Childhood asthma

Childhood asthma is the same lung disease as adults, but children often have different symptoms. Doctors also call it childhood asthma.

If your child has asthma, their lungs and airways can easily become inflamed when they have a cold or are around objects like pollen. Symptoms may interfere with your child's daily activities or sleep. Sometimes an asthma attack can lead to a trip to the hospital.

There is no cure for asthma in children, but you can work with your child's healthcare provider to treat them without damaging their growing lungs.

Signs and symptoms of childhood asthma

Not all children have the same asthma symptoms. The child may even have different symptoms from one episode to the next. Signs and symptoms of asthma in children include:

A cough that doesn’t go away (which may be the only symptom)
Coughing spells that happen often, especially during play or exercise, at night, in cold air, or while laughing or crying
A cough that gets worse after a viral infection
Less energy during play, and stopping to catch his breath during activities
Avoiding sports or social activities
Trouble sleeping because of coughing or breathing problems
Rapid breathing
Chest tightness or pain
Wheezing, a whistling sound when breathing in or out
Seesaw motions in their chest (retractions)
Shortness of breath
Tight neck and chest muscles
Feeling weak or tired
Trouble eating, or grunting while eating (in infants)

Your child's doctor should check for any medical conditions that are preventing him from breathing.

Experts sometimes use the terms "reactive airway disease" and "bronchiolitis" when discussing wheezing with shortness of breath or cough in infants and toddlers. Tests may not confirm asthma in children younger than 5 years of age.

When to seek emergency care:

A severe asthma attack needs medical care right away. Watch for these signs:
Stopping in the middle of a sentence to catch a breath
Using stomach muscles to breathe
A belly that sinks in under their ribs when they try to get air
Chest and sides that pull in as they breathe
Widened nostrils
Fast heartbeat
Sweating more than usual
Chest pain

Causes and triggers of childhood asthma

Common triggers include:

Airway infections. This includes colds, pneumonia, and sinus infections.
Allergens. Your child might be allergic to things like cockroaches, dust mites, mold, pet dander, and pollen.
Irritants. Things like air pollution, chemicals, cold air, odors, or smoke can bother their airways.
Exercise. It can lead to wheezing, coughing, and a tight chest.
Stress. It can make your child short of breath and worsen their symptoms.

Risk factors for childhood asthma

Asthma is the leading cause of long-term illness in children.

In most children, the first symptoms appear by the age of 5. But asthma can start at any age.

Things that can make a child more prone to asthma include:

Nasal allergies (hay fever) or eczema (allergic skin rash)
A family history of asthma or allergies
A lot of respiratory infections
Low birth weight
Exposure to secondhand tobacco smoke before or after birth
African-American or Puerto Rican descent
Being raised in a low-income environment

Diagnosis of asthma in children

Your child's asthma symptoms may be gone by the time you go to the doctor. You play an important role in helping your doctor understand what's going on. Diagnostics will include:

Questions about medical history and symptoms. Your doctor will ask you about any breathing problems your child may have, as well as any family history of asthma, allergies, eczema, or other lung conditions. Describe your child's symptoms in detail, including when and how often they occur.
Physical examination. Your doctor will listen to your child's heart and lungs and examine his nose or eyes for signs of allergies.
Tests. Your child may have a chest x-ray. If they are 6 years old or older, they may have a simple lung test called spirometry. It measures the amount of air in your child's lungs and how quickly they can exhale it. This helps the doctor determine the severity of the asthma. Other tests can help find asthma triggers. These may include allergy skin tests, blood tests, and x-rays to determine whether sinus infections or gastroesophageal reflux disease worsen asthma. A test that measures the level of nitric oxide in your child's breath can also indicate airway inflammation.

Complications of asthma in children

If left uncontrolled, asthma can cause problems such as:

Severe attacks, sometimes leading to Emergency Room visits or stays in the hospital
Missed school and other activities
Fatigue
Stress, anxiety, and depression
Delays in growth or puberty
Damaged airways and lung infections
Death

Treatment of childhood asthma

Avoiding triggers, using medications, and monitoring symptoms daily are the best ways to control asthma in children of all ages.

