
• Castor oil (throughout the year)

All plants give pollen, certain plants like roses have insects to carry them from one plant to another. But other plants release them in the air, which leads to allergies when inhaled.

Weed pollen can also lead to allergic rhinitis. A special weed called ragweed pollen is the main source of triggering allergy when inhaled. Certain particular grass and weeds like congress grass or parthenium hysterophorus, bermudagrass or Cynodon dactylon, and mesquite or Prosopis juliflora weed are also the main triggers for the cause of pollen allergies in children.

2. Molds

These tend to grow on rotten wood, dried leaves, and damp roads. They release their spores into the air, and these spores when inhaled can cause allergic rhinitis.

3. Other Sources

Other causes like bird droppings may also be one of the reasons for outdoor allergies in susceptible children. Study shows that some kids may suffer from allergies due to the viral load present in the air, though this may not be included in one of the outdoor allergens.

Causes of Outdoor Allergies

A human body reacts to a foreign substance by releasing certain antibodies to fight them. Similarly, our body can misinterpret certain substances like pollen released by the environment, to a foreign body and start to react adversely. The body releases “histamines”, and as a result of this many symptoms arise. These kinds of reactions are called allergic reactions which can lead to hay fever or seasonal allergic rhinitis.

Seasonal allergic rhinitis is respiratory trouble caused by outdoor allergens. It is mostly accompanied by sinus infections as there will be a swelling of blood vessels which may lead to infections. These are mostly caused by the pollen released by certain trees, plants, grass, and weeds. Some may be seasonal and some may stay throughout the year.

Outdoor Allergy Signs And Symptoms in Children

The signs and symptoms of outdoor allergies are

• Heaviness inside the nasal passage
• Facial pain due to sinus infection
• Throat pain or itchy throat
• Continuous coughing (no sputum) and sneezing
• Headache (rare)
• Runny and congested nose.
• Wheezing and trouble breathing (in allergic asthma patients)

Outdoor allergy symptoms are almost the same as any other allergy. Allergies from outdoor sources are mostly seasonal and may not stay throughout the year. But, certain trees, grass, and weed produce pollen throughout the year which may cause such symptoms in children vulnerable to allergies.

When to Seek Medical Advice?

Though seasonal allergies are normal and may regress with time, it is important to keep track of the symptoms you experience. Hay fever or allergic rhinitis can lead to adverse reactions in some children giving rise to breathlessness and asthma if ignored. Contact your doctor if you experience symptoms for more than two weeks or if they get worse over time.

Incidences of indoor allergens are getting worse in children, partly due to pollution and mostly due to increasing exposure to the external environment. The use of chemicals in cleaning agents and their presence in the environment is also contributing to allergies. If your child is suffering from allergies, it is important to identify the sources of indoor and outdoor allergens so that the  exposure can be minimized in Children.

It is important to remember that allergies cannot be totally prevented. You can work with your doctor to identify the triggers in your child and avoid them. Your paediatrician may also prescribe antihistamines when the allergies get severe. It is important to see the doctor if you find your child’s symptoms worsening.

[Read : How To Protect Your Child From Indoor Air Pollution?]

FAQ’s

1. What Could I be Allergic to Inside The House?

There are so many factors that can trigger allergies inside the house. Some of them are dust, dust mites, pet dander, cockroaches, and other insect remains.

2. Why Are My Allergies Worse Indoors?

Since indoor allergies are not seasonal, they tend to worsen as much as you get exposed to them.

3. What Are Outdoor Allergens?

Pollen and molds are the main sources of outdoor allergens, they may be seasonal or year-round.

Read Also: Skin Prick Allergy Test in Children by Dr. Srikanta J T

It is a beautiful sight to watch your infant sleep. The innocence and that calm can melt hearts. Just as you are enjoying your little one, do you hear them breathe hard? Is their breathing noisy to you? Yes, it can be nothing or just their position but, could it be Laryngomalacia? Could it be a serious birth defect? Laryngomalacia in infants is more common than you think.

Even the slightest noise can be alarming when it is coming from that tiny body. You are eager to ensure there is nothing wrong with your newborn. Before you frantically worry about birth defects and surgeries your baby might have to endure, you need to know more about this “not-so-rare” health issue in infants. Come, let’s find out more about this.

In This Article

• What is Laryngomalacia?
• Signs and Symptoms of Laryngomalacia in Infants
• Causes of Laryngomalacia in Infants
• Diagnosis of Laryngomalacia
• How is Laryngomalacia Treated?
• FAQ’s

What is Laryngomalacia?

Laryngomalacia, one of the most common causes of noisy breathing in infants, happens due to the softening of the larynx present above the vocal cords.

All of us have a voice box – Larynx. When the tissues of this voice box soften, it results in Laryngomalacia, meaning soft Larynx. These tissues are located just above the vocal cords.

While breathing in, these issues which are a little floppy fall in and block the airway partially. Now, when the baby breathes in, this obstruction of the airways will cause noise, and this is why your infant’s breathing could be “noisy”.

Laryngomalacia is not rare and is seen in most infants right from the time of birth. Many of them have noisy breathing from birth, which slowly disappears as they get older. Some infants can even develop this when they are around 2 to 4 weeks old.

In most cases, Laryngomalacia is not a solemn condition that requires any intervention. The infant grows out of it around 20 months of age. Until then, this condition does not interfere with their breathing, eating, or swallowing.  A small percentage of them may not be able to breathe or eat properly and may even struggle to gain weight. In such cases, medical intervention or even surgery might be required.

Signs and Symptoms of Laryngomalacia in Infants

As most infants have noisy breathing in the initial days of their lives, it can be easy to miss this. Here are some signs and symptoms you need to watch out for in your infant. If you notice any of these signs, check with your baby’s doctor immediately. Do not wait for the condition to get better on its own.

1. Harsh or Noisy Breathing (Stridor)

• Stridor gets louder when they cry, exert themselves, or even while feeding.
• The stridor becomes worse when you put them on their back.
• Stridor gets louder and stronger as your infant gets older, stronger and tries to use their vocal cords more.
• Your infant struggles to breathe or eat. They do not gain weight as expected and spit-up regularly.
• There is a tug or pull in their chest or neck, as they breathe.

2. Additional Symptoms That Require Immediate Medical Attention

• Cyanosis: They turn blue due to a lack of oxygen.
• Aspiration: They inhale food into their lungs.

[Read : Meconium Aspiration Syndrome in Babies]

Causes of Laryngomalacia in Infants

So, what causes this stridor or Laryngomalacia in infants?

No one knows for sure yet. However, doctors and experts believe it could be just a defect in the way the voice box forms in the womb. The voice box needs adequate support from the muscles around it and when these muscles are relax too much or get weak, it results in Laryngomalacia. If the baby has GERD, it can worsen Laryngomalacia.

Diagnosis of Laryngomalacia

When you take your infant or baby to the doctor due to noisy breathing or any other symptoms mentioned above, they will diagnose the issue in the following manner:

1. Medical History

To start off with, the doctor will get a complete history of the baby’s health.

2. NPL Test

In the Nasopharyngolaryngoscopy test, a tiny camera with a light at the end will be inserted through your little one’s nostril. It is slowly moved down towards the larynx to check the voice box and the muscles around, up close. If the NPL test shows your baby has Laryngomalacia, the doctor will do the following to understand the extent of the issue:

3. Neck X-ray

This test will help the doctor understand if any other abnormalities might be interfering with the breathing so that the diagnosis can be made accordingly.

4. Fluoroscopy of the Airway

For this test, a contrast agent is used to illuminate the affected areas which are studied through an X-ray.

5. MLB or Microlaryngoscopy and Bronchoscopy

This is a small non-invasive procedure that is done under general anaesthesia. A lighted scope is sent through the airway to check for the loud breathing causes.

