Also called: Chronic Asthma & Children, Pediatric Asthma
Childhood asthma is among the most serious and widespread health risks afflicting children today. It is the third leading cause of hospitalization among children under the age of 15 in the United States and is the leading cause of chronic illness among children. Asthma symptoms include shortness of breath, chest tightness, coughing and wheezing.
There is no cure for asthma, but once diagnosed, it is highly treatable. Various drugs can help prevent asthma attacks, or treat them once they have begun. Physicians can also develop an asthma action plan, which allows parents to track their child’s breathing capacity and to spot when urgent medical attention might be necessary.
If a child experiences breathing problems, it is important to have the condition accurately diagnosed by a healthcare professional. The majority of asthma-related fatalities in children occur because action is delayed until long after symptoms of the disease first appear. However, fatal attacks can still occur in mild asthmatics in only a few minutes. Parents and children should take an asthma condition seriously.
The vast majority of children who develop asthma do so by age 5, and premature infants are particularly at risk. Asthma can never be cured, but symptoms may subside in some children as they grow older, while others see their symptoms progress well into adulthood. Proper diagnosis and treatment allows millions of children with asthma to live full, active lives.
About child asthma
Asthma is a bronchial condition in which airways may be chronically inflamed, even when symptoms do not appear. When the asthmatic inhales an allergen or irritant, further inflammation may occur and conditions are ripe for an asthma attack.
During an asthma attack, the smooth muscles of the bronchi (the body’s airway tubes) begin to spasm. The mast cells (a type of white blood cell) in the tissue of a child’s air passages react by producing histamine, leukotrienes and other chemicals that inflame the tissues. As these tissues swell, they produce excess mucus. This mucus fills the airway and combines with the inflammation to constrict breathing (bronchoconstriction), trapping air in the lungs.
A child suffering through an asthma attack may appear to be gasping for breath. But in fact, asthmatics have trouble breathing because their lungs are overinflated. They cannot easily exhale the air trapped in their lungs because their airways are constricted due to the inflammation and extra mucus produced. Uncontrolled, asthma can lead to other lung-related complications, such as bronchitis and pneumonia.
Asthma is the third leading cause of hospitalization among children under the age of 15 in the United States and is the leading cause of chronic illness among children. During an asthma attack, a child may experience chest tightness, coughing, wheezing and difficulty breathing. In severe cases, where breathing becomes very difficult and low blood oxygen levels are recorded, asthma attacks can be fatal.
Asthma in children falls into the same four levels of severity as with adults:
- Mild intermittent. Symptoms appear up to two days a week and two nights a month.
- Mild persistent. Symptoms appear more than two nights a month and more than twice a week, but not more than once in a single day.
- Moderate persistent. Symptoms occur every day and more than one night a week.
- Severe persistent. Symptoms occur continuously throughout the day and frequently at night.
Asthma can be especially dangerous for infants, as their lungs do not yet function efficiently enough to cope with an asthma attack. It is important to follow a physician’s asthma control plan (a physician-approved roadmap for monitoring a child’s asthma) at the first sign of an asthma attack in an infant.
Those with infants experiencing an attack should NOT do any of the following:
- Never give an infant large volumes of liquids. Instead, normal amounts should be given.
- Do not allow an infant to breathe warm, moist air from the shower or another source.
- Do not have an infant breathe into a bag held tightly over the nose and mouth.
- Never give an infant over-the-counter antihistamines or cold remedies.
There is no cure for asthma. Once a person’s airways show a tendency towards asthma, the airways will continue to show the tendency and ability to constrict for a lifetime – even during periods when inflammation is not present. Up to half of all children who experience asthma symptoms see them disappear in their teen years. However, 50 percent of those individuals will see symptoms reappear in their 30s or 40s. The reasons behind these changes are not understood. Though some outgrow their symptoms, many children with asthma will see their symptoms increase through their teen years and beyond. Proper diagnosis and treatment allows those with asthma to live full lives.
Potential causes of child asthma
The source of asthma is not fully understood. Healthcare professionals believe a combination of genetic and environmental factors determine whether or not a child becomes asthmatic. A child has a much greater chance of developing asthma when one or both parents have the condition.
