Childhood Asthma

What is childhood asthma?

Asthma is a long-term (chronic) lung disease that affects your airways. Your airways are the tubes that carry air in and out of your lungs. When you have asthma, you can’t get air into your lungs because your airways swell and get too narrow.

Like a pinched straw, this makes it hard for you to breathe, which can cause wheezing, coughing and chest tightness. Certain triggers can set off or worsen these symptoms, causing an asthma attack. Attacks can come on fast or develop slowly, and they may be life-threatening.

Asthma can begin at any age, but it most often starts during childhood when your child’s immune system is still developing. Most children who get asthma have their first symptom by age 5. Asthma can cause your child to miss school and even end up in the hospital. It’s important to have an asthma treatment plan to help manage your child’s condition.

How common is asthma in childhood?

Asthma is the leading cause of chronic illness in children. It affects about 7.5 million children in the United States. The rate of the condition in children is steadily increasing. It’s also one of the main causes of missed school for children and missed work for parents.

Why are more children getting asthma?

Researchers believe several factors may be leading to more and more children developing asthma. These factors include:

• Exposure to more allergens such as dust, air pollution and secondhand smoke.
• Not enough exposure to childhood illnesses that build up their immune systems.
• Lower rates of breastfeeding (chestfeeding), which prevent babies from receiving important immune system substances.

What are the symptoms of asthma in children?

Not all children have the same asthma symptoms. And symptoms can vary from episode to episode in the same child. Childhood asthma symptoms may include:

• Frequent coughing spells. Coughing fits may occur while your child is playing or laughing. They may also occur at night or right after your child wakes up. Coughing may be their only symptom.
• Less energy during play.
• Rapid breathing or shortness of breath (dyspnea).
• Complaining of chest tightness or their chest “hurting.”
• A whistling sound (wheezing) when your child breathes in or out.
• Retractions. When the area between your child’s ribs and neck area sinks in when they try to exhale. Retractions are a sign your child is working hard to breathe.
• Feelings of weakness or tiredness.
• Irritability.
• Trouble feeding (sucking or eating).

When your child has an asthma attack (asthma exacerbation), their symptoms may get much worse. The attacks may come on slowly or quickly. Sometimes, they can be life-threatening (status asthmaticus). If your child has any of the following warning signs of a severe attack, you should get medical help right away:

• Severe coughing.
• Rapid worsening of shortness of breath or wheezing.
• Serious breathing problems.
• Increase in respiratory rate at rest.
• Turning pale or bluish in their face, lips and/or fingernails.
• Trouble speaking, inability to speak in sentences or not being able to speak at all.

What causes childhood asthma?

Researchers don’t know the exact cause of asthma, but it often develops during childhood when your child’s immune system is still developing. Many factors may affect how your child’s lungs develop or how their body fights germs. These include:

• Genetics: Biological family history, such as a parent who has asthma.
• Allergens: Things in the environment that affect your child, such as dust or tobacco smoke.
• Viral infections at a young age: Respiratory infections that affect breathing, such as the common cold.

Is asthma contagious?

No, asthma isn’t contagious. Germs such as bacteria and viruses don’t cause the condition, so it can’t spread from person to person.

What are the risk factors for asthma in childhood?

There are many risk factors for developing childhood asthma. These include:

• Allergies.
• Family history of asthma and/or allergies.
• Frequent respiratory infections as a young child.
• Low birth weight.
• Exposure to tobacco smoke before and/or after birth.
• Being assigned male at birth (AMAB).
• Being Black, African American, Puerto Rican, Indigenous, Native American or Alaska Native.
• Living in an inner city or near high amounts of air pollution.

What are the complications of childhood asthma?

If asthma isn’t well-managed, it can cause a variety of issues and complications. These may include:

• Severe asthma attacks.
• Missed school or other activities.
• Frequent hospitalizations and/or emergency department visits.
• Permanent lung damage.

How is childhood asthma diagnosed?

