Asthma is the leading cause of chronic illness in children. It affects as many as 10 to 12 percent of children in the U.S. and, for unknown reasons, is steadily increasing. It can begin at any age, but most children have their first symptoms by age 5.

What makes a child more likely to develop asthma?

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

  • Presence of allergies
  • Family history of asthma and/or allergies
  • Recurrent respiratory infections
  • Low birth weight
  • Exposure to tobacco smoke before and/or after birth
  • Being male
  • Being African-American
  • Being raised in a low-income environment

Why are more children getting asthma?

No one really knows why a growing number of children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke. Others suspect that children are not exposed to enough childhood illnesses to build up their immune system. And still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.

How can I tell if my child has asthma?

Signs and symptoms to look for include:

  • Frequent coughing spells, which may occur during play, at night, or while laughing. It is important to know that cough may be the only symptom present.
  • Less energy during play
  • Rapid breathing
  • Complaint of chest tightness or chest "hurting"
  • Whistling sound (wheezing) when breathing in or out
  • See-saw motions (retractions) in the chest from labored breathing
  • Shortness of breath, loss of breath
  • Tightened neck and chest muscles
  • Feelings of weakness or tiredness

Keep in mind that not all children have the same asthma symptoms, and that these symptoms can vary from episode to episode in the same child. Also note that not all wheezing or coughing is caused by asthma.

In kids under 5 years of age, the most common cause of asthma symptoms is upper respiratory viral infections such as the common cold.

If your child has problems breathing, take him or her to their primary care provider doctor immediately for an evaluation. He or she then may be referred to a Pediatric Pulmonary Specialist.

How is asthma diagnosed in children?

Asthma is often difficult to diagnose in infants. However, in older children the disease can often be diagnosed based on your child's medical history, symptoms, and physical exam.

  • Medical history and symptom description: Your child's doctor will be interested in any history of breathing problems your child may have had, as well as a family history of asthma, allergies, a skin condition called eczema, or other lung disease. It is important that you describe your child's symptoms -- cough, wheezing, shortness of breath, chest pain or tightness -- in detail, including when and how often these symptoms have been occurring.
  • Physical exam: During the physical examination, the doctor will listen to your child's heart and lungs.
  • Tests: Many children will also have a chest X-ray and pulmonary function tests. Also, called lung function tests, these tests measure the amount of air in the lungs and how fast it can be exhaled. The results help the doctor determine how severe the asthma is. Generally, children younger than 3 are unable to perform pulmonary function tests. Thus, doctors rely heavily on history, symptoms, and examination in making the diagnosis.

Other tests may also be ordered to help identify particular asthma triggers. These tests may include allergy skin testing, blood tests, exhaled nitric oxide, and X-rays to determine if sinus infections or gastroesophageal reflux disease is complicating asthma.

How is asthma treated in children?

Based on your child's history and the severity of asthma, your child's doctor will develop a care plan, called an "asthma action plan." The asthma action plan describes when and how your child should use asthma medications, what to do when asthma gets worse, and when to seek emergency care for your child. Make sure you understand this plan and ask your child's doctor any questions you may have.

Your child's asthma action plan is important to successfully controlling his or her asthma. Keep it handy to remind you of your child's daily asthma management plan, as well as to guide you when your child develops asthma symptoms.

In addition to following your child's asthma action plan, you want to make sure exposure to asthma triggers is limited, and preferably avoided.

What asthma medications can children take?

If an infant or child is experiencing asthma symptoms that require treatment with a bronchodilator more than twice a week, most doctors would recommend a daily anti-inflammatory medication.

Asthma medications that are given to adults and older children can also safely be prescribed to toddlers and younger children. Medications that are approved for younger children are given in doses adjusted for their age and weight. In the case of inhaled medications, a different delivery device based on the child's age and ability may be required.

How do I give my child asthma medication?

You will probably give your child asthma medications using a spacer device or a home nebulizer (also known as a breathing machine).

The nebulizer delivers asthma medications by changing them from a liquid to a mist. Your child gets the medicine by breathing it in through a facemask. Your child may be able to use a metered dose inhaler (MDI) with a spacer. A spacer is a chamber that attaches to the MDI and holds the burst of medication. Talk with your child's doctor to see if an MDI with spacer is right for your child.

How do I know when my child's asthma is well-controlled?

You know your child's asthma is well-controlled if, with medications, your child:

  • Lives an active, normal life.
  • Has few troublesome symptoms.
  • Attends school every day.
  • Performs daily activities without difficulty.
  • Has had no urgent visits to the doctor, emergency department, or hospital.
  • Has few or no medication side effects.

