I have a 9 months old baby boy and the doctor has been given him combivent for 2 more than 2 weeks. The baby doesn't has astma. Is this ok to give this medicine such a long period of time?
Person's Gender: Male
Age: 9 months
IWe have tried singulair, ventoline and now combivent for almost 5 months now on and off. Fluimicil and bisolvon but i think it is too much drugs for a baby. Help me?
Hi, I can talk to you about your baby
Why do you say that your baby does not have asthma? For what condition are they prescribing all of these asthma medicines for? Has he had episodes of wheezing with colds? Are there asthmatics in your family? Do you guys smoke?
In the US for a baby your sons age we do not use products like Fluimicil or bisolvon unless there is a serious condition such as cystic fibrosis. Really for cough in otherwise healthy infants these are mucolytic products that have never really been demonstrated in clinical studies to be effective in making children better.
Thus the guideline by the American Academy of Pediatrics not to use them in children less than 6 years old...who you can't trust o disclose accurately whether they actually feel worse with the meds!
I am based on these meds that your baby has had a chronic cough. There are many reasons in a child this age for this and they include asthma, reflux, and run of the mill recurrent colds and in order to distinguish between your baby's symptoms I would have to have a bit more information on what his cough is like.
What I can say is that if the cough is asthmatic (we call asthma a different name when it happens to a young child, reactive airways disease due to the fact that it is a different process in a younger person and many times kids grow out of it) then the medicine in ventolin should work temporarily to stop the cough. Combivent contains ipratropium in addition the the same medicine as in ventolin which again is really only used in kids with very serious lung diseases including severe asthma.
Thus I can help you but I need to talk to you in order to give you more specific info. Feel free to respond when you can. I am in Spain and will be online for an hour more at the most. Thanks!
thank you so much for responding.
It has not been proved that my baby has asthma. The doctor here said that he has a cold, he did not have fever at non of these cold episodes. And that he was making a peeping soun din his lungs. That is why they gave him the ventolin forst and now combivent. The combivent is in combination with singulair half tablet a day and fluimicil 5 ml.
Hi doctor, thank you for taking the time to answer.
Hi doctor, thank you for taking the time to answer my question. The baby has a cold since january and has been treated with fluimicil/bisolvon and ventolin. Now he has combivent 4 times a day, fluimicil 5 ml and 1/2 tablet of singulair. He has been puffing with combivent for 2 weeks now and i have asked the advice from other pediatrician here in Curacao but he said the same.I am not trusting the treatment as i have searched the meds and got that they are for kids with severe lung diseases. He coughs and has a runny nose but the mucus is not green, which is a sign of infection. What do you recommend? i don't see why they are not curing the cold as i am giving prevnar injections and due to this cold i am falling behind. What can you recommend doctor?We don't smoke, we don't really have asthmatics in the family
US Pediatrician licensed in California living abroad
Hi doctor, thank you for your reply. The baby has not been diagnosed with asthma and we don't smoke or have asthmatics in the near family members. Since January he has been dealing with this cold and he got ventolin and bislovon. Now he got combivent, singulair half tablet and fluimmicil 5 ml. I don't trust the treatment anymore as they are not curing the cold and we are falling behind with the prevan injections. his coughs and the doctor said he is doing e a light peeping sound in his lungs, he has a bit runny nose but other wise he is very active and focues. He did not have any episodes with fever. Whta do you recommend as i am getting nervous about this. Margareth
Hi: It is now morning here thus the delay in responding, I apologize if you were looking out for my response earlier. I think that you are really justified in feeling nervous about the medicines being used in your baby. To be honest this is not what I would use in this situation. Please remember that this chat is for informational purposes only and not meant to be any type of diagnostic consultation. I will try to give you as much info as you feel you need about this even though we may need to go back and forth with time zone differences. So the first thought is what is making him cough. Then the second is if his medicine regimen is appropriate for this. I can give you some pointers on how I would decide between different causes and what I would choose medicine wise. I understand you are in Curacao and that pragmatical pediatricians may choose different options there. You may want to consider looking for a children's hospital or a pediatric pulmonary specialist at this point to get another opinion beyond what the local doctors have offered you. You may have to travel a bit but as long as it is not a huge expense it may be worth it! I am going to enter this so as not to loose my response and will continue.
If he is getting better/worse with periods of no cough in between then it is highly possible he has had multiple viral infections with cough that have made him sick. This is sometimes tough to tell as they can seem almost to overlap as if he is always sick. The key to knowing here is that the symptoms get worse/better over time. I tell parents are there days when you know and say thank goodness he is finally better!! A few nights of good sleep for all and then again the symptoms worsen. Have they used any antibiotics at all? I suspect so as this is what most would start with. There is no test for asthma at his age. What you would notice is a wheezing high pitched sound when he breathes out, which could be the peeping you are referring to. Can you hear this without the stethoscope? There are other reasons for having a high pitched sound when breathing out but they are more rare than asthma. In addition there are other reasons to have a high pitched sound at other points in the breathing cycle which include problems with the upper airway or as far down as the voice box. When does he have it? Is is made worse by being active, eating? Asthma type wheezing is made worse by colds in babies his age almost invariably but also can happen at night when well, or when exercising (crawling)...However it would go away temporarily with the proper dosing through a mask/spacer or neb device of ventolin or salbutamol. It may be accompanied by increased work of breathing and you noting him using accessory muscles to help him take a bigger breath (ribs sucking in, nose flaring, collarbone sucking in), and you may be worried about his breathing during these episodes. At his age generally you will have had at least one of these episodes during a cough/cold by now if the process is asthmatic. The fact that the cough is accompanied with runny nose and otherwise no fever makes me feel that it may be overlapping colds/viral infections. Are there other symptoms like diarrhea, poor appetite, poor sleep, etc... that happen at the same time and then get better? There are many rare reasons for having chronic cough and chronic mucus like cystic fibrosis but these babies are really sick and grow poorly. How is your baby's growth?Again I will enter this and continue.
