Viral induced wheeze

Viral induced wheeze is a whistling sound from the chest that is due to the narrowing and swelling of the airways, caused by a viral infection (e.g. a cough or a cold). It can be associated with difficulty in breathing. The symptoms may recur each time your child has a cold.  Usually the child is well in-between the viral infections but the wheeze can last for some weeks after the infection. Children under the age of 5 years are more likely to be affected as their air passages are small.

Treatment of viral induced wheeze is similar to asthma with a salbutamol (reliever) inhaler. Your child may also have been prescribed a preventer medication if they have had recurrent episodes of viral induced wheeze.


Does this mean my child has asthma?

No, not necessarily. This is a different condition from asthma, although a few children do go on to develop asthma.

Children with asthma:

  • Are often wheezy, even when they do not have a cough or cold
  • Usually have a family history of asthma and allergy
  • Are generally more breathless than their friends when they run around or become wheezy on exercise.
  • Often have a regular night time cough

If you are worried that your child has asthma, you should make an appointment to see your GP or GP asthma nurse.

When should you worry?

If your child has any of the following:

  • Has blue lips
  • Too breathless to talk or eat or drink
  • Having symptoms of cough or wheeze or breathlessness which are getting worse despite 10 puffs of salbutamol (blue) inhaler every 4 hours
  • Is pale, mottled and feels abnormally cold to touch
  • Is extremely agitated, confused or very lethargic (difficult to wake)
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern or starts grunting

Ring 999 immediately for help. Give 10 puffs of salbutamol (blue) inhaler every 10 minutes until ambulance arrives

Keep child in upright position and reassure them

If your child has any of the following:

  • Wheezing and breathless and salbutamol (blue) inhaler is not lasting 4 hours
  • Having a cough or wheeze or tight chest during the day and night
  • Too breathless to run or play or do normal activities

Immediately contact your GP and make an appointment for your child to be seen that day face to face

Increase salbutamol (blue) inhaler to 6-10 puffs every 4 hours

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

If your child has none of the above:

Watch them closely for any change and look out for any red or amber symptoms.

If your child starts to cough, wheeze or has a tight chest but can continue day to day activities; if this continues for more than 5 days contact your GP.

Give 2-5 puffs salbutamol (blue) inhaler every 4 hours until symptoms improve

What should you do?

At the start of cold symptoms (such as runny nose), begin your child on salbutamol (blue) inhaler 2 puffs every 4 hours as needed. This can be increased to up to 10 puffs at a time if your child’s symptoms are still significant. If your child is requiring increasing amounts of blue inhaler you should seek medical advice according to the table above.

1) It is vital that your child uses their inhalers correctly.

Your child’s wheeze will not be controlled if their medicines are not getting into their lungs.

Choose appropriate sized spacer with mask (or mouthpiece if they are older with good technique). Your child may need lots of positive encouragement when they first start to use the spacer. You may want to make it into a game or use a small reward to encourage them. ​

  1. Sit your child in an upright position, as this will help them to breathe in the inhaler medication

  2. Shake the inhaler and push it into the port on the end of the spacer. Holder the spacer away from your child's face

  3. If you are using a spacer with a face mask you will need to fit this over your child's nose and mouth. You will need to make sure that there are no gaps, as these will let the inhaler gases escape before they can be breathed in. Some spacers come with a mouthpiece instead of a mask. These are usually for older children who can breathe in and out just through their mouth

  4. Press the top of the inhaler firmly and release, this will administer one puff into the spacer. Allow your child to breathe in and out with the spacer mask still on their face. You may have been taught to count 10 breaths per puff, but if this is difficult for your child when you are at home the recommendation is at least 5 breaths

  5. Remove the spacer mask from your child's face. Shake the spacer and attached inhaler to get it ready for the next dose​

  6. Repeat the process until your child has had their prescribed amount of puffs

If the spacer makes a whistling noise, this means your child is breathing too quickly. Encourage them to take slower, deeper breaths to make sure they received a sufficient dose of their medicine.

Plastic spacers should be washed before 1st use and every month as per manufacturer's guidelines.

To watch a video on encouraging children to use their inhalers effectively please click here.







For videos on using your child's inhaler and spacer correctly see

See your practice nurse or doctor if you are not sure whether your child is using their inhaler properly.


2) Treatment over the next few days 

Over the next few days, your child will be recovering and hopefully will feel better.

They may still need their salbutamol (blue) inhaler if they have symptoms of chest tightness, a dry cough or shortness of breath.

If they have symptoms, you can give up to 10 puffs of their blue reliever inhaler and the effects should last for 4 hours.

If your child becomes increasingly breathless or the effects are not lasting 4 hours, you should follow the instructions outlined in the RED section.

In the event that your child has been started on steroid tablets, these should be continued once daily (usual treatment course is 3 – 5 days for prednisolone or 1 day for dexamethasone).

If you child normally uses preventative treatment(s), this should continue as normal.

If your child’s wheeze worsens in future, please follow the instructions outlined in red, amber, green traffic light table.

How long will symptoms last?

The wheezing episodes usually last 2-4 days but can be longer.

Where should you seek help?

For wear and tear, minor trips and everything in between


You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughscolds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughscolds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?


School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  • Doctors or GPs can treat many illnesses that do not warrant a visit to A&E
  • Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, you can call 111 or use 111 online.

Please note that 111 online is for people aged 5 and over. Call 111 if you need help for a child under 5.

An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services

For information on common childhood illnesses go to What is wrong with my child?


A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  • Many visits to A&E and calls to 999 could be resolved by any other NHS services
  • If your child's condition is not critical, choose another service to get them the best possible treatment
  • Help your child to understand – watch this video with them about going to A&E or riding in an ambulance
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