Most experts believe that all cases of asthma develop in the first few years of life. However, although symptoms will often begin in infancy or childhood, sometimes they do not appear until adulthood. Several immune system theories have emerged on why more children than ever before are being diagnosed with asthma. One theory is that children are less exposed to certain types of bacteria and infections than in the past. Because of this lack of exposure, they do not develop the right types of immune cells to fight off potential infections.
To make up for this lack of immune cells, other types of immune cells (called TH2 cells) are produced. TH2 cells have been called the allergy cells, because they produce a specific type of antibody called IgE that causes both allergies and asthma attacks. Allergies and asthma are closely related; about 70 percent of people who have asthma also suffer from allergies.
Premature infants have a fourfold risk of developing asthma. Babies who have been exposed to cigarette smoke while in utero are also at increased risk.
Children with asthma are more likely to experience symptoms or full-blown asthma attacks when exposed to certain allergens and other factors classified as asthma triggers. These include:
- Air pollution
- Pet dander
- Viral respiratory infections (e.g., colds, flu, bronchitis)
- Tobacco smoke
- Certain foods
- Aspirin or ibuprofen
- Cold air
- Temperature changes
- Perfumes and strong fragrances
- Emotional stress
- Sinus infections
- Sulfites (a preservative in salad bars, dehydrated soups, alcohol and other foods)
According to the National Institutes of Health, children who live in the inner city have disproportionately high rates of asthma. The cause of this is not completely understood, but contributing factors may include increased exposure to allergens, such as dust mites and cockroach debris, poor air quality and poor diet. It is known that these conditions can trigger symptoms in people with asthma. But whether such conditions may actually foster asthma itself has not been determined.
Signs and symptoms of child asthma
Most experts now believe that asthma develops in an individual within the first few years of life. These symptoms sometimes can be observed during infancy, but there are other cases where asthma does not make its presence known until later in childhood or even into adulthood.
Signs of childhood asthma differ depending on the age of the patient. Signs in infants may include:
- Noisy breathing
- Breathing increases to more than 40 breaths per minute during sleep
- Feeding or suckling ceases
- Chest size appears to expand
- Nostrils flare
- Skin is pulled tight between an infant’s ribs
- Face turns pale or red; fingernails turn bluish
- Lethargy or decrease in responsiveness
- Lack of interest in normal or favorite activities
- Frequent respiratory infections
- Changes in the sound of the child’s cry (e.g., softer than usual)
Children with asthma may exhibit several signs of the disease, or may suffer through just one symptom, such as a chronic cough. Signs and symptoms of asthma in children may include:
- Regular coughing
- Chest pain or tightness
- Less energy while playing
- Shortness of breath
- Rapid breathing
- Chin or throat itchiness
- Dark circles beneath the eyes
- Frequent respiratory infections
- Lack of interest in normal or favorite activities
It is important to note that coughing related to asthma will often occur at night or during sleep, after vigorous physical activity (e.g., running) and with emotional outbursts (e.g., laughing, crying).
Parents with children who are experiencing any of the signs or symptoms of asthma should consult a physician.
Diagnosis methods for child asthma
A physician is likely to use several methods to diagnose whether or not a child has asthma. A child’s medical history – including prior breathing problems, allergies or skin conditions – may offer important clues. A family history of asthma, allergies or eczema also indicates an increased risk for child asthma.
A complete physical examination also may uncover evidence of asthma. Diagnostic tests that measure a child’s airflow are the primary means of uncovering asthma. These are the same tests used in adults and include pulmonary function tests and spirometry. A chest x-ray may also be used to detect air trapped in the lungs or rule out other conditions and diseases known to cause symptoms similar to asthma.
Since young patients often have difficulty following the instructions given during lung testing, children under the age of 5 cannot usually perform lung function tests. Instead, a physician will often base an asthma diagnosis on the patient’s signs and symptoms, as well as the information collected from a medical history and physical examination. The physician may prescribe a bronchodilator for the child and confirm the diagnosis if the child’s signs and symptoms improve with its use.