There are two main types of asthma medications:

Fast-acting medications help relieve sudden symptoms. Your child will take these for quick relief during an asthma attack.
Long-acting drugs prevent airway inflammation and control asthma. Your child will probably take them every day.

Based on your child's history, the doctor will create an asthma action plan and give you a copy of it. This plan tells them when and how they should take their asthma medication, what to do if their asthma worsens, and when to seek emergency care. The doctor should explain how the inhaler is used. Make sure you fully understand this plan and ask your doctor any questions you may have.

Give copies to caregivers, teachers, and even the bus driver so they know what to do if a child has an asthma attack away from home.

Many asthma medications contain steroids, which can have side effects. They can irritate your child's mouth and throat. Some studies show that, over time, they can cause slow growth, bone problems, and cataracts. Once your child takes them, his body will not be able to produce as many natural steroids. But left untreated, asthma can lead to health problems and hospital visits. You and your doctor should discuss the pros and cons of medications when developing an asthma action plan.

Childhood asthma medicine

Infants and young children may take some of the same types of asthma medications as older children and adults. Inhaled steroids may be needed to treat long-term asthma or wheezing in infants.

Children under 4 years of age may receive lower doses and take medications through a nebulizer. This device turns the medication from a liquid into a mist that your child inhales into their lungs. Your doctor will tell you how often to do these breathing procedures. This is usually up to four times a day, for about 10-15 minutes at a time. To use the nebulizer:

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

There are recommendations for the treatment of bronchial asthma in children under 4 years of age. This includes the use of fast-acting medications (such as albuterol) for intermittent symptoms. The next step is a low dose of an inhaled steroid or montelukast (Singulair). After 4 years, the focus shifts from symptom control to disease management. If your child's asthma has been under control for at least 3 months, the doctor may lower the medication.

For older children, a metered-dose inhaler with a spacer can be used instead of a nebulizer. A spacer is a chamber that attaches to an inhaler and holds a dose of medication. This allows your child to inhale the medicine into their lungs at their own pace. To use the spacer inhaler:

Wash your hands.
The first time you use it, prime the inhaler 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 and then do it all again.
Help them rise their mouth, brush their teeth, or get a drink of water.

How to avoid childhood asthma triggers

To help prevent asthma attacks or keep them from getting worse, focus on known triggers by doing the following:

Don’t let anyone smoke in your home or car.
Clean bedding and carpets often to fight dust mites.
Keep pets out of your child’s bedroom. An air filter can help with allergens.
Get regular pest control to avoid cockroaches.
Fix leaks and use dehumidifiers to prevent mold.
Don’t use scented cleaning products or candles.
Check daily air quality reports in your area.
Help your child stay at a healthy weight.
If they have heartburn, keep it under control heartburn.
If exercise is a trigger, your child’s doctor might have your child use the inhaler 20 minutes before the activity to keep their airways open.
Make sure they get a flu shot every year.

Outlook for asthma in children

There is no cure for asthma, but your child can learn to control it. They should be able to:

Prevent long-term symptoms
Go to school every day
Avoid asthma symptoms at night
Take part in daily activities, play, and take part in sports
Avoid urgent visits to the doctor, emergency room, or hospital
Use and adjust medications to control symptoms with few or no side effects
If they have trouble meeting all of these goals, ask their doctor for advice.

Experts don't know much about infant lung function and asthma. But they believe that a child is more likely to be diagnosed with asthma at age 7 if they have had multiple episodes of wheezing, the mother had asthma, or allergies.

Once a child's airways become sensitive, they remain so for life. But about 50% of children experience a dramatic decrease in asthma symptoms by the time they reach adolescence. They may seem to have outgrown their asthma, but for some, symptoms will reappear in adulthood. It is impossible to predict what might happen to your child.

Learning about asthma and how to control it is an important step in managing your child's condition. Work closely with their healthcare team to learn everything you can about asthma, how to avoid triggers, what medications do, and how to treat them.