6. EGD or Esophagogastroduodenoscopy

This is an outpatient procedure that allows the doctor to check your baby’s oesophagus, stomach, and duodenum.

7. pH Probe

Doctor may perform or suggest this test to check the pH balance and treat acid reflux if that is the cause for the loud breathing.

8. FEES

Functional Endoscopic Evaluation of the Swallows. This test helps the doctor evaluate the swallowing capability of the infant or the baby struggling with laryngomalacia

These tests help the doctor understand the extent of the issue and how much your little one is affected by it.

As a parent, it is important you take your baby to the doctor as soon as you realize they have stridor or have other symptoms. Delaying a consultation can only make it harder for the baby to breathe and grow as expected. If the Laryngomalacia is severe, a delay in diagnosis is not advisable.

How is Laryngomalacia Treated?

In most cases, Laryngomalacia will subside and go away on its own as the infant grows. Many babies get over their stridor by the time they reach one year of age and many others, by the time they turn two. In very few cases, the Laryngomalacia may be severe and require medications or even surgery.

1. Medication

If your little one is suffering from GERD and is spitting up very often, it will worsen the Laryngomalacia. So, your doctor might prescribe medicines to control GERD. The medication can help reduce swelling and chest retractions.

[Read : GERD and Reflux in Babies]

2. Surgery

If the condition is serious and the doctor does not expect it to resolve on its own, they will suggest Supraglottoplasty – surgery for Laryngomalacia. The doctor may not recommend surgery unless absolutely necessary.

Your doctor might recommend or consider it only if the symptoms are severe like:

• Apneas that are life-threatening
• Blue spells
• No weight gains despite feeding well
• Requires extra oxygen support
• Heart or lung issues as a result of an inability to breathe easily

Despite surgery, your baby’s noisy breathing may not go away completely. However, it can help in the following ways:

• Symptoms will become less severe
• Apneas might completely stop or at least reduce significantly
• Reduces the need for extra oxygen support
• Improvement in swallowing
• Helps gain weight
• Once the surgery is complete, the doctor will check your baby’s swallow to ensure it is safe.

It is very common to hear an infant or a baby breathe loud when they are asleep. Especially infants sleeping on their backs. Sometimes it could be Laryngomalacia and most times it will sort out on its own. It is very natural to panic when something is off with your tiny bundle of joy. With timely diagnosis and treatment, laryngomalacia in infants can resolve quickly.

FAQ’s

1. Does Laryngomalacia go Away on its Own?

Yes, in most cases it does. Many infants get over it by the time they are a year old and many others by the time they are two years old. Very rarely medications or surgery might be required.

2. Does Laryngomalacia Affect Development?

Yes, it does. As it blocks the airway, the infant is unable to breathe effectively. The lack of sufficient oxygen to various parts of the body affects growth. Laryngomalacia also interferes with the way an infant swallows. When they are unable to swallow their food, it has a direct impact on their weight and growth.

Read Also: Sleep Apnea in Babies: Causes, Symptoms and Treatment by Dr. Srikanta J T

A newborn baby is very delicate and vulnerable to many infections and dependent on the parents for every little thing. The parents also have a high level of curiosity to understand all the new things that happen with the arrival of the baby. Babies are always not all pleasant, the poop and the vomit, the very first faeces of the child are not something familiar to the parents. Apart from the routine, new babies can go through certain other uncomfortable situations too. This article discusses in depth about meconium aspiration syndrome in babies.

Meconium is a medical term that refers to the first stool or the faeces of the newborn. This stool is odourless than the regular ones as the baby only takes amniotic fluid as their intake. The regular stool is yellowish while meconium is green, thick dark and tar-like. Sometimes newborn babies can breathe a mixture of meconium and amniotic fluid into their lungs at the delivery time. Though not very common, this condition can happen.

In This Article

• What is Meconium Aspiration Syndrome?
• Causes of Meconium Aspiration Syndrome in Babies
• What Are The Symptoms of Meconium Aspiration Syndrome?
• How is MAS Diagnosed?
• How is MAS Treated?
• Can You Prevent Meconium Aspiration?
• What Complications Are Associated With Meconium Aspiration?
• FAQ’s

What is Meconium Aspiration Syndrome?

Meconium refers to the first stool or faeces of the newborn. The MAS or the Meconium Aspiration Syndrome occurs when a newborn is over the due date and inhales a mixture of meconium and amniotic fluid in the lungs at the time of labour or in the womb. This syndrome can be a cause of acute illness and even death in a few newborns.

MAS is due to stress that the foetus undergoes, as a result of which it may pass stool on the womb. This stool is dark green in colour. Post-delivery, the infant will pass meconium stools for the initial few days as well. During delivery, under stress, this meconium mixes with the amniotic fluid which surrounds the foetus. The fetus can breathe this fluid mixture into the lungs before, during or after the birth causing Meconium Aspiration Syndrome.

Even though MAS is not fatal, it can lead to severe health issues for the newborn. And if not treated on time or left untreated can even lead to death.

Causes of Meconium Aspiration Syndrome in Babies

MAS is the inhalation of the mixture of amniotic fluid and meconium by the foetus into their lungs. This can take place in the womb or during labour. The meconium is a dark green, thick, sticky, stool that has mucus and some intestinal secretions as well. The babies generally pass the first stool either after a few hours of birth or after a few days of birth. Due to destress during labour, the to-be born baby may inhale this mixture of amniotic fluid and faeces resulting in MAS.  MAS may lead to respiratory issues and even lead to severe complications or illness.

The Common reasons for the foetal distress and premature releasing of meconium are

• A pregnancy that exceeds 40 weeks
• Long-lasting or difficult labour
• Health problems of the mother such as gestational diabetes or hypertension, heart ailments or chronic breathing disorder
• Umbilical cord complications
• Poor fetal growth due to some infection or problem
• Smoking during pregnancy

The foetus will not produce meconium unless it is in the later stages of pregnancy. As the pregnancy advances to the date, the amount of amniotic fluid also keeps reducing. This can concentrate the meconium as well. Thus, MAS is common in newborn babies that are past 40 weeks. It is uncommon in preterm babies or otherwise.

[Read : Slow Fetal Growth During Pregnancy]

What Are The Symptoms of Meconium Aspiration Syndrome?

If the foetus expels meconium inside the womb, the signs and symptoms start to appear in the fetal stage. The infants who inhale meconium during labour show signs within a few hours after their birth. The most common symptom of MAS is respiratory disorder. The infant may either start breathing every heavily or start grunting during breathing. Many newborns can even stop breathing if the airways are blocked by the meconium.

Symptoms of MAS include

• Respiratory distress
• Low blood pressure
• Bluish skin colour of the baby, also known as cyanosis
• Limpness in the baby at the time of birth
• Amniotic fluid with green colour streaks
• Low heart rate before the birth of the baby
• Low Apgar score of the baby (evaluation because of heart rate, skin colour, muscle tone, reflexes and breathing rate)
• Breathing disorder (rapid, suspension or laboured breathing)
• Breathing with a grunting sound
• Pulling in of the chest wall
• Yellow skin or nails due to long exposure to meconium

[Read : Know All About The Apgar Score In Newborns]

How is MAS Diagnosed?

MAS diagnosis takes place depending on the presence of meconium in the amniotic fluid. The doctor will diagnose MAS through the following steps

• Observing the low heart rate of the foetus
• Examining lung patches with a chest x-ray. This helps to find out if a material has entered the lungs of the newborn.
• Blood gas test that helps to detect the low oxygen and carbon dioxide levels.
• Assessing the abnormal breathing sound with the help of a stethoscope.

How is MAS Treated?

Any infant who is active, breathing normally and crying at the time of birth needs no treatment even with the presence of meconium in the amniotic fluid. It is however important to keep the baby under observation as MAS symptoms can appear within 24 hours.

