Cough, Wheeze under 5 years of age

Under 5 years of age it is not straightforward to make a robust diagnosis of asthma.

It is therefore important that children in asthma preventors since they were 2 or 3 yearsare reviewed to consider a step down and stopping of asthma treatment.

About 1 in 4 children under 5 who wheeze have asthma. These are likely to have eczema, a parent still on asthma treatment, a full blood count showing eosinophilia and if we do specific IgE to dog, cat and house dust mite one or more likely to be positive .

The most important thing to do for children with cough are to see them when they are unwell and document wheeze, increased work of breathing and possibly lowish saturations . We can make a diagnosis of viral wheeze or asthma only if see them and note down these things .

The second important thing is to pick up persistent wet cough lasting every day without missing a day without changing for over 4 weeks. These may have low grade infection and merit 2 to 4 weeks of coamoxiclav and if this does not clear the cough or it clears and recurs they merit a referral. These children will have no chest signs.

High fever with localised crackles usually merit antibiotics.

Low grade fever with wheeze and crackles usually need wheeze treatment and a review in 48 hours to make sure chest sounds better though cough may persist.