Lungs are for life. Until recently, people thought that childhood infections were the main cause of long-term poor health. But doctors are discovering that many breathing problems have their roots even earlier – in the womb and the first year of a child’s life
How do lungs work?
When we breathe in, our lungs take in air. Our lungs get oxygen from the air into our bloodstream. They also take carbon dioxide out of our bloodstream, and get it out of our bodies when we breathe out.
Your lungs lie on either side of your heart. They fill the inside of your chest. In an adult, each lung weighs about half a kilo. The right lung is a bit bigger than the left one because there is more room for it; the left lung has to share the space with your heart.
Your lungs are made up of lobes. There are three on the right and two on the left. The inside of your lungs look like a giant sponge. They are a mass of fine tubes. The smallest tubes end in tiny air sacs. There are around 300 million of these sacs. If they were spread out flat they would cover a piece of ground about the size of a tennis court.
The air sacs have very thin walls. They are criss-crossed with tiny blood vessels. This is where oxygen and carbon dioxide move between your blood stream and your lungs.
Your lungs are protected by your rib cage. Between the ribs are muscles that we use for breathing. There is a thin lining between your lungs and your ribs. This lining has two layers which slide over each other. This means that the lungs can expand and contract as we breathe.
Below the lungs is a dome-shaped muscle – your diaphragm. The diaphragm separates your chest from your abdomen and is also used in breathing.
Healthy adult lungs work very hard. Every day they:
- process over 7,000 litres of blood and nearly 6,000 litres of air
- fight off the infections carried by germs that enter the body
- increase their work-rate more than 20 times during heavy exercise
How lungs develop
The lungs start to form in the first eight weeks of life, often before a woman even knows she is pregnant. By month five the airways have developed, but they are still very small. The airways are the tubes we breathe through. They must grow a lot before birth so that the baby can breathe by itself.
The lungs carry on developing after we are born. Our airways end in tiny sacs. During the first 18 months of life, many many more of these sacs develop. After our second birthday, very few new sacs develop but the existing sacs get bigger.
Why do only some children develop a lung disease?
The lungs are very sensitive, especially while they are growing. Any damage to them can often be permanent. But it is not always clear why some children’s lungs grow normally and others don’t.
Why are premature babies more prone to lung disease?
Premature babies’ lungs are not as developed as babies born at full term – they haven’t had enough time to develop.
Premature lungs often don’t have enough ‘surfactant’, this is a substance that lines the lungs and stops the air sacs from collapsing.
Complications can also play a part; such as womb infections, which may lead to premature birth
Some children born prematurely need life support machines. The high oxygen level they breathe helps their undeveloped lungs cope with breathing by themselves. But it also stops the air sacs from developing properly – this can also lead to breathing difficulties
Is lung disease a problem for all premature babies?
About one baby in ten is born early. Only a very small number are at risk of having a severe lung condition; about one in every hundred premature babies. It’s normally those with very low birthweight – usually under 1.5 kg – who are most at risk.
What is done to help parents?
Hospitals try to help parents whose children need life support after birth. They encourage parents to be as involved as they can. Children respond to care from their parents, even when they are in such a delicate condition. It’s also important for parents to bond as much as possible with their baby. Hospital staff will try hard to help parents.
Trained counsellors are also available to help parents cope. It is difficult when your child is in hospital.
If you want to give your unborn child the very best start in life, then you should not smoke. Anyone you live with shouldn’t smoke around you either.
If you smoke, you should stop when you start trying for a baby, not when you get pregnant. If your baby is unplanned, you should stop as soon as you know you are pregnant. Even stopping 20 weeks into your pregnancy will be helping your baby a lot.
If a mother smokes during pregnancy, her baby is more likely to have:
- narrow airways
- more chance of a being born early
- low body weight at birth
After birth, the child is more likely to:
- have periods of trouble with their breathing in the first few years of life
- miss school because of coughs, wheezing, viral infections and middle ear infections
These symptoms may carry on into adult life. This would lead to long-term medical problems.
There are various treatments on the market designed to help you give up smoking. These may not be suitable for pregnant women. Please speak with your doctor or practice nurse for details.
Smoking around babies and children, is dangerous for their health as well. It is estimated that 17,000 children under the age of five are admitted to hospital every year as a result of breathing in second-hand smoke.
Please go here for more information about stopping smoking.
What happens as my child grows older?
Premature children may still have trouble with their breathing long after they leave hospital. They are often wheezy in their first three years of life. Often they will be vulnerable to viral infections. These can sometimes be life-threatening. Among the most obvious signs that a child has breathing difficulties are:
- coughing breathlessness or panting during feeding
- the skin turning bluish due to a lack of oxygen
- high pitched noisy breathing, usually from high in the chest or throat
- poor weight gain
More research is needed to find out how lung problems in early life affect the lungs into adult life.
Some lung conditions in children
Asthma is diagnosed in more than one in five under-fives. But what is called asthma in early childhood is not just one disease – it’s various disorders that have similar symptoms. Some of these symptoms might be:
- shortness of breath
- wheezing and tightness in the chest
We don’t know what causes asthma, although a variety of things can trigger it.
The role of allergens
An allergen is something that can trigger an allergic response; pet hair or dust mites, for example. Allergens set off a chain reaction that results in the release of toxins in your airways. This produces inflammation, which in turn produces excess mucus. This makes the airways narrower, which makes it hard to breathe.
In more serious cases, full-blown asthmatic attacks can happen.
Ask your doctor or practice nurse about any help your child may need.