The treatment of MAS depends on various factors, like the amount of inhaled meconium, the health of the newborn and the duration of exposure.

In case the newborn shows signs of MAS, like low heart rate, respiratory trouble, poor muscle tone, it must undergo these procedures.

1. Amnioinfusion

Amnioinfusion is good for babies who have a high risk of MAS due to very limited monitoring resources. A sterile liquid is injected into the amniotic fluid during delivery which helps in dissolving the meconium. It even reduces the inhaled amount of the fluid by the infant.

2. Respiratory Support

If the newborn cannot breathe or has a low heart rate, the doctor makes use of a bag and a mask and help them breathe, this will deliver oxygen to the baby and help in inflating the lungs.

3. For Babies With Acute MAS

The babies who have acute MAS symptoms must undergo the given procedures for better improvement.

• Oxygen therapy to make sure there is sufficient oxygen in the blood.
• Antibiotics such as ampicillin and gentamicin given intravenous to prevent or treat an infection.
• Use of a ventilator (a breathing machine) to help your infant breathe.
• Radiant warmer to keep the baby’s body temperature in the given range.
• Chest physiotherapy to loosen the meconium trapped. The baby’s chest is tapped at regular periods.
• ECMO or extracorporeal membrane oxygenation (ECMO) in case the baby does not respond to other procedures or has high blood pressure in the lungs.
• Surfactant to help open up the lungs.

Can You Prevent Meconium Aspiration?

Early detection of MAS is the best way to prevent it. Getting monitoring of the foetus through ultrasonography and check-ups can help to assess if the baby is undergoing stress. The doctor can take the necessary steps to get rid of fetal suffering and pain at the time of labour. This even helps in reducing the chances of the development of Meconium Aspiration Syndrome or MAS.

In case the baby is experiencing stress, the doctor can assess and offer treatment to the baby immediately if there are any signs or indicators of MAS.

Here are some precautions you can take to avoid the potential risk of MAS

• Get your check-ups and ultrasonography tests done in a diligent manner.
• In case of health complications like diabetes, follow medications, treatment, and diet properly to reduce the risk of MAS during delivery.
• Avoid smoking and drinking during pregnancy.
• Consult your OBGYN if you see a green stain liquid during a water break.

What Complications Are Associated With Meconium Aspiration?

Most of the overdue newborns who have had MAS do not have long term health issues. Yet MAS is a serious issue and can impact the baby’s health.

• If meconium reaches the lungs it can lead to infection as well as inflammation and there are high chances of a chronic lung disease etc.
• Meconium can block the airways of the baby leading to lung being expanded. If this happens, the lungs can collapse or even rupture.
• MAS can lead to an increase of the infant to develop a condition known as Pulmonary Hypertension of the Newborn known as PPHN. The high blood pressure in the vessels of the lungs of the infant can restrict the blood flow and make it difficult for the baby to breathe. This condition is rare but a fatal one.
• Very rarely, severe conditions of MAS can limit the oxygen intake to the brain resulting in permanent brain damage.
• Aspiration Pneumonia is one of the complications that can occur due to MAS.
• Developmental issues like neurological disorders are also a possible complication for a newborn who has experienced MAS
• On rare occasions, severe MAS may limit oxygen to the brain leading to permanent brain damage.

Meconium aspiration syndrome in babies is treatable with timely intervention and by taking all necessary precautions. Pregnant women with underlying health issues should undergo regular examination and testing, especially towards the delivery date. Most babies get back to their normal health within a few days post-delivery. Long-term complications are rare but a possibility.

FAQ’s

1. Can Babies Survive Meconium Aspiration?

Yes, it is not difficult for the babies to survive meconium aspiration. If left untreated or not treated at time, the results are incurable. If the baby shows breathing disorder and abnormal chest X-ray with MAS, additional oxygen and medical assistance is a must.

2. Can Swallowing Meconium Cause Brain Damage?

Meconium is a cause as well as a sign of less oxygen. In the absence of careful management during labour and delivery or immediately after birth, it can lead to brain injury, cerebral palsy, and permanent disability. If the meconium does not clear from the airways or lungs of the baby, it can have severe consequences and can result in shortage of oxygen, brain injury, less oxygen and death before time.

Read Also: All You Should Know About Newborn Pee and Poop in the first 24 Hours After Birth

The human immune system reacts to foreign bodies to protect us from infections. In some cases, our body begins to treat certain normal things like food items, environmental and seasonal changes as foreign bodies and starts to react. These kinds of adverse reactions are called allergies. Any substance that triggers an allergic reaction is called an allergen. Allergies are quite common in children. Not all, but some types of allergies are genetic, and kids inherit them from their parents. Skin prick test in children is routinely used to identify such allergies.

Allergies in your child can be efficiently identified and treated by an allergist or an immunologist. They conduct several tests before considering the path for treatment. There are two types of tests, skin tests and blood tests. One of the major tests among skin tests includes the skin prick test. Allergens troubling your child can be identified through this test. It is a safe test to be performed on children of all ages and involves a step-by-step process in which the different types of allergens are used. Through this test, the doctors can identify the allergens which are responsible for the allergic reaction.

In This Article

• Allergies in Children
• Types of Allergies in Children and The Reactions
• When Should You Consider Getting Your Child Tested For Allergies?
• What Are The Different Types of Tests Available For Allergies?
• How do You Prepare Your Child For a Skin Prick Test?
• Procedure For a Skin Prick Test in Children
• What Devices Are Used For Skin Prick Test in Children?
• Advantages of SPT
• Limitations of SPT
• Are There Any Side Effects of Skin Prick Test?
• FAQ’s

Allergies in Children

It is quite common for children to have allergies. Allergies may occur due to food, season, and environment. Most allergies in children regress once their immune system is mature enough to handle different kinds of foods. Some inherited allergies like eczema may demand the attention of the doctor.

The substances that trigger allergies in children are called allergens. An allergy is an immediate reaction to a substance that is touched or consumed. Children mostly suffer from allergic reactions in the form of a skin rash or a stuffy running nose. The cause may not be obvious, but there are several reasons as to why a child might suffer an allergy. Doctors say that most of the allergies in children are genetic.

Types of Allergies in Children and the Reactions

Different types of allergies can occur due to different reasons. We list some of the common allergies in children and their manifestations.

1. Seasonal Allergies

Seasonal allergies are the allergies that occur due to seasonal or environmental changes. These kinds of allergies are more common in toddlers. Seasonal allergies can cause allergic rhinitis.

Reactions

• Stuffy nose
• Running nose
• Continuous sneezing

2. Food allergies

Food allergies are very common in children. These allergies may occur due to milk, soya, certain kinds of seafood, and nuts like peanuts and walnuts.

Reactions

• Wheezing
• Nausea and vomiting
• Indigestion
• Diarrhoea
• Trouble breathing
• Stomachache
• Hives
• Rashes on skin

[Read : Nuts and Peanuts Allergies In Children]

3. Environmental Allergies

Environmental allergies occur due to pollen, insect bites, and other external factors like certain soaps, shampoos, house hold cleaners and detergents.

Reactions

• Rashes on skin or hives
• Scaly skin or itchy skin
• Wheezing
• Red and itchy eyes

[Read : Insect Bites: First Aid And Home Remedies]

When Should You Consider Getting Your Child Tested For Allergies?

Since the immune system of a child is still in a developing stage, most of the food and seasonal allergies go away as they grow. But not all allergies are the same. Get an appointment with your child’s paediatrician if you see persistent allergic symptoms such as

• Runny nose
• Wheezing and trouble breathing
• Asthma
• Hives on the skin
• Rashes on the skin
• The continuous cold that does not regress

Continuous symptoms can be annoying for your little one. See a doctor if you notice any obvious allergy symptoms. It is also important to know your family history to understand the heredity of the allergies that your family carries. If there is any genetic inheritance of allergies, and you don’t have the allergy, it implies that you are just a carrier of that particular gene.

