Childhood Asthma

Childhood Asthama

In childhood asthma, the lungs and airways become easily inflamed when exposed to certain triggers. Such triggers include inhaling pollen or catching a cold or other respiratory infection. Childhood asthma can cause irritating daily symptoms that interfere with play, sports, school and sleep. In some children, unmanaged asthma can cause dangerous asthma attacks.

Childhood asthma isn’t a different disease from asthma in adults, but children face unique challenges. The condition is a leading cause of emergency department visits, hospitalizations and missed school days.

Unfortunately, childhood asthma can’t be cured, and symptoms can continue into adulthood. But with the right treatment, you and your child can keep symptoms under control and prevent damage to growing lungs.

Symptoms

Common childhood asthma symptoms include:

  • A whistling or wheezing sound when breathing out.
  • Shortness of breath.
  • Chest congestion or tightness.
  • Frequent coughing that worsens when your child:
    • Has a viral infection.
    • Is sleeping.
    • Is exercising.
    • Is in the cold air.

Childhood asthma also might cause:

  • Trouble sleeping due to shortness of breath, coughing or wheezing.
  • Bouts of coughing or wheezing that get worse with a cold or the flu.
  • Delayed recovery or bronchitis after a respiratory infection.
  • Trouble breathing that hampers play or exercise.
  • Fatigue, which can be due to poor sleep.

Asthma symptoms vary from child to child and might get worse or better over time. Your child might have only one symptom, such as a lingering cough or chest congestion.

It can be difficult to tell whether your child’s symptoms are caused by asthma. Wheezing and other asthma-like symptoms can be caused by infectious bronchitis or another respiratory problem.

When to see a doctor

Take your child to see a health care provider if you suspect that your child has asthma. Early treatment will help control symptoms and possibly prevent asthma attacks.

Make an appointment with your child’s provider if you notice:

  • Coughing that is constant, is intermittent or seems linked to physical activity.
  • Wheezing or whistling sounds when your child breathes out.
  • Shortness of breath or rapid breathing.
  • Complaints of chest tightness.
  • Repeated episodes of suspected bronchitis or pneumonia.

Children who have asthma may say things such as, “My chest feels funny” or “I’m always coughing.” Listen for coughing in children, which might not wake them, when they are asleep. Crying, laughing, yelling, or strong emotional reactions and stress also might trigger coughing or wheezing.

If your child is diagnosed with asthma, creating an asthma plan can help you and other caregivers monitor symptoms and know what to do if an asthma attack occurs.

When to seek emergency treatment

In severe cases, you might see your child’s chest and sides pulling inward when breathing is difficult. Your child might have an increased heartbeat, sweating and chest pain. Seek emergency care if your child:

  • Has to stop in midsentence to take a breath.
  • Is using abdominal muscles to breathe.
  • Has widened nostrils when breathing in.
  • Is trying so hard to breathe that the abdomen is sucked under the ribs during a breath.

Even if your child hasn’t been diagnosed with asthma, seek medical attention immediately if you notice troubled breathing. Although episodes of asthma vary in severity, asthma attacks can start with coughing, which progresses to wheezing and labored breathing.

Causes

Childhood asthma causes aren’t fully understood. Some factors thought to be involved include having:

  • A tendency to develop allergies that runs in the family.
  • Parents with asthma.
  • Some types of airway infections at a very young age.
  • Exposure to environmental factors, such as cigarette smoke or other air pollution.

Increased immune system sensitivity causes the lungs and airways to swell and produce mucus when exposed to certain triggers. Reaction to a trigger can be delayed, making it more difficult to identify the trigger. Triggers vary from child to child and can include:

  • Viral infections such as the common cold.
  • Exposure to air pollutants, such as tobacco smoke.
  • Allergies to dust mites, pet dander, pollen or mold.
  • Physical activity.
  • Weather changes or cold air.

Sometimes, asthma symptoms occur with no apparent triggers.

Risk factors

Factors that might increase your child’s chance of developing asthma include:

  • Exposure to tobacco smoke, including before birth.
  • Previous allergic reactions, including skin reactions, food allergies or hay fever, also called allergic rhinitis.
  • A family history of asthma or allergies.
  • Living in an area with high pollution.
  • Obesity.
  • Respiratory conditions, such as a chronic runny or stuffy nose, inflamed sinuses, or pneumonia.
  • Gastroesophageal reflux disease (GERD)
  • Being male.
  • Being Black or Puerto Rican.

Complications

Asthma can cause a number of complications, including:

  • Severe asthma attacks that require emergency treatment or hospital care.
  • Permanent decline in lung function.
  • Missed school days or falling behind in schoolwork.
  • Poor sleep and fatigue.
  • Symptoms that interfere with play, sports or other activities.

Prevention

Careful planning and avoiding asthma triggers are the best ways to prevent asthma attacks.

  • Limit exposure to asthma triggers. Help your child avoid the allergens and irritants that trigger asthma symptoms.
  • Don’t allow smoking around your child. Exposure to tobacco smoke during infancy is a strong risk factor for childhood asthma, as well as a common trigger of asthma attacks.
  • Encourage your child to be active. As long as your child’s asthma is well controlled, regular physical activity can help the lungs work more efficiently.

