Asthma in children

Asthma affects the airways, the breathing tubes that carry air from the nose to the lungs. It makes the muscles around these tubes tighten and the lining swell and produce sticky mucus. The tubes become narrow, which makes it hard to breathe and can also cause coughing, wheezing, shortness of breath and chest tightness.

Asthma is one of the most common reasons children visit doctors, miss days at school or have to go to hospital. Around 1 in 10 children have asthma. With good management, your child should be able to lead a healthy, active life.

We don’t know the exact reason some children develop asthma. Children are more likely to get asthma if they:

• have family members with asthma or allergies
• were born prematurely or with a low birth weight
• are around air pollution, mold or second-hand cigarette smoke

Learning about your child’s asthma#

There is a lot to think about and plan for when your child has asthma, so it is important to learn as much about it as you can. Your doctor and pharmacist are there to help, so talk to them about any concerns.

To help your child, you need to know:

• what makes their asthma worse
• what signs tell you they are having trouble breathing
• what medicine they need and how to use it correctly
• what to do if they have a serious flare-up or attack — know and follow asthma first aid

Make sure you always have an updated written asthma action plan.

Asthma is different for every child#

Some children have asthma that only shows up once in a while, or after exercise or a cold. Others have symptoms every day. There are different ways to manage each pattern, but no matter how often your child gets asthma, they can still have a serious flare-up that needs urgent treatment.

Triggers#

Triggers are things that can cause asthma symptoms. They are different for each child, and a child can have more than one. Symptoms can appear hours after being around a trigger, which can make asthma hard to identify. Once you know your child’s triggers, it is easier to help them stay away from them. Common triggers include:

• cigarette smoke
• colds and flu
• indoor and outdoor air pollution
• allergies, such as dust mites, animals, pollen or mold
• cold, dry air
• exercise

Symptoms#

Common symptoms include:

• coughing
• wheezing — a whistling noise when breathing
• chest tightness or pain (young children might complain of a “sore tummy”)
• shortness of breath or difficulty breathing

Your child may have all of these symptoms or just a few. They are often worse at night, in the early morning, during exercise or when around a trigger.

Take your child to the doctor if you are concerned about any breathing problems. It helps to keep a record of symptoms to discuss with your doctor, such as:

• when the symptoms happen, how bad they are and how often
• how long they last and whether they change over time
• whether they are worse after exercise, playing, or colds or flu
• whether they are worse after being around animals, pollens or mold

You can also record your child’s breathing on your phone. Your doctor will use this information to decide how to help.

Diagnosis#

Diagnosing asthma in children younger than 5 can be difficult, because young children cough or wheeze for many different reasons. Signs that may point to asthma include wheezing that happens more than once (with or without an illness), and constant coughing or bouts of coughing that become worse at night.

Your doctor might order a breathing test called spirometry. This is only for school-aged children, because it is too hard for younger children to do. It involves breathing hard and fast into a machine that measures how well the lungs are working, and it is not painful. Your doctor may also refer you to a children’s asthma specialist.

Treatment and asthma action plans#

The aims of asthma treatment are to keep your child’s lungs as healthy as possible, keep symptoms under control, and stop asthma from interfering with school or play.

Your doctor will help you make a plan to manage your child’s asthma. It will include medication, follow-up appointments and a written asthma action plan to keep symptoms under control and help your child enjoy a full and active life.

Everyone with asthma should have an action plan. You and your doctor write it together, and you take a copy home. Your school or childcare service may also ask for a copy. Your doctor should review the plan once a year. An action plan usually includes:

• the date and the name of the person who prepared it
• a list of your child’s usual asthma medicines
• when to give more reliever medicine
• signs of worsening asthma and what to do if you see them
• when to see a doctor or go to the emergency department
• what to do in an asthma emergency

Asthma medication#

Almost all asthma medication comes as an inhaler (or puffer). The main types are:

• Relievers: taken when your child is showing signs or symptoms. These should be available to your child at all times.
• Preventers: taken daily to prevent symptoms and flare-ups. These are not needed by all young children, and your doctor will tell you if they think your child needs one.

Your doctor can talk to you about which medication is best for your child. Never reduce or change the dose without speaking with your doctor first.

Spacers#

All people with asthma should use a spacer, especially young children — it is very hard to give young children asthma medicine without one. A spacer is an empty container that attaches to a puffer and has its own mouthpiece to breathe through. It helps more medicine reach deep inside the lungs.

Babies and young children may need a special face mask attached to the spacer. These fit tightly around the mouth and nose so that none of the medicine leaks out.

If you are having trouble getting your child to take their medicine, don’t stress — talk to your pharmacist about ways to encourage them.

Side effects#

Doctors have prescribed most asthma medicines to children for many years, so we know a lot about possible side effects. If you are worried, speak to your doctor. Do not stop or change the dose without speaking with your doctor first.

Common side effects from preventers include a hoarse voice, a sore mouth and throat, and thrush in the mouth and throat. Using a spacer and rinsing the mouth after use greatly lowers these risks. In children, the preventer tablet montelukast can cause sleep problems or nightmares, behavior changes or tantrums, headache, and feeling sad. If you notice any of these, talk to your doctor.

Common side effects from relievers include a fast heartbeat and trembling.

Asthma emergencies#

To prepare for an emergency, make sure your child has an asthma action plan and keep a copy somewhere easy to reach at home. Send a copy to anyone who cares for your child, and to their school or childcare service. You may like to take a photo of it so you always have a copy with you.

An asthma attack can quickly become an emergency, but taking quick action can reduce that risk. If the symptoms of an attack appear, follow your child’s asthma action plan.

Symptoms of an asthma emergency in children include:

• finding it very hard to breathe, or not breathing at all
• trouble speaking, or stopping every few words to breathe
• blue lips
• drowsiness
• symptoms getting worse very quickly
• the reliever not working, or none being available

If your child is having a severe or life-threatening attack, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance and start asthma first aid. Tell them that your child has asthma, even if it is usually mild.

Childcare and school#

Give your child’s school or childcare service a copy of the asthma action plan — they will need it to enroll your child. Make sure they have a spacer and reliever medicine for your child, update the plan every year or whenever the medicine changes, and tell staff if your child’s asthma changes or if you have any concerns.

Key Points#

• Asthma makes the muscles in the airways tighten and the lining swell and produce sticky mucus.
• This narrows the airways and makes it hard to breathe.
• It can also cause coughing, wheezing, shortness of breath and chest tightness.
• Asthma is one of the most common reasons children visit doctors, miss school or go to hospital.
• It is important to learn as much about your child’s asthma as you can.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).