How Can I Tell if my Child Has Asthma?
Not all children have the same asthma symptoms, and these symptoms can vary from episode to episode in the same child. Possible signs and symptoms of asthma in children include:
- Frequent coughing spells, which may occur during play, at night, or while laughing or crying
- A chronic cough (which may be the only symptom)
- Less energy during play
- Rapid breathing (intermittently)
- Complaint of chest tightness or chest "hurting"
- Whistling sound when breathing in or out -- called wheezing.
- See-saw motions in the chest from labored breathing. These motions are called retractions.
- Shortness of breath, loss of breath
- Tightened neck and chest muscles
- Feelings of weakness or tiredness
While these are some symptoms of asthma in children, your child's doctor should evaluate any illness that complicates your child's breathing. Many pediatricians use terms like "reactive airways disease" or bronchiolitis when describing episodes of wheezing with shortness of breath or cough in infants and toddlers (even though these illnesses usually respond to asthma medications). Tests to confirm asthma may not be accurate until after age 5.
How Common Is Asthma in Children?
Asthma is the leading cause of chronic illness in children. It affects about 7 million children in the United States and, for unknown reasons, is steadily increasing. Asthma can begin at any age (even in the very elderly), but most children have their first symptoms by age 5.
There are many risk factors for developing childhood asthma. These include:
- Nasal allergies (hay fever) or eczema (allergic skin rash)
- A family history of asthma or allergies
- Frequent respiratory infections
- Low birth weight
- Exposure to tobacco smoke before or after birth
- Black or Puerto-Rican ethnicity
- Being raised in a low-income environment
Why Is the Rate of Asthma in Children Increasing?
No one really knows the exact reasons why more and more children are developing asthma. Some experts suggest that children spend too much time indoors and are exposed to more and more dust, air pollution, and secondhand smoke. Some suspect that children are not exposed to enough childhood illnesses to direct the attention of their immune system to bacteria and viruses.
How Is Asthma Diagnosed in Children?
Asthma in children can often be diagnosed based on medical history, symptoms, and a physical exam. Keep in mind that oftentimes when you take your infant or older child to the doctor with asthma symptoms, the symptoms may be gone by the time the doctor evaluates the child. That's why parents are key in helping the doctor understand the child's signs and symptoms of asthma.
- Medical history and asthma symptom description: Your child's doctor will be interested in any history of breathing problems you or 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 exam, the doctor will listen to your child's heart and lungs and look for signs of an allergic nose or eyes.
- Tests: Many children will also have a chest X-ray and, for those ages 6 and older, a simple lung function test called spirometry. Spirometry measures 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. Other tests may also be ordered to help identify particular "asthma triggers" for your child's asthma. These tests may include allergy skin testing, blood tests (IgE or RAST), and X-rays to determine if sinus infections or gastroesophageal reflux disease (GERD) are complicating asthma. An asthma test that measures the amount of nitric oxide in the breath (eNO) is available in some places.
How Is Asthma Treated in Children?
Avoiding triggers, using medications, and keeping an eye on daily asthma symptoms are the ways to control asthma in children of all ages. Children with asthma should always be kept away from all sources of smoke. Proper use of medication is the basis of good asthma control.
Based on your child's history and the severity of asthma, his or her doctor will develop an Asthma Action Plan and give you a written copy. This plan describes when and how your child should use asthma drugs, what to do when asthma gets worse (falls into the yellow or red zones), 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 written Asthma Action Plan is important to the successful control of 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. Also make sure your child's caregiver and school teacher has a copy of the Asthma Action Plan, so they will know how to treat the child's symptoms if she should have an asthma attack away from home.
For more information and for a printable asthma action plan, see WebMD's article on Developing an Asthma Action Plan.
How Do I Give Asthma Drugs if my Child Is a Toddler?
Infants and toddlers may use some of the same type of asthma drugs as older children and adults. Inhaled steroids may be key to managing infants with chronic asthma or wheezing. However, the medications are given differently to children under 4 years of age (such as with an asthma nebulizer and mask), and with lower daily doses.
The latest asthma guidelines recommend a stepwise approach for managing asthma in children up to 4 years of age. This includes the use of quick-relief medications (such as albuterol) for intermittent asthma symptoms. A low-dose of an inhaled steroid, cromolyn, or Singulair is the next step up. Then the intensity of the asthma treatment is focused on controlling their asthma. If the child's asthma is controlled for at least three months, your child's doctor may decrease the medication or "step down" the asthma treatment. Consult with your asthma specialist for exact medications and dosages.
Depending on your young child's age, you may use inhaled asthma drugs or liquid medications delivered with an asthma nebulizer. A nebulizer delivers asthma medications by changing them from a liquid to a mist. As a mist, your child will breathe the medications through a face mask. These breathing treatments usually take about 10-15 minutes and may be given up to four times a day. Your child's doctor will tell you how often to give your child breathing treatments.
Depending on their age, 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. This allows your child to breathe the medication into his lungs at his own pace. Talk with your child's doctor about your child using an MDI with a spacer.
What Are the Goals of Treating my Child's Asthma?
Asthma can't be cured, but it can be controlled. The goals of asthma treatment for your child are listed below. If your child is unable to achieve all of these goals, you should contact your child's doctor for advice. Your child should be able to:
- Live an active, normal life
- Prevent chronic and troublesome symptoms
- Attend school every day
- Avoid asthma symptoms during the night
- Perform daily activities, play, and engage in sports without difficulty
- Stop the need for urgent visits to the doctor, emergency department, or hospital
- Use and adjust medications to control asthma with little or no side effects
By learning about asthma and how it can be controlled, you take an important step toward managing your child's disease. Work closely with your child's asthma care team to learn all you can about asthma, how to avoid asthma triggers, what asthma drugs do, and how to correctly give asthma treatments.
Will My Child Outgrow Asthma?
So much is unknown about infant lung function and asthma. Experts believe that a child is more likely to be diagnosed with asthma after the age of 7, however, if he has had multiple wheezing episodes, has a mother with asthma, or has allergies.
In addition, once a person's airways become sensitive, they remain that way for life. However, about 50% of children experience a noticeable decrease in asthma symptoms by the time they become adolescents, therefore appearing to have "outgrown" their asthma. Some of these children will develop asthma symptoms again as adults. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life.