By learning about asthma and how it can be controlled, you take an important step toward managing your child's disease. We encourage you to work closely with your child's asthma care team to learn all you can about asthma, how to avoid triggers, what medications do, and how to correctly give them. With proper care, your child can live free of asthma symptoms and maintain a normal, healthy lifestyle.

Will my child outgrow asthma?

Once a person's airways become sensitive, they remain that way for life. However, about half of children experience a noticeable decrease in asthma symptoms by the time they become adolescents, therefore appearing to have "outgrown" their asthma. However, about half of these children will develop symptoms again in their 30s and/or 40s. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life.

What do I do when my child has an asthma attack?

If your child is showing symptoms of an asthma attack:

  • Give your child his/her reliever medicine according to the asthma action plan.
  • Wait 5 to15 minutes. If the symptoms disappear, your child should be able to resume whatever activity he or she was doing. If symptoms persist, follow your child's asthma action plan for further therapy. If your child fails to improve or you are not sure what action to take, call your child's care provider.
  • Danger signs are severe wheezing, severe coughing, trouble walking and/or talking, or blue lips and/or fingernails. If any of these are present, go to the emergency department or call 911.

Children with asthma often have symptoms at school, so it is very important to get the school involved in caring for your child's asthma. This is true even if your child has only a mild case of asthma or if he or she does not need to take asthma medicines while at school.

Most schools have several children with asthma, so school nurses and many teachers are very familiar with helping children with asthma. Still, it is important to take steps to ensure that your child gets adequate attention and that all relevant school personnel are familiar with what is needed to help your child.

You can look at this in two ways: there are things you need to do to prevent your child from having an asthma attack at school, and there are things you need to do to make sure that your child gets the right treatment if an asthma attack occurs at school.

What can I do to prevent my child from having an asthma attack at school?

The most important thing is to talk to your child and, depending on how old he or she is, explain as much about the disease that your child will understand. Ideally, your child should also:

  • Keep track of when it is time to take the medicine.
  • Know how to use the inhaler properly.

School officials should know about your child's asthma, including:

  • How severe it is
  • What the triggers are
  • What medications to use and how to properly give them
  • What to do in case of an asthma attack

All of these things should be written up and a list should be distributed to every school official who may be caring for your child. If possible, you should try to arrange a meeting with the school officials and explain the triggers, severity, symptoms, and treatment of your child's asthma.

You should look at your child's classroom and other areas where he or she goes in school to see if there are any triggers. If you identify possible triggers for your child's asthma (dust mites and dust are common triggers in a classroom), you should work with the teacher to reduce your child's exposure to these triggers.

It is very important to provide the school nurse with all of your child's asthma medicines and the proper instructions. Remember that for some medicines, like inhalers, there is often no way to tell whether or not the inhaler still has medicine. You need to keep track of this and replace the medicines at school on a regular basis. Some of the newer inhaler devices have dose counters, and you will be able to tell when the medication needs to be refilled. Be sure to check every few months that the school is taking care of your child's asthma and that everyone involved understands your child's condition.

Here is a list of people at school who must be involved:

  • Class teacher: This is the adult who is most likely to be around if your child has an asthma attack at school. The more the class teacher knows and the more vigilant he or she is, the better the chances that your child will be properly helped. Sometimes, kids who have difficulty breathing do not perform as well in school, even though they do not have asthma attacks. The class teacher should look out for this.
  • School nurse: You must talk to the school nurse and get an idea of what the school policies are. If your school shares a school nurse with other schools, make an appointment to see the nurse when she is in the school and find out who will be in charge when the nurse is not around.
  • Art teacher, music teacher, or any other teacher who regularly spends time with your child.
  • Physical education (PE) teacher: The PE teacher has a special responsibility. In addition to spending time with your child like other teachers, the PE teacher should keep an extra eye on your child when he or she is exercising, since exercise can trigger asthma. Also, you should make sure that your child is not being left out because he or she has asthma. The PE teacher should encourage your child to participate as long as the asthma is under control.
  • Office staff, principal
  • Counselor: This is an important person to talk to, especially if your child has other problems, such as learning problems or problems dealing with other kids.
  • Substitute teachers: You should try to talk to substitute teachers yourself. The regular teachers should also inform substitute teachers about your child's condition. This is where a written set of instructions from you can be particularly valuable.

In addition to the above, the more teachers and other adults at school who know about your child's asthma, the better. Your child could have an asthma attack while at lunch or in the hallway; these are places where the class teacher may not be present.

What emergency instructions should I give the school?

The school should have a clear set of instructions (your care provider can help with this) about what symptoms it should look out for, and what treatment it should give. The school should have a clear idea of when to call your care provider and when to call 911.

You should make sure that the instruction sheet you hand out to all school officials has your doctor's phone number, your preferred hospital (emergency room), as well as contact numbers for you, other guardians for the child, and a trusted friend.

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