Once you visit a paediatrician, they may conduct a physical examination before going for any other tests. Doctors may also ask for the clinical history and current medical status of the child and question the parents regarding any hereditary allergies before proceeding for clinical tests.

What Are the Different Types of Tests Available For Allergies?

There are different types of tests available for allergies. Doctors may require examining the kid before prescribing any particular test. Allergy tests for children include skin tests and blood tests.

1. Skin Tests

Again, the skin tests are of three types- skin prick test, patch test and intradermal test.

a) Skin Prick Test

This test is done by placing a small amount of allergen on the surface of your child’s skin. The doctors will scratch that part of the skin with a lancet (a needle-like tool) and leave it to react. The skin prick test may typically need 15-20 mins to show the results.

b) Patch Test

This kind of test is carried out by applying the allergen adhesive on the surface of the skin. The results will be recorded as positive if the doctors observe a small red bump that arises after 48 hours of testing.

c) Intradermal Test

An intradermal test is a kind of skin test in which an allergen is inserted into the top layer of the skin. The result can be seen as a red bump on the surface of the skin if your little one is allergic to that particular allergen.

2. Blood Tests

Blood tests are conducted to check the antibodies reacting to the allergens. These antibodies, also called IgE antibodies, are allergen-specific antibodies that react to certain allergens. Blood tests are preferred over skin tests in children. Skin tests very rarely cause anaphylactic reactions. Skin tests, especially intradermal skin tests, may cause adverse effects if your child is extremely allergic to the allergen.

During blood tests, pathologists will collect the blood sample and induce allergen into it. Blood starts to produce specific antibodies that react to that allergen. If your child’s blood reacts to specific allergens without them showing any external symptoms, it indicates that your child may be sensitized to that particular allergen and is not allergic.

How do You Prepare Your Child For a Skin Prick Test?

If you are getting a skin prick test for the first time, you may want to know how you can prepare your little one and yourself for the process. Here are a few things you must remember.

1. Stop Certain Medications

Certain drugs like antihistamines are used to treat allergic symptoms. Antihistamines are the drugs that are used to reduce allergy symptoms like runny nose, and itchy and red eyes. When the allergen binds to an antibody, it releases histamine which causes the reaction by

• Increasing mucus levels, (runny nose and teary eyes).
• Triggering the nerve endings causing itching and irritation
• Releasing more acid into the stomach.

Doctors routinely prescribe antihistamine medications to treat allergies in your little one, but these medications may interfere with skin test results. It is important to speak to your doctor about your child’s ongoing medication before proceeding with any kind of skin test.

2. Make Your Child Feel Comfortable

Children tend to fear strange places and strange people, especially in settings such as a hospital or a diagnostic center. You can make them feel comfortable by staying with them and reassuring them during the test. Your presence will give them the comfort and warmth they need. Try to reassure them that the procedure will be simple and quick.

3. Set Expectations Before Hand

If your child is a little older and is at an age to understand, you can explain the reasons for the test and how it is done. You can also share videos with them to familiarise them with the process. This may give them a better understanding and they will feel better during the testing process.

4. Get a Toy That Your Child Would Like to Play With

If your child is too young, talking to them about the process may not be feasible. Allergy tests are not painful, but the results may take some time. The tests may also cause irritation or itching at the place of the test. Distracting your kid with their favourite toy or a book during that time is a good option. Do not let them touch the spot and engage them in every possible way you can.

Procedure For a Skin Prick Test in Children

Skin prick test is mostly done on the upper back for children. Doctors may suggest proceeding with the test for two or more allergens. Before starting the test, the doctor or specialist will go through the infant’s medical records and understand the previous medical history. They will also conduct necessary screening for ongoing medical conditions like asthma and other respiratory allergies.

The procedure for skin prick test in children includes the following steps.

• The test will start with the process of disinfection of the test site.
• A water-soluble marker will be used to mark for the number and the type of allergens that need to be tested.
• The technician will then place small drops of allergens one after the other above the marked area.
• A small needle-like tool called a lancet is used to slightly prick the skin.
• For each pricking, a new lancet must be used.
• The technician will wipe off the allergens after pricking.
• After a gap of 15 minutes, the doctor or technician will check the results.

Positive – Reddening around the pricked area along with a small bump which is called a wheal. Formation of wheals indicates that your child is allergic to that particular allergen.
Negative – The skin under the pricked area remains normal and does not react.

Skin prick test never causes bleeding, and it is very much safe for children. Your little one might experience slight irritation and itching around the area. Itching and irritation mostly subside in a few minutes. Red spots at the reacted area will also regress within a short time.

What Devices Are Used For Skin Prick Test in Children?

Skin prick testing is a very mild clinical procedure that should be done under the supervision of experienced doctors. Skin prick testing would need very minimal devices. Lancet and grading scale are the two important tools that are mandatory for skin prick tests. The process requires

• Clean disinfectant wipes. Nurses will use these to disinfect the area where they are going to administer the test.
• Water-soluble marker to mark for allergens.
• Droppers, add small drops of allergens on the respective markings.
• A small needle-like device called a lancet to prick the skin for the allergens to get inside.
• Clean tissue paper to wipe off the sample drops on the skin.
• Grading scales to measure the positively reacted site on the skin.

Advantages of SPT

The advantages of skin prick test are

• Skin prick test is a simple and inexpensive test.
• SPT is painless, unlike blood tests.
• It gives results in a very short time and is efficient.
• This test is more sensitive to IgE allergens when compared to IgE antibody tests.
• It can detect allergies effectively.
• The test is an extremely safe and best way to identify the allergens that are responsible for allergic reactions in children.
• Children can be cooperative during the procedure, unlike blood tests.

Limitations of SPT

Like the advantages, there are certain limitations of Skin Prick Testing.

• It is important to ensure the testing with a good quality reagent.
• An under-quality reagent may result in false results.
• The doctors and the staff must be equipped and must be efficient in handling adverse reactions that can still occur in rare cases.
• SPT can be ineffective in children who are on cold and other antiallergic medications.

Are There Any Side Effects of Skin Prick Test?

Some rare but predicted side effects can occur post the procedure of skin prick testing.

1. Children may experience delayed symptoms like prolonged itching and irritation on the skin.
2. Systemic allergic reactions are one of the side effects which is rare but not so rare post SPT. These reactions are non-localized, and the inflammation can spread to other parts of the body.
3. There were rare observations of anaphylactic reactions in children. Especially for intradermal skin tests, they induce the allergen into the top layer of the skin and leave it to react. Food allergy tests can cause anaphylactic reactions in children.
4. Dizziness and lightheadedness because of the allergens can be side effects. Experienced staff can manage such symptoms in the hospital.
5. If the side effects prolong and if your child starts to feel unwell after leaving the hospital, do not hesitate to consult your child’s paediatrician immediately.

An allergy is an abnormal reaction of the body’s immune system to normal things. Your child may exhibit certain symptoms like skin rashes, skin hives, and other digestive problems for some new foods. It means that their body is trying to deny them food, treating it as foreign. To understand the problem, doctors may prescribe SPT, one of the safest tests for the identification of allergens.

Skin prick test in children is an inexpensive, painless, and effective test to identify the allergens that trouble your little one. It is important to get allergies treated in infancy. Allergies can affect children in several ways in the form of sleep deprivation and poor appetite. Getting an appointment with your doctor for any obvious symptoms can be the best decision for you and your child.

FAQ’s

1. How do I Know if My Child Has Allergies?

Your child starts showing certain symptoms of allergies like

• Skin rash or a hive
• Indigestion
• Itchy or irritated skin
• Small red bumps on the skin
• Diarrhoea
• Trouble breathing or wheezing
• Reddened eyes

Any of the above obvious symptoms should be taken to the notice of the doctor. Symptoms like difficulty in breathing can be life-threatening if ignored.

