Asthma in Children (Childhood Asthma)

What Is Childhood Asthma?

Childhood asthma is the same disease adults get, but it affects children differently. Your little one’s lungs and airways can easily get inflamed when they’re exposed to things like pollen or a cold. The symptoms may only make it hard for your child to play outside, take part in sports, or sleep. But sometimes they can cause dangerous asthma attacks that result in a trip to the hospital. Childhood asthma isn’t curable, but you can work with your child’s doctor to treat it and prevent damage to their growing lungs.

Signs and Symptoms of Asthma in Kids

Not all children have the same asthma symptoms, and they can vary from episode to episode in the same child. Possible signs and symptoms of asthma in children include:

  • Frequent coughing spells, which can happen during play, at night, or while laughing or crying
  • A chronic cough (which may be the only symptom)
  • Less energy during play
  • Rapid breathing (from time to time)
  • Complaint of chest tightness or chest hurting
  • Wheezing -- a whistling sound when breathing in or out
  • Retractions -- seesaw motions in the chest from labored breathing
  • Shortness of breath, loss of breath
  • Tightened neck and chest muscles
  • Feeling weak or tired

While these are some signs, your child's doctor should check out any illness that makes it hard for her to breathe. A doctor might 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.

Causes and Triggers of Childhood Asthma

Common triggers include:

  • Airway infections: Colds, pneumonia, sinus infections
  • Allergens: Things your child is allergic to, like cockroaches, dust mites, mold, pet dander, pollen
  • Irritants: Things that bother the airways like air pollution, chemicals, cold air, odors, smoke
  • Exercise: It can lead to wheezing, coughing, and a tight chest.
  • Stress: It can make your child feel short of breath and worsen their symptoms.

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How Is Asthma Diagnosed in Children?

By the time you get your child into the doctor’s office, her asthma symptoms may be gone. That means you are key in helping the doctor understand what’s going on. When you see the doctor, you can expect:

  • Questions about medical history and asthma symptoms: The doctor will ask about any history of breathing problems you or your child may have had, as well as any family history of asthma, allergies, a skin condition called eczema, or other lung disease. It’s important that you describe your child's symptoms -- coughing, wheezing, shortness of breath, chest pain, or tightness -- in detail, including when and how often they happen.
  • 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: Your child might get a chest X-ray. If she’s 6 or older, she may take a simple test to see how well her lungs work called spirometry. It measures the amount of air in her lungs and how fast she can blow it out. This helps the doctor find out how severe her asthma is. Other tests can help find her asthma triggers. They may include allergy skin testing, blood tests (IgE or RAST), and X-rays to find out if sinus infections or gastroesophageal reflux disease (GERD) is making her asthma worse. A test that measures the level of nitric oxide (eNO) in her breath can also point to inflamed airways.

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 elderly), but most children have their first symptoms by age 5.

Many things can make childhood asthma more likely:

  • 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

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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. Keep them away from all sources of smoke.

There are two main types of asthma medications:

  • Quick-relief medications help with sudden symptoms. Your child will take them for fast help during an asthma attack.
  • Long-acting medications work to prevent airway inflammation and keep your child’s asthma under control. Your child will probably take them every day.

Based on your child's history and how bad her asthma is, her doctor will come up with an asthma action plan and give you a written copy. This plan describes when and how she should use asthma drugs, what to do when asthma gets worse, and when to seek emergency care. Make sure you understand this plan and ask the doctor any questions you may have.

Your child's written asthma action plan is key to controlling her asthma. Keep it handy to remind you of the daily management plan and as a guide when she gets asthma symptoms. Make sure her caregivers and teachers have copies so they’ll know how to treat her symptoms if she has an asthma attack away from home.

Note that many of these medications contain steroids, which have side effects. They can irritate your child’s mouth and throat in the short term. Over a long period, they may stunt growth and lead to a bone problem like osteoporosis, reduced blood supply to the bones, and cataracts. They might make your child’s body less able to make natural steroids. But untreated asthma can lead to hospital visits, so you and your doctor should weigh the pros and cons when creating an asthma action plan.

When to Go to the ER

Your child needs emergency care for a severe asthma attack. Watch for these signs:

  • Stopping in midsentence to catch a breath
  • Using their stomach muscles to breathe
  • Their abdomen sinks in under their ribs when they try to get air.
  • Their chest and side pull in as they breathe.
  • Their nostrils widen.
  • Their heartbeat races
  • They sweat.
  • They have chest pain.