Blood testing may be recommended in some children to detect antibodies associated with asthma and allergic reactions. Infants who do not exhibit signs of asthma but nonetheless register elevated levels of immunoglobulin E (IgE) may be at greater risk for developing asthma later in life.
Parents can also play a vital role in the ongoing diagnosis of their child’s asthma by using a peak flow meter. This device measures the amount of air flowing into and out of a child’s lungs. By using it every day, parents can detect changes in a child’s breathing capacity before the condition manifests itself in asthma symptoms. Peak flow meters can also help a parent determine the severity of an asthma attack once it has begun.
Treatment options for child asthma
Once a child has been diagnosed with asthma, a physician will develop an asthma action plan to help parents monitor the condition so they know when medical care is required. A typical plan will contain the following elements:
- A list of specific symptoms that often precede a child’s asthma attacks
- Steps to take during an attack
- How to recognize a serious attack, and what to do about it
- How to recognize an emergency
- A plan for addressing any asthma-related complications that may arise while a child is at school or participating in athletics
Treatment of asthma in children, as well as adults, has two main goals: prevent or reduce inflammation and relax the smooth muscles that tighten during bronchospasm. A number of medications may be used for this purpose and their use is similar in children as with adults. Asthma medications fall into two categories:
- Quick-relief medications. These are designed to instantly relieve the symptoms of an asthma attack.
- Long-term-control medications. These are designed to minimize inflammation and prevent asthma flare-ups before they occur.
Asthma medications can be delivered either in pill form, liquid form or through an inhaler or nebulizer, which allows the drug to travel directly to the bronchial tubes while minimizing the effect on the rest of the body.
However, some children feel stigmatized by having to carry and use an inhaler as part of their regular therapy. Parents need to patiently explain the benefits of these medications and the importance of using them regularly. It might help to point out that many celebrities, including movie stars and athletes use inhalers to treat their own asthma. For more information, see Tips for parents.
Bronchodilators are the primary class of medications used to treat acute asthma in children and adults. These widen a person’s airways by relaxing the bronchial smooth muscle. Other asthma medications prevent attacks and include corticosteroids, mast cell stabilizers and leukotriene modifiers.
Inhaled steroid nasal sprays are commonly prescribed as an effective treatment for the inflammation associated with childhood asthma – though corticosteroids do not treat the asthma condition itself, as bronchodilators do. Many parents are concerned about inhaled corticosteroids because they appear to affect growth rates. However, research has found that low to moderate doses of the drug do not affect a child’s ultimate height. Parents who are concerned should speak with the child’s physician regarding inhaled corticosteroids.
It is important to maintain regular checkups so a physician can track the progress of the condition. The frequency of checkups depends upon the child’s asthma diagnosis:
- Mild intermittent or mild persistent asthma (symptoms occurring twice a week or less [mild intermittent] or more than twice a week, but not daily [mild persistent]) – every six to 12 months
- Moderate persistent asthma (daily symptoms) – every three to four months
- Severe persistent asthma (continual symptoms) – every one to two months
When asthma is managed properly, children with the condition can lead full, active lives. They will not have asthma-related absences from school and should be able to fully participate in school activities, including athletics.
Tips for parents of children with asthma
Research suggests that breastfeeding infants for at least the first four months may offer some protection against asthma during early childhood. However, this protection may last only as long as the mother continues to breast-feed. If the mother is asthmatic, it is possible the child may have a higher chance of developing asthma later in life. Even so, medical professionals recommend breast-feeding because of the proven benefits it offers over formula feeding.
Although asthma is a condition that affects all age groups, child asthma brings with it special concerns that parents and healthcare workers need to address. Asthma can be frightening for children who may not understand what is happening to their body. Parents should be honest with children about what is taking place, and willing to answer questions that may arise. Anxiety is a major trigger for asthma attacks, particularly in children. Informed and supported children are likely to be less anxious about their condition.
It is also important for parents to stay calm and reassuring during an asthma attack. A child who senses panic in their parent is more likely to feel anxious themselves. This can lead to a worsening of symptoms.
In addition, there are several things that parents can do to reduce the frequency of asthma attacks in their children. These include:
- Reduce the child’s exposure to environmental triggers, such as pollens, secondhand tobacco smoke and animal dander.
