Had the most chill 11-month-old I have literally ever met presenting with some wheezing, hence prompting the classic "bronchiolitis vs asthma" assessment. The kiddo did indeed have a positive family history for atopy and was also from an ethnocultural population that is highly at-risk for atopic disorders, so despite her young age I was actually suspicious it could be asthma.
I explained all this to the parents, expressing that we would do a trial of short-acting beta agonist (SABA) inhaler therapy immediately and if it helped, we would know this was an asthmatic presentation, and if not, then we would treat as bronchiolitis. Now, usually children under 3 years of age will either attempt to claw your eyes out when you get near them with the aerochamber mask, or they'll scream continuously, which actually facilitates getting the meds into them. Because of this, for most kiddos that are in this age group, I'll try to give them the puffers while sitting off to one side of them with my arm around their shoulders to hold the mask on their face, so I'm not blocking their view of their caregiver or whatever they might be using to distract them (read: Peppa Pig, Cocomelon, etc.). If this tactic does not work, then we go to plan B, which is getting the parent to sit behind the child with the child's back to their chest, their legs crossed over the kiddo's legs, hugging their arms to their sides; I will hold the mask onto the kiddo's face with one hand and essentially follow their head movements to keep the mask in place while they thrash move.
However, in this case, little miss wheezy was content to sit still and take big breaths with the mask on her face, and sat through all 10 breaths per puff without the tiniest peep of protest. I was honestly flabbergasted. Then, at puff 3 out of 4, she actually snuggled into my side and put her little hand on my leg, and we kind of cuddled like that until the rest of the puffs were done.
When I moved to listen to her lungs post-SABA, she gave me the cutest little pouty face because I disrupted her comfy snuggles. I honestly could have just sat with her all day, she was so cute. I marveled to her parents about how well she took the puffers, and her mom laughed, "Of course, only for you... when we have had to try to give her the puffer before at home, she was so mad!!"
🥺 little bean, thank you for giving me my first salbutamol snuggle.