How asthma is treated
Asthma in childhood may lead to permanent scarring and narrowing of the airways. However, proper treatment means that most people with asthma lead completely normal lives. Many treatments are available usually involving inhalers (‘puffers’), used with a spacer. Talk over your child’s specific problem with your doctor.
Sometimes children with asthma wake at night coughing while others are more wheezy during the day. These may be signs that your child needs more treatment. If so, see your doctor.
Chronic lung disease of the new born (CLDN)
This condition is also known as ‘chronic lung disease of prematurity’ or ‘bronchopulmonary dysplasia’ (BPD). It particularly affects premature babies who need oxygen or artificial ventilation early in their life. This damages the baby’s airways and lungs and causes breathlessness and an on-going need for oxygen.
Many of these babies will go home on continuous oxygen therapy. It is important to protect babies with CLDN from viral infections as far as possible in infancy. You can do this by immunisation and by avoiding places where infected children and adults are likely to be.
In general, the breathlessness and need for oxygen get better with time. Few of these babies continue to need oxygen after the first one to two years. Children who have had CLDN are more likely to be chesty and wheezy in their pre-school years, and their lung function is abnormal. But this doesn’t usually cause major problems in later childhood.
Cysts are not very common. In early pregnancy, a small part of the lung may develop wrongly. This can lead to cysts forming. In most cases they shrink as the child grows in the womb, and the baby is born healthy. Sometimes, though, an operation is needed to remove them. Most infants recover well.
Respiratory synctial virus (RSV)
RSV is a very common virus that causes mild cold-like symptoms. Most of us with a healthy immune system will not be harmed. But premature babies or young children who have a pre-existing lung condition are at high risk of becoming unwell, often seriously, from RSV. Also at risk are babies with heart disease, immune problems and those with cystic fibrosis.
Most RSV infections happen between October and March. The early symptoms are usually:
- a runny nose
- mild fever
- sore throat
- mild cough
- blocked nose
- ear infection
After three to five days the symptoms may get worse if the virus spreads to the lungs and can then include:
- rapid breathing
- a strong cough
If your baby has a cold which appears to be getting worse, or if you have any questions regarding your baby’s condition, ask your doctor for advice.
RSV is thought to be mainly spread by physical contact. The virus can survive for several hours on toys, work surfaces and on used tissues. It can also be passed on by an infected person coughing and sneezing. Frequent hand washing is very important to stop the spread of RSV. So is throwing away used tissues, and washing toys which have been used by children with colds. It is important not to expose your baby to cigarette smoke.
Some babies with RSV have chesty problems throughout their childhood. It’s estimated that 30 per cent of the babies admitted to hospital with RSV will still have wheezing episodes 10 years later.
RSV is the commonest cause of a condition called bronchiolitis – inflammation and obstruction of the lung’s tiniest airways.
In the autumn and winter months, viral bronchiolitis is a common childhood illness. Bronchiolitis may be a particular problem in children whose lungs have not developed normally. The most common cause of this in the first year of life is a viral infection (like RSV).
Symptoms to look out for include:
- your baby developing a cold that does not settle down
- breathing difficulties
Most babies get better without treatment but some need to go to hospital.
Cystic fibrosis (CF)
Cystic fibrosis happens when babies inherit faulty genes from their parents. It mainly affects the lungs and digestive system. Thick mucus accumulates in the lungs, making it difficult to clear the airways. This leads to infection and inflammation, which damage the delicate lung tissue and reduce lung function. Respiratory failure is the biggest cause of death in CF patients.
How will CF affect my child?
The most obvious feature is a persistent cough. Many children with CF also have wheezing when their chests are very congested. This can be a problem, as a severe attack can lead to coughing up mucus and vomiting. Children with CF may not be able to digest their food properly, they can suffer with diarrhoea and may not put on weight.
How is it treated?
Treatment for people with CF has improved greatly in recent years. Specific treatments depend on your child’s particular condition but often involve:
- medicines (including antibiotics)
- vitamins and food supplements
What does the future hold for young people with CF?
Better treatment has helped people with CF live longer. In 1969, half of all people with CF lived until the age of 14; by 1996, this had risen to 31. Most children born recently with CF will be living well into their 40s. This is very encouraging. It is also hoped that a cure may be found within the next 10 to 20 years.
When is hospital treatment necessary?
The early days of coping with a child who has a chronic lung condition are frightening. As your experience grows, so will your knowledge of what to do. If you have any doubt that your home treatment is effective, you should speak with your doctor or nurse. If necessary, go back to the hospital for reassurance.
Who can I call on when caring for my child at home?
Hospitals will ensure that you are trained in the use of any medicines and equipment your child may need. There is also a whole network of community-based help that families can call on such as: community paediatricians; paediatric nurses; and your GP.
In some areas there may also be a local ‘domiciliary physiotherapist’. This person helps with physiotherapy in the home. Ask your doctor if one is available and if they can help your child.
Parents can also be trained to help their children use a whole range of equipment, including:
- inhalers and spacers
- suction devices for removing the build-up of mucus in the airways
- nebulisers and injection kits for medicines
- oxygen equipment
What other help can I get if my child has a lung condition?
As well as the community medical support services that are available, there may be a local support group for parents of children with lung disease in your area. Your GP or local hospital may be able to put you in touch with them.
If you have any questions you can also call the British Lung Foundation help line on 08458 50 50 20. The helpline is staffed by respiratory nurses, welfare benefits advisors, parent counsellors and a paediatric nurse. Please go here for more information/
There are a number of state benefits that you may be entitled to. For help with these, call the British Lung Foundation helpline on, and ask to speak with a benefits adviser.