Another possiblity is reflux but most parents know a baby with reflux due to the vomiting and history of well, relfuxing since birth. It is more rare as a baby to develop it all of a sudden but you should see some affect in how he eats if this were the cause of his cough. In terms of the medicines, I would not use anything but the ventolin at this point if I were opting for an asthmatic process. Singulair in his age is not used much except for severe asthma/lung disease (like the combivent). Long before using this (or combivent!) I would have tried an inhaled corticosteroid for a month or so to see if it were to help. If you note some relief in the peeping noise with Ventolin this would be where I would go next. I would not as mentioned before use the syrups at all in a child this age (or really any child who can cough and does not have severe disease) as they have never been shown to do much of anything. Example when I would use them is again CF, or a child with neuromuscular disease who can't cough and need thinner mucus. I would also consider a chest Xray and perhaps some basic blood tests if he is coughing all the time, not growing well and not better in between episodes. What I can say for certain is that I share your anxiety about what is happening and it is frustrating when you really have few options for expert guidance but know something is just not right. I will await your response to some of my questions so that I may better try to point you in the direction. It is 9:20 am here and I will go about my day but check in frequently for a response. Thanks!
Dear dr Navitsky,
sorry for the many response as my computer was hanging yesterday. Giancarlo does not have problems with frequent diarrhea or so. He has not a wheezing/peeuping sound when he breaths, his breathing sounds are normal. he sleeps very well, all through the night and he eats like no other. He was even a bit overweight at somepoint and has now more weight and body than other children his age, but now he is not overweight. He is growing perfectly as has been said by the nurses that checks babies out every 2 months here ( it is a must here on the island). He is not having signs of asthma and has been checked by four doctors here of different area and no one told me that he is having asthma.. i feel more for the overlapping viral infections as he goes to a daycare and the other kids come with their viruses. My concern is that I am not trusting the treatment as the same kind of treatment has been given on and off. I know taht after 10 days of treatment a medicine is not always effective anymore and of course I want him cured. Some days a think that we have this finally behind us, than he falls back. But I was already planning to fly to the Dominican Republic with him as we have friends over there that are doctors and maybe they can help me out with curing the issue. Here in Curacao we are very Dutch and it takes forever to get a doctor as they are on vacation, or in a seminar or doing something else, they have to good of a life here. His brabbeling goes very well, he can even "sing" along with that ay ay seu te pego song!He loves it!They haven't given him antibiotics yet for treating this cold and cough. Other wise he seems like a normal kid, the only thing is taht he has that cough and on and off runny nose and when i go to the doctor they hear that wheezing sound and gives him the same treatment, and I don't trust thea treatment anymore as I think it is to heavy for a 9 month old baby, surely my baby that was a premie. he was born 6 weeks before due date. Thank you doctor for your time y que tenga buen dia alla en España! Margareth Craneveldt
Hi Margareth sounds like I need to go to Curacao instead! After this post and finding out he is in daycare it is highly likely he has recurrent viruses. Kids in daycare can have even more of the 10-12 normal colds a year allowed for a healthy child. If his symptoms go away in between this is likely the cause. There is nothing other than increased resistance to virus that comes with experiencing the infections that will protect him, as well as good hand hygeine and plenty of sleep and good nutrition. For colds there is NO treatment that is recommended other than trying to keep him comfortable (with ibuprofen or tylenol, lots of love, fluids and rest). We do not recommend mucolytic syrups for cough or runny nose associated with a cold in the US. If he wheezes with each cold (the peeping sound) he has reactive airways disease or early asthma even though they have not said it this way. There is nothing else that causes temporary wheezing with viral infections in a young child really. The treatment for this is Ventolin with colds 2 puffs every 4-6 hours around the clock with a mask spacer device or a neb machine until his cough clears (usually about a week to 2). If his cough gets worse and he has much difficulty breathing oral steroids for a short course may be indicated. If he frequently gets very sick with breathing and is using the the inhaler most days rather than not than an inhaler with steroid is indicated. If he has cough with exercise, laughing, strong odors, crying, and when he is not sick at night these are symptoms of more persistant asthma and again need an inhaled corticosteroid daily. I would not use Combivent in a child such as your son with apparent mild disease but only the ventolin component (salbutamol). Being born at 34 weeks shouldn't cause him too many problems now unless he had lung disease and spent some time on oxygen (rare at 34 weeks gestation but can happen to a few babies) Te deseo todo lo mejor! Feel free to ask me any direct questions in the future and respond to this feed on this one if you need to.