Asthma is often difficult to diagnose in children, especially when they’re younger than age 6. The condition can have similar symptoms to other illnesses. And some children don’t develop symptoms of asthma often, so it can be mistaken for another respiratory condition. In addition, younger children often can’t perform pulmonary function tests that diagnose asthma.

Your child’s pediatrician may diagnose the disease based on your child’s medical history, symptoms and a physical examination. Your child’s provider will ask you if your child has any history of breathing problems. They’ll also ask about any family history of asthma, allergies or other lung diseases. Be sure to describe your child’s symptoms in detail, including when and how often these symptoms have been occurring.

Your child’s pediatrician may refer your child to a specialist, such as a pediatric pulmonologist or a pediatric allergist.

What tests will be done to diagnose asthma in childhood?

If possible, your child’s provider may request a few tests to diagnose asthma. These tests may include:

• Lung (pulmonary) function tests: These tests measure the amount of air in your child’s lungs and how fast they can exhale it (breathe it out). The results will help your child’s provider determine how severe your child’s asthma is.
• Allergy skin testing and blood tests: These can help identify which allergens may be triggering a reaction from your child’s immune system.
• Chest X-ray: Your child’s provider may use imaging tests such as chest X-rays to rule out conditions other than asthma.

Young children usually aren’t able to perform pulmonary function tests. So your child’s provider may suggest trying asthma medications to see how well your child responds.

How is asthma in childhood treated?

Childhood asthma treatment includes the development of an “asthma action plan” with your child’s provider. The plan will detail ways to manage your child’s symptoms and prevent asthma attacks. The plan will also describe:

• When and how your child should use asthma medication.
• What to do when their asthma gets worse.
• When to seek emergency care for your child.

Make sure you understand this plan and ask your child’s provider any questions you may have. The asthma action plan is important to the success of managing your child’s asthma. Keep it handy to remind you of your child’s daily asthma management plan and to guide you when your child develops asthma symptoms. You should also give a copy of the asthma action plan to your child’s school staff and other caregivers.

In addition to following the asthma action plan, try to limit (and avoid, if possible) exposure to asthma triggers. Your child’s provider can help you with strategies to avoid triggers.

Childhood asthma medications

Childhood asthma medications include the same medications that adults and older children take but in different forms and dosages. In the case of inhaled medications, your child may need to use a different delivery device based on their age and ability.

Depending on the severity of your child’s condition, they may need to take medicine only as needed or every day. Some medicines help prevent or relieve symptoms of an asthma attack. Other medicines work to control or prevent the swelling of your child’s airways.

Quick-relief medicines

Quick-relief medicines, or short-term relief medicines, help prevent or relieve asthma symptoms. If your child has mild asthma or their condition only occurs with physical activity, a quick-relief medicine may be all they need. These types of medicines include an inhaler your child will carry at all times.

Types of quick-relief medicines include:

• Short-acting beta2-agonists (SABAs): SABAs, such as albuterol, can quickly open your child’s airways to let air flow through them during an asthma attack. They also help prevent attacks caused by physical activity. SABAs used to be called “rescue” medicine or inhalers. Providers now prefer the term “quick-relief” because you can and should use the medicine for any asthma symptom, not just for asthma attacks.
• Short-acting anticholinergics: Anticholinergics, such as ipratropium bromide, a rapid-acting bronchodilator, can also help open your child’s airways quickly. Anticholinergics may be less effective than SABAs. But some children develop side effects from SABAs, and anticholinergics are a good alternative option.
• Systemic corticosteroids: Corticosteroids can help reduce the swelling (inflammation) in your child’s airways caused by asthma symptoms. Your child can take these medicines by mouth (orally) or by injection. They can also quickly help your child recover after an asthma attack.

Long-term control medicines

Your child’s provider may also prescribe medications for them to take daily to help prevent asthma attacks and control their symptoms. These medicines prevent your child’s airways from narrowing and can help reduce inflammation.