  • See your child’s health care provider when necessary. Check in regularly. Don’t ignore signs that your child’s asthma might not be under control, such as needing to use a quick-relief inhaler too often.

    Asthma changes over time. Consulting your child’s provider can help you make needed treatment adjustments to control symptoms.

  • Help your child maintain a healthy weight. Being overweight can worsen asthma symptoms, and it puts your child at risk of other health problems.
  • Keep heartburn under control. Acid reflux or severe heartburn might worsen your child’s asthma symptoms. To control acid reflux, your child may need prescription medicines or medicines you can buy off the shelf.

Diagnosis

Asthma can be hard to diagnose. Your child’s health care provider considers the symptoms and their frequency and your child’s medical history. Your child might need tests to rule out other conditions and to identify the most likely cause of the symptoms.

A number of childhood conditions can have symptoms similar to those caused by asthma. To complicate the diagnosis further, these conditions also commonly occur with asthma. So your child’s provider will have to determine whether your child’s symptoms are caused by asthma, a condition other than asthma, or both asthma and another condition.

Conditions that can cause asthma-like symptoms include:

  • Rhinitis.
  • Sinusitis.
  • Acid reflux or gastroesophageal reflux disease (GERD).
  • Airway problems.
  • Dysfunctional breathing.
  • Respiratory tract infections such as bronchiolitis and respiratory syncytial virus (RSV).

Your child may need the following tests:

  • Lung function tests, also called spirometry. Health care providers diagnose asthma in children with the same tests used to identify the disease in adults. Spirometry measures how much air your child can exhale and how quickly. Your child might have lung function tests at rest, after exercising and after taking asthma medicine.

    Another lung function test is brochoprovocation. Using spirometry, this test measures how the lungs react to certain provocations, such as exercise or exposure to cold air.

  • Exhaled nitric oxide test. If the diagnosis of asthma is uncertain after lung function tests, your health care provider might recommend measuring the level of nitric oxide in an exhaled sample of your child’s breath. Nitric oxide testing also can help determine whether steroid medicines might be helpful for your child’s asthma.

These asthma tests aren’t accurate before 5 years of age, however. For younger children, your provider will rely on information you and your child provide about symptoms. Sometimes a diagnosis can’t be made until later, after months or even years of observing symptoms.

Allergy tests for allergic asthma

If your child seems to have asthma that’s triggered by allergies, the health care provider might recommend allergy skin testing. During a skin test, the skin is pricked with extracts of common allergy-causing substances, such as animal dander, mold or dust mites, and observed for signs of an allergic reaction.

 

Treatment

Initial treatment depends on the severity of your child’s asthma. The goal of asthma treatment is to keep symptoms under control, meaning that your child has:

  • Minimal or no symptoms.
  • Few or no asthma flare-ups.
  • No limitations on physical activities or exercise.
  • Minimal use of quick-relief inhalers, such as albuterol (ProAir HFA, Ventolin HFA, others). These also are called rescue inhalers.
  • Few or no side effects from medicines.

Treating asthma involves both preventing symptoms and treating an asthma attack in progress. The right medicine for your child depends on a few things, including:

  • Age.
  • Symptoms.
  • Asthma triggers.
  • What seems to work best to keep your child’s asthma under control.

For children younger than age 3 who have mild symptoms of asthma, your provider might use a wait-and-see approach. This is because the long-term effects of asthma medicine in infants and young children aren’t clear.

However, if an infant or toddler has frequent or severe wheezing episodes, a health care provider might prescribe a medicine to see if it improves symptoms.

Self care

Taking steps to reduce your child’s exposure to asthma triggers will lessen the possibility of asthma attacks. Steps to help avoid triggers vary depending on what triggers your child’s asthma. Here are some things that may help:

  • Maintain low humidity at home. If you live in a damp climate, talk to your child’s doctor about using a device to keep the air drier, called a dehumidifier.
  • Keep indoor air clean. Have a heating and air conditioning professional check your air conditioning system every year. Change the filters in your furnace and air conditioner according to the manufacturer’s instructions. Also consider installing a small-particle filter in your ventilation system.
  • Reduce pet dander. If your child is allergic to dander, it’s best to avoid pets with fur or feathers. If you have pets, regularly bathing or grooming them also might reduce the amount of dander. Keep pets out of your child’s room.
  • Use your air conditioner. Air conditioning helps reduce the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your child’s exposure to dust mites. If you don’t have air conditioning, try to keep your windows closed during pollen season.
  • Keep dust to a minimum. Reduce dust that can aggravate nighttime symptoms by adjusting certain items in your child’s bedroom. For example, encase pillows, mattresses and box springs in dustproof covers. Consider removing carpeting and installing hard flooring in your home, particularly in your child’s bedroom. Use washable curtains and blinds.
  • Clean regularly. Clean your home at least once a week to remove dust and allergens.
  • Reduce your child’s exposure to cold air. If your child’s asthma is worsened by cold, dry air, wearing a face mask outside can help.