Note: for children with an established diagnosis of asthma, see the CKS topic on Asthma.

First episode of cough of wheeze in a child aged under 5 years

• Children with wheeze and any high risk features — admit immediately. Treat with a bronchodilator whilst awaiting transfer.
• Children with wheeze at intermediate risk — treat with a bronchodilator and assess 15–30 minutes after completing treatment.
• Children who respond to bronchodilators — prescribe a bronchodilator and spacer device to use as required. Manage at home.
• Children who do not respond to bronchodilators — arrange hospital assessment.
• Children with wheeze at low risk — consider a trial of treatment with bronchodilators. Manage at home.
• For children managed at home advise carers to check on the child regularly, including through the night, and seek medical advice if they are unable to cope, or if the child deteriorates, particularly if:
• Breathing rate increases, or there are any episodes of apnoea or signs of increased effort of breathing.
• A baby takes less than 50% of its normal feeds, or there are signs of dehydration such as dry mouth or infrequent passage of urine.
• A baby becomes less responsive or difficult to rouse.
• There is persistent worsening of fever.

Management of further episodes

• The management of further episodes of cough and wheeze in children under the age of 5 years depends upon whether symptoms occur only in association with a viral infection, or whether they also wheeze in response to other triggers (possible asthma).
• For children with further episodes of viral-induced cough and wheeze, management with bronchodilators should be guided by the child's response to an initial trial of therapy.
• In children under 2 years of age who do not respond to bronchodilators, consider repeating a trial of therapy intermittently to determine whether they have become more responsive as they have become older.
• For children with suspected asthma, see the CKS topic on Asthma.

In depth