Paediatric respiratory medicine: children's asthma, wheeze, sleep and chest conditions

Children's airways are smaller and their immune systems still developing, so breathing problems behave differently from those in adults. Paediatric respiratory medicine covers conditions of the nose, throat, windpipe and lungs, and the way breathing is controlled during sleep.

Most childhood chest illness is managed by GPs, community paediatric teams and general paediatricians. A paediatric respiratory consultant is a children's doctor with further training in lung disease who works in larger hospitals alongside specialist respiratory nurses, physiotherapists, physiologists and pharmacists. They overlap with ENT surgeons for conditions such as enlarged adenoids and with allergists for children whose asthma is linked with allergy.

The main task is to work out whether breathing symptoms are due to asthma, a viral wheeze that will pass, structural or infective disease, or problems outside the lungs such as reflux, vocal cord dysfunction or anxiety-related breathing pattern.

• Asthma, with wheeze, cough, breathlessness and chest tightness that vary over time and are often worse at night or with exercise or triggers such as pollen, dust, cold air and viral infection.

• Preschool wheeze, which is common in toddlers with colds and does not always mean the child will go on to have asthma.

• Bronchiolitis, a common chest infection in babies and children under 2, which the NHS says has no specific treatment but can be serious in some children who then need hospital care.

• Croup, a barking cough with a hoarse voice and sometimes a rasping noise when breathing in, caused by swelling around the voice box and windpipe.

• Chronic or recurrent cough, including protracted bacterial bronchitis, post-infectious cough and, in some children, whooping cough, for which the NHS says babies under 6 months are at highest risk of complications.

• Cystic fibrosis and other long-term conditions such as bronchiectasis, usually under the care of a specialist centre.

• Sleep-disordered breathing, including snoring and obstructive sleep apnoea, often related to enlarged tonsils and adenoids.

• Breathing problems in children born prematurely, with neuromuscular disease or with complex medical conditions.

The NHS says asthma is diagnosed through questions, listening to the chest and sometimes simple breathing tests, and that diagnosis can take time because symptoms vary. Tests are chosen to suit the child's age, because lung function testing needs cooperation that most children can only give from around school age.

Asthma care follows a stepwise approach with reliever and preventer inhalers, spacers, a personal asthma action plan and regular review. The NHS says a care team explains how and when to use medicines, how to monitor asthma, how to avoid triggers and what to do if symptoms get worse. A small number of children with severe asthma that persists despite good treatment are assessed in specialist services, which may consider biological medicines.

Bronchiolitis and croup are usually managed at home with fluids, comfort and monitoring, although some children need oxygen, feeding support or medicine in hospital. Sleep apnoea in children is frequently treated by removing enlarged tonsils and adenoids, and some children use CPAP at night. Cystic fibrosis is managed by specialist teams with regular physiotherapy, nutrition support, antibiotics and modern modulator medicines.

Parents are taught inhaler technique, which is often the most useful single intervention, together with how to recognise worsening breathing and when to seek help. Smoke-free homes and cars matter for every child with a breathing condition.

On the NHS, children are seen first by a GP, practice nurse or urgent care service, and referred to a general paediatric clinic if symptoms persist, if there are frequent attacks or hospital admissions, or if growth or development is affected. Tertiary services take children with severe asthma, cystic fibrosis, long-term ventilation needs or complex airway disease.

Privately, parents can often see a paediatric respiratory consultant after a GP or paediatrician letter, with quicker access to lung function tests, allergy tests and sleep studies. Check that the consultant is on the GMC specialist register for paediatrics, ask whether emergency admission is available and which hospital would take the child, and ask for a written plan to share with school and the GP.

• Bring a diary or phone video of the cough, wheeze or noisy breathing, along with inhalers and spacers so technique can be checked.

• Ask what is causing the symptoms, what the triggers are and how the child should be monitored.

• Ask for a written asthma action plan and what to do if the child gets worse, and make sure school has a copy.

• Ask what tests are planned, how they work for a child of this age and what the results will change.

• Call NHS 111 or an urgent GP appointment for suspected croup, a bronchiolitis cold that is getting worse, poor feeding or signs of dehydration, as the NHS advises.

• Call 999 or go to A&E if a child is struggling to breathe, with grunting, tummy sucking under the ribs or pauses in breathing, has blue or grey skin, lips or tongue, or is very sleepy, floppy or hard to wake.