2. What Are Children Allergic to?

Children can be allergic to

• Milk
• Soya
• Certain nuts like peanuts
• Certain types of seafood

It is important to observe your kid after administering certain foods, especially if you have allergies running in families (hereditary). Any clear symptom should be reported to the doctor.

3. What is a Safe Allergy Test For Children?

There are two types of tests performed for allergies.

• Skin tests
• Blood tests

Skin tests, particularly SPT (Skin Prick Test) are considered as an effective test to be performed on children. These tests are also safe for children.

Read Also: Top 10 Potential Allergenic Foods For Your Baby

Nebulizers are quick and effective in administering the medicine necessary for certain severe respiratory conditions. A nebulizer aids in treating chronic lung conditions such as allergic asthma attacks (breathing issues caused by allergies), cystic fibrosis (a thick mucus formation that clogs the lungs), and other respiratory diseases like COPD (Chronic Obstructive Pulmonary Disease), a condition that happens due to smoking and exposure to harmful fumes. When you have a respiratory issue that needs constant care, a good knowledge of the use of a nebulizer and its side effects is essential

It is essential to understand that a nebulizer is not suggested to use at home as a regular medicine until the doctor prescribes it. The medications used in the nebulizers are meant to reduce the inflammation in the airways, loosen the thick mucus and kill the bacteria. This will help in reducing the difficulty in breathing and wheezing. Every medication has its uses and side effects and the same applies to nebulizers too.

In This Article

• What is a Nebulizer?
• Types of Nebulizers
• Different Medicines Used in a Nebulizer
• How Often to Nebulize a Child?
• When to Use a Nebulizer For a Child?
• What Conditions Can Nebulization Medications Treat?
• Side Effects of Nebulizer Use
• Different Nebulizers Available in the Indian Market
• Should You Consider Nebulization For Kids at Home?
• When Should You Consider Consulting a Doctor?
• FAQ’s

What is a Nebulizer?

A nebulizer is a device that turns liquid medication into a fine mist. The mist or aerosol particles make it easy for the patient to inhale the medication into the lungs. Nebulizers are generally used for lung diseases like COPD, asthma attacks, cystic fibrosis, and other lung-related diseases. A nebulizer contains three parts, a container that holds the medicine, a compressor that turns the medicine into mist, and a connecting tube that passes the converted mist to the patient through a mask.

Types of Nebulizers

There are three different types of nebulizers.

1. Jet Nebulizer

A Jet nebulizer uses air as a compressed gas to make mist out of the medication that is inside the device.

2. Ultrasonic Nebulizer

These nebulizers make mist or aerosol through high-frequency vibrations and are mostly used in hospitals. Ultrasonic nebulizers are not allowed outside hospital use.

3. Mesh Nebulizers

Mesh nebulizers pass the liquid medication through a fine mesh converting them into the finest aerosol.

Different Medicines Used in a Nebulizer

Nebulizers are meant to administer medications like bronchodilators, corticosteroids, sterile saline solutions, and some antibiotics.

1. Bronchodilators

These medications are used to widen the airways in case of serious breathing problems. Usually, they are prescribed for conditions like Chronic Obstructive Pulmonary Disease and asthma. In rare cases, they are also prescribed for children suffering from bronchiolitis. Bronchodilators like albuterol, levalbuterol containing beta2-agonists help in relaxing the muscles and in opening up the airways. These kinds of bronchodilators should never be used without the consent of a doctor.

2. Corticosteroids

Corticosteroids are another type of medication that is used in nebulizers. Nebulized corticosteroids help in reducing the symptoms of respiratory diseases, mainly allergic asthma. Corticosteroids can also be used through inhalers. Patients with extreme asthma might need a heavy dosage of this medication. However, in severe cases, nebulization is a process that can only be done by experienced professional staff.

3. Saline Solutions

Sterile saline solutions are another kind of medication used in nebulizers to reduce the thickness of the mucus. Thick and sticky mucus can block airways and lead to trouble breathing. Taking nebulized saline solutions can help reduce wheezing and other breathing troubles that are caused by mucus formation.

4. Antibiotics

These medications can also be prescribed for nebulization. Antibiotics are mainly used to treat certain bacterial infections in the lungs.

[Read : Breathing Problems In Children]

How Often to Nebulize a Child?

Administering medications through nebulizers can help a child relax and breathe easily. But the usage of nebulizers must always fall under emergency cases and must be used only if the situation demands. Keep in touch with your pediatrician regarding the usage of the nebulizer, when and how to use it. Mild symptoms might not always require a nebulizer. Repeated usage of medication and nebulization can also lead to side effects.

At the suggestion of your doctor, keep the mobile nebulizers handy only if your child is at high risk of catching the Respiratory Syncytial Virus or has chronic allergic asthma attacks frequently. Additionally, getting trained under your family pediatrician can be very helpful in understanding the usage of a nebulizer at home. Do not make it a habit of using a nebulizer for a simple cold and dry nose.

When to Use a Nebulizer For a Child?

Along with understanding how to use a nebulizer for a child, a parent must also understand when to use it. Misuse or unnecessary use can cause problems for a child and lead to unnecessary health issues.

You can use a nebulizer for you child in the following situations.

• Your child has an underlying lung condition, is prematurely born, and is at a high risk of catching bronchiolitis severely. Doctors may suggest bronchodilators that are used with nebulizers for temporary relief from severe symptoms.
• They have chronic allergic asthma, and if these attacks are frequent, doctors may suggest a nebulized medication for quick relief.
• Your kid is suffering from cystic fibrosis, which is a hereditary disease, nebulization with the right medication can help in reducing the thickness of the mucus and help them breathe easily.

A regular talk with your doctor regarding the condition of your child can help them understand the severity. Nebulizers can be rarely used at home based on the symptoms of your child under the supervision of your pediatrician.

[Read : Bronchiolitis in Babies]

What Conditions Can Nebulization Medications Treat?

As we mentioned earlier, there are different types of medications to use in a nebulizer. Each of these medications is specific to different respiratory conditions.

We now list the conditions that each of these medications treats.

1. Inflammation in Airways

• Bronchodilators can help in reducing the inflammation caused in both smaller and larger airways (bronchi and bronchioles).
• These come under the class of medications such as albuterol and levalbuterol come under the class of beta 2 agonists.

2. Asthma, COPD, and Other Lung Conditions

• Nebulized corticosteroids treat chronic conditions such as asthma that happen due to allergic reactions.
• These also help in treating COPD, an inflammatory lung condition that occurs due to the inhalation of tobacco and other harmful fumes. It is not a pediatric condition, but your child will be at risk of developing it if they start smoking at a very early age or are exposed to any harmful fumes.

3. Respiratory Issues Due to Infections

• Antibiotics are used in nebulizers to treat certain kinds of bacterial infections in the airways and lungs.

4. Mucus Formation

• Sterile saline solutions through nebulization help treat thick mucus formation and related breathing troubles.
• Saline solutions can help in loosening the mucus, thus helping with easy breathing.

All these medications used through nebulizers can help in reducing severe symptoms like wheezing, heavy breathing, pauses while breathing and chest heaviness due to mucus.

Side Effects of Nebulizer Use

Nebulizers should only be used in medical conditions under medical supervision. With proper dosage of medication, they can be extremely effective than any oral medication for your child. Nebulizers are quick in administering the medicine directly to the lungs. This can help the child recover quickly from severe symptoms. Like any medicine, nebulized medications and the usage of nebulizers also have some side effects.