- Encourage a healthy lifestyle that includes proper rest, good nutrition and regular exercise.
- Make sure children take their asthma medications.
- Combat obesity in children. For reasons not fully understood, there appears to be a correlation between obesity and increased incidence of asthma.
Experts also stress the importance of continuity in asthma treatment. Research shows that children who see the same healthcare provider over long periods of time are less likely to be hospitalized or to need emergency treatment for their asthma. Children who see the same physician are likely to develop a bond of trust. This makes them less anxious about their asthma, and more likely to follow their physician’s treatment plan.
A child’s asthma symptoms travel with them, so parents need to work with their school or childcare facility in setting up a framework to address the child’s asthma-related needs away from home. Whether for a child’s school, day care, camp or even a friend’s home, parents are encouraged t
- Talk to responsible adults about their child’s asthma, including its severity, likely triggers, symptoms, medications and how best to address a problem should one occur. Asthma action plans should also be handed out so this information can easily be found on paper.
- Document this information in writing and make sure officials have it on file.
- Make sure the child, if old enough, is also aware of this information and can communicate it to others if needed.
- Visit the classroom or other environment to look for possible triggers that may be lurking.
- Make sure the environment has a peak flow meter and adults who understand how it works.
- Make sure asthma medications are labeled and confirm that teachers or other responsible adults know how to properly use them.
- Set clear guidelines regarding when it is necessary to call for emergency care, and provide emergency contact numbers.
- Repeat this process every few months, both verbally and in writing, to update information and address any changes.
Starting back at school in the fall is a particularly vulnerable time for children with asthma. Respiratory infections are more common at this time of year and a child may be more prone to these when they are exposed to other children in a tight classroom. In addition, the rapid changes in temperature that occur in the fall in large portions of the country can trigger asthma. Exposure to stress and indoor irritants may also play a role. It is important that parents help their children to carefully follow all preventive regimens at this time of year to limit their vulnerability.
Exercise-induced asthma is a common problem for child asthmatics. As the child exercises and breathes intensely, water is lost in the lungs. This leads to cooling of the lung lining, constriction of airway muscles and breathing difficulties. Exercise-induced asthma is most likely to flare during cold, dry weather, with most symptoms peaking within 15 minutes after exercise has finished. However, symptoms sometimes appear hours after activity.
It is important to inform coaches or other activity leaders about a child’s asthma. Although exercise can trigger an asthma attack, the benefits usually outweigh the risks. Higher levels of fitness may actually reduce the likelihood of an attack occurring. Long warm-ups and cool-downs are known to reduce the odds of an attack. Consult a physician about whether a child should take medication prior to exercising. As long as an asthma action plan is in place to deal with symptoms that may arise, activity is usually encouraged in children with asthma.
Encouraging children to take responsibility for the care and management of their asthma can help them feel more in control of the condition. Children need to learn to recognize their symptoms, and to properly use devices such as an inhaler or peak flow meter when indicated.
A child should know the warning signs of an impending attack, including peak flow meter readings that indicate danger ahead. Develop a written action plan so a child knows how to respond to an emergency, step by step. This should include phone numbers to call for help. Make sure the plan is easily accessible to the child, as well as caregivers such as grandparents and baby-sitters.
Children confident of their ability to respond to symptoms are on their way to turning a potentially frightening disorder into a manageable part of daily life.
Questions for your doctor
Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions related to asthma and children:
- Do my child’s symptoms indicate asthma?
- What tests will you use to determine if my child has asthma?
- What may have caused my child to develop this condition?
- How serious is my child’s asthma?
- What dangers does asthma pose to my child’s overall health?
- What are my child’s treatment options?
- How will the condition change as my child gets older? Will my child outgrow the asthma?
- What factors may trigger an asthma attack in my child?
- What steps can I take to reduce my child’s risk for an asthma attack?
- What steps can I take to ensure my child’s asthma-related needs will be addressed when he or she is at school?
- Will I have to limit my child’s physical activity level? Will my child be able to play sports?
- Are my other children likely to develop asthma as well?
- My child is frightened by their asthma. Can you recommend ways to calm my child’s fears?