Types of long-term control medicines include:

• Corticosteroids: Corticosteroids are an anti-inflammatory medication that can help reduce swelling (inflammation). Your child may take them by mouth (orally), but providers prefer the inhaled form. Your child can take the medicine in a liquid form (used in a nebulizer), in a metered dose inhaler (MDI) or in a dry powder inhaler (DPI). When using an MDI, your child must always use a valved holding chamber.
• Leukotriene modifiers: These medicines can help reduce swelling in your child’s airways and keep them open. Your child’s provider may prescribe them alone or with corticosteroids. Leukotriene modifiers work by decreasing the effects of a chemical in your child’s body called leukotriene.
• Long-acting beta2-agonists (LABAs): LABAs help prevent your child’s airways from narrowing by relaxing the muscles that surround them. Your child’s provider will often prescribe them with a corticosteroid. They may recommend a LABA when a standard dose of an inhaled steroid isn’t enough to manage your child’s daily symptoms. A LABA must be used with an inhaled steroid (this is called combination therapy).

Complications/side effects of the treatment

Most people tolerate asthma medications well, and providers find that the benefits of the medications usually outweigh any risks. However, all medications can have potential side effects. Asthma medication can lead to side effects such as:

• Rash or swelling.
• Oral thrush.
• Increased heart rate.
• Nervousness.
• Weight gain.
• Headache.

If your child develops severe side effects, talk to their provider about adjusting their dose or changing their medication.

Can childhood asthma be prevented?

You can’t prevent childhood asthma because the exact cause of the condition is unknown. In addition, your child may develop asthma if their immune system is still developing.

How can I lower my child’s risk?

Although childhood asthma isn’t preventable, there are some steps you can take to lower your child’s risk of developing it. These steps include:

• Keeping your home free of mold and dampness.
• Avoiding air pollution as much as possible.
• Helping your child maintain a healthy weight.

What can I expect if my child has asthma?

There’s no cure for asthma. But most children can manage their asthma with appropriate treatment and prevention strategies. Untreated asthma can lead to long-term complications such as permanent lung damage.

How will you know when your child's asthma is well-managed?

You’ll know that your child’s asthma is well-managed if, while on medication, your child:

• Lives an active, normal life.
• Has few troublesome symptoms.
• Doesn’t miss school because of symptoms.
• Performs daily activities without difficulty.
• Has had no urgent visits to their pediatrician, emergency department or hospital.
• Has few or no side effects from their medications.

Does childhood asthma go away?

Once a person’s airways become sensitive, they remain that way for life. About half of children who have asthma have a noticeable decrease in symptoms by the time they become adolescents. Therefore, they appear to outgrow childhood asthma.

However, childhood asthma can come back. About half of the children who seem to outgrow their asthma will develop asthma symptoms again in their 30s or 40s. Unfortunately, there’s no way to predict whose symptoms will decrease during adolescence and whose will return later in life.

When should my child see their healthcare provider?

You should seek care for your child if they have symptoms of asthma along with any of the following risk factors:

• Hospitalization for asthma within the past year.
• A life-threatening asthma attack in the past.
• Recent need for oral corticosteroids to treat asthma.
• Use of more than one inhaled canister of a SABA medicine each month.
• A mental health condition or substance use disorder.
• A food allergy.

What should you do if your child has an asthma attack?

If your child is showing symptoms of an asthma attack:

• Give your child their reliever medicine according to their asthma action plan.
• Wait 15 minutes. If their symptoms go away, your child should be able to resume whatever activity they were doing. If symptoms persist, follow the asthma action plan for further therapy. If your child doesn’t improve, or if you aren’t sure what action to take, call your child’s healthcare provider.

When should I take my child to the ER?

You should call 911 or take your child to the nearest emergency room if they have any of the danger signs of an asthma attack. These signs include:

• Severe wheezing.
• Severe coughing.
• Trouble walking and/or talking.
• Blue skin, lips and/or fingernails.

A note from Cleveland Clinic

By learning about your child’s asthma, you take an important step toward managing their disease. Work closely with your child’s asthma care team to learn how to avoid asthma triggers, what medications to use and how to correctly give them. With proper care, your child can live free of asthma symptoms and maintain a normal, healthy lifestyle.