Children often complain about side effects such as

• Having a dry or irritated throat after the process of nebulization.
• Increased heartbeat, and anxiety.
• Headache or nausea after the process of nebulization.
• Secondary infections due to the improper cleaning of the nebulizer. (disinfecting the nebulizer and cleaning it properly is very important after every use).
• Severe stomach pain due to the improper mixing or improper dosage of medicines.
• Developing rashes or hives in very rare cases.

The side effects can be controlled and avoided if the nebulizer is used under the supervision of a doctor. If you are nebulizing your child at home under essential conditions, rush your child to the doctor if you see any of the above symptoms and side effects.

Different Nebulizers Available in the Indian Market

Nebulizers are made to deliver the medicine quickly to the lungs. These can act effectively because they supply the medicine in the form of aerosols. These small particles can rapidly start working against the ailments providing relief.

There are three types of nebulizers available. They are

1. Jet Nebulizers

Jet Nebulizers deliver mist or aerosol particles using compressed gas. They use oxygen to compress the medicine and convert it into a fine mist. The compressed gas flows at high speed to convert the liquid medication into an aerosol. This mist can quickly travel into the lungs to treat the condition. These kinds of nebulizers are generally used in hospitals due to their heavy weight. They deliver the medication through a long tube that is connected to a reservoir on one side and the mouthpiece on the other side.

2. Ultrasonic Nebulizers

Ultrasonic nebulizers deliver the liquid medication by using high frequencies. These are powered by electricity and do not make noise because of the ultrasonic waves that are under function. Through high-frequency waves, the liquid medicine is converted into aerosol and is administered through a mouthpiece or a mask. The aerosol particles are larger when compared to the particles delivered by Jet nebulizers. Ultrasonic nebulizers are mostly used in hospitals.

3. Mesh Nebulizers

Mesh nebulizers fall under the new inventions. These kinds of nebulizers work effectively and are very expensive. Mesh nebulizers work on vibrations and deliver the liquid medicine through a mesh converting them into fine particles. These kinds of nebulizers do not make any noise and are extremely comfortable to carry outdoors.

Should You Consider Nebulization For Kids at Home?

Nebulizers are used to treat respiratory ailments and chronic lung conditions. Children who are at the risk of developing allergic asthma attacks and other viral infections like bronchiolitis fall under the category that may need nebulization. But nebulization should only be considered if the child is having severe symptoms like wheezing, difficulty breathing, unable to take any fluids, and cyanosis (lack of oxygen supply). One should always visit and talk to a doctor if they see their child developing these symptoms. In such cases, the child may need hospitalization.

Nebulizers should be used very carefully. In case of cyanosis, doctors may need to supply oxygen along with nebulization. So, it is not safe to give nebulization to kids at home as regular medicine. In some rare cases, doctors may consider giving a nebulizer for children at home with a proper prescription and dosage. Keeping in regular touch with your doctor during such situations may help you avoid any side effects.

When Should You Consider Consulting a Doctor?

Children who suffer from respiratory ailments suffer mild to serious symptoms. Mild symptoms can often be treated at home with proper care and hydration. However, severe symptoms must never be ignored and should be taken to the notice of your pediatrician at any cost.

Severe Symptoms of Asthma in a Child

• Wheezing sound while breathing.
• Aggressive cough and shortness of breath.
• Tight feeling in the chest, or heaviness in the chest.

Severe Symptoms For Bronchiolitis in a Child

• Wheezing or grunting sound while breathing.
• Drawing the chest completely inside while inhaling.
• Rapid or shallow breathing.
• Cyanosis or lack of oxygen. Turning lips and fingertips blue.

Children with these symptoms may require immediate hospitalization. Keeping track of the symptoms that your child suffers and a timely appointment with the doctor can help them recover without any complications and side effects.

Nebulizers can help children with respiratory diseases to recover quickly. Nebulizers are made in such a way that they deliver the medicine in the form of fine liquid particles called aerosols that can quickly enter the airways. But experts do not recommend using a nebulizer at home. Improper or incorrect usage can cause severe side effects. Unnoticed side effects can prove to be extremely dangerous. Considering your child’s condition, doctors may prescribe a nebulizer in very rare cases. Otherwise, a nebulizer should always be used under the supervision of a doctor or in the hospital if the child is suffering from severe symptoms.

[Read : Asthma in Toddlers]

FAQ’s

1. Is Nebulization Only For Children Suffering From Asthma?

Nebulization is prescribed for children suffering from different respiratory ailments like allergic asthma, cystic fibrosis, bronchiolitis, and other viral infections that affect the airways. Nebulizers help in reducing inflammation or loosening the thick mucus. As a result, breathing becomes easy and normal.

2. Are Inhalers and Nebulizers the Same?

Inhalers and nebulizers work for the same cause. They deliver the medication to the lungs quickly in the form of aerosols thus making it work faster. The nebulizer sends the medicine in the form of a fine mist that can be directly inhaled without any difficulty. This will reach the airways and lungs without any effort and start working quickly. Inhaler needs a bit of to consuming the medicine that comes in the form of mist in a pre-measured dosage. There are types of both nebulizers and inhalers, both work for the same purpose.

3. Can a Nebulizer be Used For Respiratory Illness as Well?

Yes, a nebulizer can help treat and clear respiratory problems that are caused by chronic asthma, cystic fibrosis, and other viral infections that block airways. But you should always use a nebulizer under the supervision of a doctor with a proper prescription. Using nebulizers at home without the consent of a doctor can cause serious side effects.

4. Will My Kid Need to Take Deep Breaths During Nebulization?

Nebulizers are very effective at delivering medicine to the lungs. This will not need any effort. Nebulizers release the medicine in the form of a fine mist with different techniques. Nebulizers come with a mouthpiece that is connected to a tube. This will help the child inhale medicine through normal breathing.

5. Does Nebulization Cause Addiction?

Nebulizer is a device that supplies medicine. Medicines such as antibiotics or steroids can help in loosening the thick mucus. Nebulizers help a patient suffering from respiratory illnesses and issues and cannot cause any addiction. The medicines administered through nebulizers help clear the infected airways. Regular nebulization for small and mild symptoms is strictly not suggested.

6. Does Nebulizer Use High Dosage of Medicines?

Nebulizers are used for patients suffering from respiratory problems. The dosage of the medication depends on the severity of the condition. Nebulizers can also be used to administer high doses of medicines in very rare cases.

Read Also: Tuberculosis in Children – Symptoms, Treatment and Remedies by Dr. Srikanta J T

Tuberculosis (TB) is a common disease that can affect people of any age- from children to adults, to even the older generation. There was a time when the name TB created fear and was deemed life-threatening, more so, when children contracted this disease. Today, though, with the advances in research, testing methodologies, and the development of new drugs, the disease is being treated efficiently. The mortality rate has come down drastically, especially in countries like India, where the incidence of this disease is higher.

Despite the many testing and treatment methods, at times, TB can cause rare deaths. This happens because of a lack of awareness of the disease and its symptoms. Early detection and timely treatment are the key to quick recovery and escaping the long term ill-effects of tuberculosis. Through this article, we aim to take an in-depth look at the various aspects of tuberculosis in children such as the causes, symptoms, progression of the disease, testing, and treatment options available for parents. We hope to help parents make an educated and informed approach when dealing with their kids who have been affected by TB.

In This Article

• What is Tuberculosis?
• Progression of Tuberculosis in Children
• Pulmonary Tuberculosis in Children
• Manifestation of Tuberculosis in Children
• Causes of Tuberculosis in Children
• Which Child is at a Higher Risk of Getting Tuberculosis?
• Diagnosis of Tuberculosis in Children
• Treatment of Tuberculosis in Children
• Home Care For Children Infected With Tuberculosis
• How to Prevent My Child From Getting Tuberculosis?
• When to Call Your Doctor?
• FAQ’s

What is Tuberculosis?

