Special Considerations for Infants and Young Children

• The care of infants and small children with suspected asthma deserves special consideration because of the potential to modulate the disease process early on and alleviate the increased morbidity associated with uncontrolled asthma in this age group. • After confounders and masqueraders of asthma have been excluded in the evaluation of children with suspected asthma, recurrent wheezing in infants and young children still comprises a heterogeneous group of conditions with different risk factors and prognoses. • The diagnosis of asthma in infants and small children is often based on clinical grounds and complicated by the lack of clinically available tools that meet the criteria for the definition of asthma used in older children and adults such as airway inflammation, bronchial hyperresponsiveness and airflow limitation. • Difficulties in the management of asthma include limited effective and convenient delivery devices, complete dependence on the caregivers to carry out the treatment regimen, and an inadequate selection of medications completely devoid of adverse effects. • A partnership approach with emphasis on education, monitoring and training is key in the effective management of chronic cough or recurrent wheezing illnesses in very young children. • Clinical trials using as needed treatment interventions have shown favorable efficacy outcomes, aimed at preventing severe exacerbations in young children with recurrent wheezing; however, trials aimed at primary prevention are still lacking.