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Dr. Navitsky
Dr. Navitsky , Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1037
Experience:  US Pediatrician licensed in California living abroad.
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Rattle in chest, wheezing and occassional cough. Help!

Resolved Question:

Rattle in chest, slight wheezing when breathing, occasional cough. No fever, no difficulty breathing. Not a constant cough.

Submitted: 4 years ago.
Category: Pediatrics
Expert:  Dr. Navitsky replied 4 years ago.

Jnavits12 :

Hi there.

Is this the first wheezing episode for your child? I am assuming he also has a bit of a runny nose maybe you thought he had a cold before you started to notice the rattle?

So without difficulty breathing there is really no dangerous emergency.... Most of the time if this is the first episode for him and he has a cold... It is probably virally mediated and called "bronchiolitis" and basically as long as they are comfortable, require no breathing assistance...etc... they can be monitored as an outpatient with no treatment other than what you are using.

Basically I like to keep track of a babies episodes of bronchiolitis to kind of keep count for the future... If they have wheezing that I hear with my stethoscope more than 2-3 times, I consider them to have an asthma like disease called "reactive airways disease"and would be more apt to treat them with medicines like Albuterol as well as keep a close eye to watch out for the need for daily medicines.

JACUSTOMER-69hluoyn- :

First time wheezing, no runny nose, watery eyes. He had RSV a month ago, but it cleared up.

Jnavits12 :

With his RSV was he treated with albuterol?

JACUSTOMER-69hluoyn- :

No, just a decongestant and baby tylenol

Jnavits12 :

RSV in itself is the classic cause of bronchiolitis around this time of the year. Did the doctor tell you his chest was clear? Did they test for it with a nasal swab?

JACUSTOMER-69hluoyn- :

Yes, tested for and confirmed. Said his chest was clear

Jnavits12 :

So after having RSV the lungs can be a bit "sensitive" and you can have wheezing after with the next cold. How long have you noted the rattle/vibrations in his chest...a few days?

JACUSTOMER-69hluoyn- :

Coughed a few times on Wednesday, then started to notice wheezing/rattle on Thursday

Jnavits12 :

So what I would recommend is that as today is Friday...Unless your pedi's office has open hours tomorrow or Sunday, you may want to consider having him seen today. The rattle may be coming from his upper airway/throat area and not from his lungs which his doctor will be able to tell... However if it is coming from his chest, his chance of getting worse before he gets better is actually higher.

Otherwise if you choose to keep him at home and watch him you would watch for difficulty breathing, in the form of the chest sucking in, seeing all of his ribs really well defined, flaring of the nostrils, irritability, poor feeding as well as more sleepy than usual and not as physically active.. These would be reasons to visit the ED, which is always a non pleasant experience!

Thus as it may still be am for you depending on where you are in the US, you may be able to enter the weekend feeling more secure if your doctor feels that he is doing Ok when he is seen. Generally if you tell the office staff that you hear wheezing/rattling in his chest, they will try to get you in this day.

As far as other things you can do at home, Baby Vicks is fine to use... Just make sure to use the dosing on the bottle as in smaller babies you can use too much.... The humidifier can also help to make the air he breathes less dry and thus perhaps avoid a tickle from breathing dry air that can start a coughing fit.

JACUSTOMER-69hluoyn- :

Ok. So most likely sensitivity due to recent rsv?

Jnavits12 :

Having him sleep upright strapped into his car seat for example is another thing you can do if you feel that he is having problems dealing with the mucus in his throat and it makes him cough. Although it is hard to have RSV as a 5 month old and not have wheezing, I would be suspicious that this may be his second time.... Are either of you or other family members asthmatic, allergic, or have eczema?

JACUSTOMER-69hluoyn- :

Nope

Jnavits12 :

Good... So I give babies with no family history of allergic types diseases a few wheezing episodes before I get suspicious... Especially when they get one bad virus after another...there are a few that cause bronchiolitis. Having him listened to will help determine whether he is actually wheezing or not as many times due to the inability to clear his throat (at 6 months totally normal) I have heard parents worried about wheezing when really the noise is coming from the mucus rattling around in the upper airway, but wheezing or the possibility of it, I tend to take seriously!

JACUSTOMER-69hluoyn- :

Yes, noise is from upper chest, lower lungs sound clear

Jnavits12 :

Did you listen to him with your ears... You actually can tell by doing this!

JACUSTOMER-69hluoyn- :

yes, listened to his back

Jnavits12 :

Ok... The other way I can tell is if the sound is kind of intermittent. They cough and clear the throat and the rattle goes away and then after a few minutes and more mucus comes down...And the rattling comes back

JACUSTOMER-69hluoyn- :

Ok, did sound a little less after he coughed

Jnavits12 :

If you feel that it is coming from his throat, still be watchful for signs of difficulty breathing and other things that you would be concerned about with a cold, pain, poor feeding, fevers, dehydration... Which would be reasons to take him in, but you can feel safe watching him. If you feel however at all apprehensive, best on a Friday pm to hedge your bets and make a trip in.

I wish you the best of luck and hopefully he will get better soon! If you need to ask me anything else about this, please feel free to just respond to the same thread.

Good luck

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