Tuberculosis, or TB as it is more popularly known, is a mycobacterial infection that most commonly affects the lungs, an important part of the respiratory system. This infection first affects the lungs and then moves to the lymph nodes causing different forms of TB. Having said that, TB can affect other parts of the body too which we will discuss later. This form of TB which affects organs other than the lungs, is known as extra-pulmonary TB.

The bacteria responsible for causing tuberculosis is known as Mycobacterium tuberculosis or M. tuberculosis. This bacteria travels and spreads through the air. If your child is in the same room as someone (Contact) who has the tuberculosis infection and happens to inhale the droplets that the infected person spreads through coughing or sneezing, the chances are that your child can catch TB too. In most cases, it is difficult to trace or know the primary contact. In this context, it is also essential to understand that many people, both children and adults, tend to carry a dormant form of M. tuberculosis in their bodies. But this presence itself doesn’t cause TB. When the child or adult’s immune system is down or the body has lost its ability to fight diseases, this gives the ideal environment for the bacteria to wake up and cause tuberculosis.

The different types of extrapulmonary tuberculosis include:

• Parenchymal TB (Lung)
• Mediastinal TB
• Pleural TB
• Endobronchial TB
• TB meningitis affecting the central nervous system
• Abdominal TB affecting the intestines, liver, and spleen
• Urogenital TB affecting kidney and bladder
• Tb affecting the musculoskeletal system which includes the bones and joints

[Read : Meningitis In Children]

Progression of Tuberculosis in Children

As we mentioned earlier, tuberculosis occurs due to air-borne bacteria and the disease is highly contagious. For easy understanding, the progression of this disease can be broken into three stages.

1. Exposure

When a child breathes air-borne tuberculosis bacteria, the bacteria find their way through the nose into the lungs and enter the lungs.

2. Latent Stage

In some cases, the body’s immune system fights the bacteria, and the disease remains in a dormant stage. This is known as primary tuberculosis. Some children can recover from this primary TB without showing symptoms or evidence of the disease.

3. Active Stage

There comes a stage when the immune system is no longer able to suppress the multiplication of the bacteria. At this point, the bacteria reactivates and the child will officially contract the disease. Some weeks can pass before the reactivation of the bacteria and the appearance of the symptoms post-exposure. Once these symptoms start showing, it becomes pertinent to take the child to the doctor for consultation and run the necessary tests so that timely treatment can be provided.

Parents must remember that pediatric tuberculosis is a curable disease and taking the child to the doctor at the earliest onset of symptoms will prevent further damage and kick-start the healing process.

Pulmonary Tuberculosis in Children

We know that the lungs are the first organ of the body to be affected by tuberculosis since the bacteria find an easy entryway through the nose via the breathing process. Once the bacterium gets the chance to get active, it quickly takes advantage of favourable temperature and atmosphere and starts multiplying. At this stage, it slowly starts penetrating the different parts of the lungs, causing different conditions, which we will explain a little further in this article.

Symptoms of Pulmonary Tuberculosis

• The earliest symptoms of pediatric tuberculosis include mild coughing accompanied by a low-grade fever.
• In some cases, the child may suddenly develop a cough, fever, and flu-like symptoms that can sometimes subside within a week or have intermittent symptoms for weeks.
• Some school-going kids do not show any symptoms (silent TB) or can show symptoms such as dry cough (with no phlegm), mild breathlessness, lack of appetite, and fever with night sweats.
• Younger kids can also start losing weight, may not show proper growth, and can experience stunted growth if the condition isn’t treated on time.

To sum up, the symptoms you should look for to suspect TB in your child include:

Primary Symptoms

• Dry cough (that seems to continue for a period of 3 weeks)
• Mild dyspnea or breathing difficulty or gasping for air
• Pain in the chest area
• Coughing blood (in severe cases)
• Low-grade fever
• Night sweats or chills

Additional Symptoms

• Lack of appetite
• Weight loss
• Nausea and vomiting
• Lethargy

Manifestation of Tuberculosis in Children

We earlier discussed that TB bacteria, once they enter the lungs, can affect different parts of the lungs and the body as well. Lymph nodes most commonly get affected due to tuberculosis. Let us take a look at the types of manifestations of pediatric tuberculosis.

1. Tuberculous Lymphadenopathy

Generally speaking, lymphadenopathy is a disease of the lymph nodes where the lymph nodes become of abnormal size and consistency. So, what exactly is a lymph node? A lymph node is a small bean-shaped structure and is an integral part of your body’s immune system. Lymph nodes play a vital role in filtering the blood that travels through the lymphatic system. Lymphatic fluids carry white blood cells that help fight disease and infections.

When TB bacteria affect the lymph nodes, they can cause the nodes to enlarge, resulting in diseased lymph nodes. This condition is called tuberculous lymphadenopathy. In some cases, the lung nodules get infected due to the presence of TB bacteria, resulting in scarring, known as a granuloma. In all these cases, lymph nodes stop functioning well, consequently reducing immunity.

Common symptoms of tuberculous lymphadenopathy include

• Fever
• Swelling of lymph nodes
• Dry cough
• Pain in the chest
• Loss of appetite
• Loss of weight

2. Mediastinal Lymphadenopathy

The term mediastinal lymphadenopathy refers to the enlargement of lymph nodes present in the mediastinum. The mediastinum is the area present between the lungs and houses your lymph nodes, thymus glands, trachea, cardiac nerves, etc.

When the lymph nodes present in the mediastinum get enlarged due to tuberculosis infection, it results in a condition called tuberculosis mediastinal lymphadenopathy. The chances of contracting this condition are higher in kids; while age advances, the risk goes down. For this reason, the occurrence of mediastinal tuberculosis is quite rare in adults.

In children, tuberculosis and in most cases, pulmonary tuberculosis is the major cause of mediastinal lymphadenopathy. The tuberculosis bacteria that enters the lungs passes through pulmonary lymph channels and enters mediastinal lymph nodes, causing inflammation.

Common symptoms of Mediastinal Lymphadenopathy associated with TB include

• Fever and night sweats
• Dry coughing
• Shortness of breath and difficulty breathing
• Weight loss
• Chest pain

3. Pleural Effusion

Pleural effusion can account for up to 20% of tuberculosis cases in children. A pleura is a thin tissue layer that forms a covering over the lungs and lines the chest cavity’s interior walls. Tuberculosis can sometimes result in fluid accumulation in the pleural space ( the space between the lung lining and the lung tissue). This fluid accumulation is known as pleural effusion, as a result of which the lungs which are normally soft like a sponge turn hard and lose their sponge-like consistency.

Some of the symptoms of TB Pleural Effusion include

• Dry cough (with no sputum)
• Chest pain
• Difficulty breathing/gasping for breath
• Inability to breathe in lying down position or Orthopnea

[Read : Breathing Problems In Children]

Causes of Tuberculosis in Children

Tuberculosis in children mainly spreads through the air when the child breathes the air that contains TB bacteria. A single exposure usually may not cause the disease unless the child has a low immune system. TB can occur after multiple exposures or when a latent or inactive TB bacteria turns active under specific conditions such as low immunity.

Which Child is at a Higher Risk of Getting Tuberculosis?

Now that we know how tuberculosis occurs and spreads, let us also try to understand if there is a specific set of children that are more prone to contracting TB than the others. The following group of children may have higher chances of getting TB.

• Children growing in developing countries are at a higher risk due to lower sanitary conditions, overcrowding, and low nutrition levels.
• Children growing in the same household as other TB patients are also at a higher risk of getting TB.
• Kids younger than four years of age and those nearing puberty age.
• Children suffering from autoimmune diseases or conditions, diseases such as HIV, or children going through immunosuppressive therapies or drugs.