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How Do I Give Asthma Drugs to a Toddler?

Infants and toddlers may use some of the same types of asthma drugs as older children and adults. Inhaled steroids can be key to managing infants with chronic asthma or wheezing.

Children under 4 may get lower doses and take their medications through an asthma nebulizer. This device changes the medicine from a liquid to a mist that your child breathes in through a face mask. The doctor will tell you how often to give these breathing treatments, but it’s usually up to four times a day, about 10-15 minutes at a time. To use the nebulizer:

  • Wash your hands.
  • Place the medicine in the nebulizer.
  • Connect the tubes from the compressor to the base.
  • Attach the mouthpiece.
  • Turn the compressor on and look for a light mist to come from the nebulizer.
  • Put the mouthpiece in your child’s mouth and have them close their lips around it.
  • Have them breathe in until their treatment time is up.
  • Turn the nebulizer off when the medicine is gone.
  • Have your child cough to clear any mucus.

The latest asthma guidelines have steps for managing asthma in children up to age 4. This includes the use of quick-relief medications (like albuterol) for off-and-on asthma symptoms. A low dose of an inhaled steroid, cromolyn, or Singulair is the next step up. Then the focus shifts from symptom control to disease management. If you can control her asthma for at least 3 months, the doctor may lower, or step down, her asthma treatment. He’ll talk to you about exact medications and dosages.

Younger children will probably take inhaled asthma drugs or liquid medications with a nebulizer. Older kids 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 lets your child breathe the medication into her lungs at her own pace. To use an inhaler with a spacer:

  • Wash your hands.
  • Prime the inhaler the first time you use it by spraying it 4 times into the air.
  • Put the inhaler into the opening at the end of the spacer.
  • Shake it for 10 seconds.
  • Have your child turn their head to the side and breathe out.
  • Have them close their mouth around the mouthpiece of the spacer.
  • Tell them to take a slow deep breath.
  • Make them hold it in and count to 10.
  • Have them slowly breathe out.
  • If your doctor prescribes two puffs of medicine, wait 1 minute after the first puff, then do it all again.
  • Help them rise their mouth, brush their teeth, or get a drink of water.

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What Are the Goals of Treating My Child's Asthma?

Asthma can't be cured, but it can be controlled. If your child can’t meet all of these goals, contact her doctor for advice. She should be able to:

  • Live an active, normal life
  • Prevent chronic and troublesome symptoms
  • Attend school every day
  • Avoid asthma symptoms during the night
  • Do 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 to control it, you take an important step toward managing your child's disease. Work closely with her 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?

Much is unknown about infant lung function and asthma. But experts believe that a child is more likely to be diagnosed with asthma after the age of 7 if she’s had multiple wheezing episodes, has a mother with asthma, or has allergies.

Also, once her airways become sensitive, they remain that way for life. But about 50% of children see a sharp drop in asthma symptoms once they reach their teens. It may seem they’ve outgrown their asthma, but some will have symptoms again as adults. Unfortunately, there’s no way to predict who will be affected.

Why Is Childhood Asthma on the Rise?

No one really knows the exact reasons why more and more children are getting asthma. Some experts suggest that children spend too much time indoors with dust, air pollution, and secondhand smoke. Others say kids aren’t exposed to enough childhood illnesses to help their immune systems learn to fight bacteria and viruses.

WebMD Medical Reference Reviewed by Dan Brennan, MD on September 03, 2019

Sources

SOURCES: 

Allergy & Asthma Network: Mothers of Asthmatics: "School House: Keeping Healthy at School." 

American Academy of Allergy, Asthma & Immunology: "Tips to remember: Childhood asthma," “Childhood Asthma.”

American Lung Association: "Asthma." 

Allergy & Asthma Network: Mothers of Asthmatics: "Off to School with Confidence."

Asthma and Allergy Foundation of America: "Asthma in Infants."

Mayo Clinic: “Nitric oxide test for asthma,” “Childhood asthma.”

American Academy of Pediatrics: “Asthma Triggers and What to do About Them.”

Cleveland Clinic: “Home Nebulizer,” “Stress and Asthma.”

The Children’s Hospital of Philadelphia: “Safety of Steroids for Asthma.”

Nationwide Children’s Hospital: “How to Use an Inhaler with a Spacer and Mouthpiece.”

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