Reactive Airway Disease in Toddlers
Content reviewed against published AAP, NHLBI guidelines
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If your baby has been diagnosed with or you suspect reactive airway disease in toddlers, here is what the evidence says.
The short answer
Reactive airway disease (RAD) is a term used when young children have recurrent wheezing episodes, often triggered by viral infections, but are too young for a formal asthma diagnosis. The airways of these children are overly sensitive and narrow in response to triggers, causing wheezing, coughing, and difficulty breathing. Not all children with RAD will develop asthma, but the conditions share similar treatments including bronchodilators and inhaled corticosteroids.
Key takeaways
- Reactive airway disease (RAD) is a term used when young children have recurrent wheezing episodes, often triggered by viral infections, but are too young for a formal asthma diagnosis. The airways of these children are overly sensitive and narrow in response to triggers, causing wheezing, coughing, and difficulty breathing. Not all children with RAD will develop asthma, but the conditions share similar treatments including bronchodilators and inhaled corticosteroids.
- Usually normal when: Baby wheezes briefly during a single viral cold and then breathes normally after recovery
- Call your doctor if: Your child is wheezing and having significant difficulty breathing with chest retractions or belly breathing
- Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
Parents everywhere have the same worry. You are doing the right thing by looking into it.
By Age
What to expect by age
0-3 months
Wheezing in very young infants is usually caused by viral infections like RSV bronchiolitis rather than reactive airway disease. The small airways of newborns are easily narrowed by mucus and inflammation. A single wheezing episode in a young infant does not indicate RAD. However, if your baby was premature or has a family history of asthma, mention this to your pediatrician as these are risk factors.
3-6 months
Recurrent wheezing episodes in babies this age may begin to raise concern for reactive airways, especially if they occur with multiple viral infections. Your pediatrician may prescribe a bronchodilator (like albuterol via nebulizer) to see if it helps. Improvement with bronchodilator treatment supports the possibility of reactive airways. Keep track of wheezing episodes and what seems to trigger them.
6-12 months
If your baby has had three or more wheezing episodes, your pediatrician may use the term "reactive airway disease." Risk factors for this progressing to asthma include family history of asthma, personal history of eczema, allergic sensitization, and wheezing without colds. Treatment may include a daily inhaled corticosteroid during cold season or as-needed bronchodilator therapy.
12 months+
Toddlers with RAD who continue to have frequent wheezing episodes may be transitioned to an asthma management plan. The Asthma Predictive Index helps estimate whether a wheezing toddler will develop persistent asthma: major criteria include a parent with asthma or personal eczema, while minor criteria include allergic rhinitis, wheezing apart from colds, and blood eosinophilia. Discuss a long-term management plan with your pediatrician.
What Should You Do?
When to take action
- Baby wheezes briefly during a single viral cold and then breathes normally after recovery
- Toddler has occasional mild wheezing with upper respiratory infections that responds to treatment
- Baby makes noisy breathing sounds from nasal congestion (not true wheezing from the chest)
- Toddler has mild exercise-related cough that resolves quickly with rest
- Your child wheezes with every cold or respiratory infection
- Your child has had three or more wheezing episodes in the past year
- Wheezing is triggered by exercise, cold air, or laughing in addition to viral infections
- Your child is wheezing and having significant difficulty breathing with chest retractions or belly breathing
- Your child's lips or fingernails turn blue or gray during a wheezing episode -- call 911
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Reactive Airway Disease in Toddlers.
Things to mention
- Your child wheezes with every cold or respiratory infection
- Your child has had three or more wheezing episodes in the past year
- Wheezing is triggered by exercise, cold air, or laughing in addition to viral infections
Observations to share
- Your child wheezes with every cold or respiratory infection
- Your child has had three or more wheezing episodes in the past year
- Wheezing is triggered by exercise, cold air, or laughing in addition to viral infections
Urgent signs to report immediately
- Your child is wheezing and having significant difficulty breathing with chest retractions or belly breathing
- Your child's lips or fingernails turn blue or gray during a wheezing episode -- call 911
My notes
From ismybabyalright.com — free, evidence-based baby health guides
Related Resources
Frequently asked questions
Is reactive airway disease in toddlers normal?
When should I call the doctor about reactive airway disease in toddlers?
When is reactive airway disease in toddlers normal?
What causes reactive airway disease in toddlers?
What should I mention to my pediatrician about reactive airway disease in toddlers?
Is reactive airway disease in toddlers normal at 0-3 months?
Is reactive airway disease in toddlers normal at 3-6 months?
Should I go to the ER for reactive airway disease in toddlers?
Does reactive airway disease in toddlers go away on its own?
References
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Resources
Bottom line
Most cases of reactive airway disease in toddlers are normal. Talk to your pediatrician if your child is wheezing and having significant difficulty breathing with chest retractions or belly breathing.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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