Asthma in Children

Determining whether a child has asthma can be difficult.

Asthma is typically diagnosed with a medical exam and a test that measures the airflow in and out of the lungs. Children who are of preschool age or younger may not be able to complete the airflow test, which requires blowing very hard into a tube. And since infants and toddlers can’t describe how they feel, parents, other family members and caregivers need to be alert for symptoms.

Tell your child’s pediatrician if anyone in your family has asthma or allergies, such as hay fever, hives or eczema. Both allergies and asthma run in families; if they run in yours, it’s more likely that your child will have them. If you have a family history of asthma or allergies, you may be referred to an allergist.

The allergist may perform skin or blood tests to see whether your child has allergies that can trigger asthma symptoms. These tests can be done at any age. The allergist also may prescribe one or more asthma medicines. If your child gets better while taking the medicine, it can be a signal that your child’s symptoms are due to asthma.

Asthma symptoms in children

Most children with asthma have symptoms before they turn 5. In very young children, it may be hard for parents, and even doctors, to recognize that the symptoms are due to asthma. The bronchial tubes in infants, toddlers and preschoolers are already small and narrow, and head colds, chest colds and other illnesses can inflame these airways, making them even smaller and more irritated.

The symptoms of pediatric asthma can range from a nagging cough that lingers for days or weeks to sudden and scary breathing emergencies. Common symptoms include:

  • Coughing, especially at night
  • A wheezing or whistling sound, especially when breathing out
  • Trouble breathing or fast breathing that causes the skin around the ribs or neck to pull in tightly
  • Frequent colds that settle in the chest

Your child might have only one of these symptoms, or several of them. You may think it’s just a cold or bronchitis. If the symptoms recur, that’s a clue that your child might have asthma. In addition, symptoms may worsen when your child is around asthma triggers, such as irritants in the air (smoke or strong odors, for example) or allergens like pollen, pet dander and dust mites.

Asthma Management and Treatment

Any asthma symptom, whether mild or severe, is always serious; even mild symptoms can quickly become life-threatening. Poorly controlled and undiagnosed asthma in small children can result in trips to the emergency room, hospital stays, missed workdays for parents and suffering that small children are unable to express. It’s very important for a child with asthma to receive proper treatment.

The treatment will depend on the severity and frequency of the symptoms. To deal with childhood asthma, the doctor may prescribe two types of medicines:

  • Any child who has asthma needs a bronchodilator (quick relief) medicine (such as albuterol) to treat the noisy part of the disease — the coughing, wheezing and shortness of breath that occur with symptoms or an asthma attack. This medicine (typically an inhaler) should be with the child at all times for use at the first sign of symptoms.
  • Anti-inflammatory medicine treats the quiet part of asthma — the inflammation of the airways. A long-term control medicine, it is taken daily to prevent asthma symptoms and attacks. The most effective anti-inflammatories for asthma are corticosteroids.

Your child can take both medicines using an aerosol inhaler (MDI, or metered-dose inhaler) with a device called a holding chamber (which helps to ensure that all the medication reaches the lungs) or through a nebulizer, a machine that includes compressor tubing and a mask to help deliver the medication. Your child’s doctor, nurse or pharmacist can teach you how to use both so you can determine what works best.

Asthma medicines are very safe and effective when used as directed. Some studies have suggested that continued use of corticosteroid medicines can slightly slow a child’s growth, but being able to breathe outweighs this risk.

If you think that your child might have asthma, speak to your pediatrician or to an allergist. An allergist can help you create an asthma action plan so that you know when your child’s asthma is under control, when you need to change medicines and when emergency help is needed. An asthma action plan should have goals for your child’s asthma treatment and health.

If medications don’t help, or your child can’t avoid asthma triggers, your allergist may recommend allergy shots (immunotherapy).

When Will My Child Outgrow Asthma?

This is one of the biggest myths about asthma. Asthma is a lifelong disease that cannot be “outgrown.” A child’s immune system changes throughout life and asthma symptoms will, too. However, the child will always have the potential to experience asthma symptoms and must be aware that they can return at any time.

Revised and reprinted with permission from the American College of Allergy, Asthma & Immunology

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