Diagnosis of Tuberculosis in Children

A child who shows the classic symptoms of TB will be taken to a doctor who will analyse the symptoms, understand the current living conditions, possible exposure and the health history of the child and the family. After this, the doctor may prescribe one or more of the following tests.

Traditional Diagnostic Methods For Diagnosing Tuberculosis in Children

The conventional tests that doctors routinely use to find out if your child has tuberculosis include:

1. TB Skin Test

The TB skin test is also known as the Mantoux tuberculin skin test or Mantoux test for short. This test will require two visits to the lab. On the first visit, the technician will inject a small quantity of fluid into the skin of your child’s lower part of the arm and mark the injection site with a marker pen. You must take your child back to the lab after 48 to 72 hours. Depending on the inflammation at the test site, the technician may suggest the possibility of TB infection.

2. TB Blood Test

The blood tests to evaluate a patient for TB are called Interferon Gamma Release Assays or IGRAs. These blood tests quickly help identify the presence of TB bacterial infection in your child. If a child fails a skin test but still seems to show TB symptoms, the doctor may prescribe a TB blood test.

3. Chest X-Ray

X-rays are one of the traditionally used methods to diagnose TB. The technician will look for the presence of nodules, fluid formation, or anything unusual when taking the X-ray. Your child’s doctor may co-relate the finding of the X-ray with other tests and symptoms before making a final diagnosis and starting the child on treatments.

4. Sputum Testing

Rapid sputum tests are prescribed by doctors when other tests remain inconclusive. Sputum culture is routinely used by doctors and looks for the presence of TB bacteria in the sputum to confirm TB infection.

5. Biopsy of Abnormal Glands

In cases of extrapulmonary tuberculosis, a biopsy is used to confirm the presence of infection. The doctor or technician will draw tissue or fluid samples from the suspected TB site which will then be sent for evaluation.

The conventional testing methods, while effective to a certain extent, may not always give confirmatory results. These tests do not focus too much on the microbiology part and may not help the doctors in identifying which antibiotic the specific bacteria may be resistant to.

Keeping this in mind, the National Tuberculosis Eradication Programme (NTEP) 2021 has brought in new guidelines with advanced testing methodologies that can help in easier and quicker diagnosis and suggest the best treatment options.

Modern Diagnostic Methods to Detect Tuberculosis in Children

Modern diagnostic methods move away from conventional smear microscopy to the highly sensitive molecular methods of diagnosis. Let us look at some of the NTEP-approved tests that can yield better results and quicker diagnoses.

1. NAAT Tests

Rapid Nucleic Acid Amplification Tests or NAATs have a higher sensitivity and a quicker turnaround time. In most cases, they indicate drug resistance, too, giving the doctors timely information so that they can choose alternative medications without wasting time.

2. Gene-Xpert

The Gene-Xpert test, also called the Xpert-RIF/MTB Assay, is considered the gold standard in tuberculosis testing at early stages where other testing methods yield negative results. On the other hand, this test also helps detect rifampicin drug resistance at early stages. Gene-Xpert is a cartridge-based NAAT or CBNAAT and is gaining wide acceptance as the best available test for the early detection of tuberculosis.

3. Line Probe Assays (LPA)

The NTEP 2021 also recommends Line Probe Assays for early detection and multi-drug resistance identification. This test includes multiple NAAT tests that check for resistance to rifampicin and isoniazid, and also second-level medications and injections.

NTEP has also come up with a strategy named U-DST under which it makes it mandatory for every patient to undergo NAAT testing to help identify possible drug resistance. The key is to check old cases as well as fresh cases for drug resistance and provide alternative drug options for quicker recovery and prevention of infection recurrences.

Treatment of Tuberculosis in Children

The National Tuberculosis Eradication Programme, or NTEP, has introduced a daily treatment regimen specific to kids where kids will be given dispersible tablets in fixed dose combinations. Your child’s doctor will prescribe the correct dosages depending on age, weight, and other factors. Your doctor may also recommend pyridoxine supplementation to prevent long-term side effects from the drugs.

Home Care For Children Infected With Tuberculosis

Children need a lot of care in their recovery process. While timely detection and doctor consultation are the key to recovery, proper medication and home care will help quicken this process. Let us go through a few essential aspects when caring for your child with TB at home.

1. Medication

It is vital that your child takes the medication at the exact prescribed times and at the same timings every day. This will ensure that the medications work effectively. Missed doses can lead to drug resistance which can be quite serious later. Set an alarm if needed to ensure that your child is taking their medicines on time.

2. Follow-Up Visits

Keep up with all the follow-up visits as recommended by the doctor. This will help the doctor monitor your child’s progress and make any changes or write additional tests if needed. You must also be well-informed about any side effects to look out for so that you can contact your doctor immediately if your child shows any reactions to the medications.

3. Diet and Exercise

Tuberculosis is a wasting infection that can create lethargy, loss of weight, loss of appetite, and a general feeling of unwellness in your child. Parents and caretakers should ensure that the child has a balanced diet, gets proper sleep and a good amount of exercise as well. Your doctor can advise you on these aspects. Following them to the T will allow your child to recover quickly from fatigue and other secondary symptoms.

4. Emotional Help

TB-infected children can take a while to recover from the infection. During this time, parents must provide all the emotional support and help keep up the spirit of their child. The child, unable to move out much and battling with the symptoms, can often feel let-down and depressed. At this stage, parents providing emotional support can be of great help. Parents also must ensure that their child stays at home and does not mix with other children to prevent the spread of this infection.

How to Prevent My Child From Getting Tuberculosis?

Since TB is an air-borne infection, it may be difficult to predict how and when your child can contract the infection. However, a few simple steps can prevent your child from suffering from an active infection.

• Keep your child away from known cases of TB.
• If anyone in your family is infected with TB, let them isolate themselves. Keep a separate set of utensils for them to avoid the spread of infection.
• Good immunity is the key to avoiding the conversion of latent TB to active TB. Encourage your child to have a healthy and balanced diet rich in protein that covers all food groups. A proper diet and exercise are the key to preventing tuberculosis in your child.
• Talk to your child’s doctor about the BCG vaccine if your child has not got their vaccination.

[Read : Healthy Eating – Ways to Inculcate Healthy Eating Habits in Kids]

When to Call Your Doctor?

Staying informed about the symptoms and identifying them at the right time are the crucial first steps to fighting TB. The moment you suspect an infection either due to symptoms or due to exposure to a known case, you can consult a paediatrician. They will guide you through the right steps of diagnosis and treatment.

Look for the following symptoms:

• Low grade or high fever that continues for more than a week
• Dry cough (with no sputum)
• Chest pain
• Loss of appetite
• Loss of weight
• Coughing up blood in sputum
• Breathlessness

You must also consult your doctor if your child is having severe reactions to the medications in the course of treatment.

There was a time when TB was a worrying disease, but not anymore. With advanced testing and treatment options and increased medical knowledge, treatment and recovery have become easy. Just remember to consult your doctor at the earliest suspicion, get the tests done, and follow the treatment protocols religiously. Your child will recover and get back to a healthy normal within time.

FAQ’s

1. At What Age Can You Test Children For TB?

TB can happen at any age. Children below the age of four and children nearing puberty are more susceptible to this infection. You can get your child tested if they show symptoms such as a long-drawn fever, dry cough that lasts for more than a week, fatigue, lack of appetite and sudden weight loss.

2. How Do You Know if Your Child Has TB?

If your child is showing symptoms like high fever, continuous cough, blood in sputum, and fatigue, you must immediately take your child to the doctor. The doctor will check your child’s medical history and run a few tests which will confirm if your child has got the infection.

3. Is TB Curable Permanently Among Children?

Yes!! The right doctor, timely diagnosis and proper treatment protocol can ensure that your child gets treated permanently.

Read Also: Pneumonia in Children – Causes, Symptoms And Treatment by Dr. Srikanta J T