ABSTRACT
Despite the fact that wheezing in infancy and early childhood is one of the commonest problems seen by the pediatrician, management of these children is often difficult and uncertain. Over the past few years a number of guidelines have been published in order to try to standardize the treatment of asthma in adults and children.1-4 In these management guidelines it is often tacitly assumed that the very young wheezy child responds in the same way as older children or adults, and although the guidelines suggest minor modifications, they basically recommend the same medication as for older patient with the implication that these are likely to help. The American Academy of Asthma, Allergy and Immunology, in collaboration with the American Academy of Pediatrics and others,3 published guidelines for managing asthma in children which imply that all infants and young children who wheeze because they are atopic or suffer from viralinduced wheeze may benefit from asthma treatment. Careful reading of the small print in some of the guidelines indicates that all is not as simple as it seems. In the British version there is a warning concerning problems in the management of very young children which emphasizes the difficulty in diagnosis, the fact that most treatments have very poor efficacy and that there are very few controlled trials of treatment in this age group.2
