Asthma in Children
Overview
Does asthma affect children?
Asthma is the leading cause of chronic (long-term) illness in children. It affects more than 7 million children in the United States. For unknown reasons, the rate is steadily increasing. Asthma can begin at any age, but most children who have it have their first symptom by age 5.
Why are more children getting asthma?
No one really knows why more and more children are developing asthma. Suggestions include the following:
- Children are being exposed to more and more allergens such as dust, air pollution and second-hand (and even third-hand) smoke.
- Children aren't exposed to enough childhood illnesses to build up their immune systems.
- Lower rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.
Symptoms and Causes
What makes a child more likely to develop asthma?
There are many risk factors for developing childhood asthma. These include:
- Allergies.
- Family history of asthma, allergies and atopy (a genetic, or inherited, likelihood to develop allergies and asthma).
- Frequent respiratory infections.
- Low birth weight.
- Exposure to tobacco smoke before and/or after birth.
- Being male.
- Being African American.
- Being raised in a low-income environment.
In children who are under five years of age, the most common cause of asthma symptoms is upper respiratory viral infections such as the common cold.
What are the signs and symptoms of asthma in children?
Signs and symptoms of asthma in children include:
- Frequent coughing spells, which may occur while the child is playing, laughing, or at night or right after waking. Coughing may be the only symptom.
- Less energy during play.
- Rapid breathing.
- Complaint of chest tightness or the chest "hurting."
- Whistling sound (wheezing) when the child is breathing in or out.
- Retractions (see-saw motions) in the chest from difficulty breathing.
- Shortness of breath or loss of breath.
- Tightened neck and chest muscles.
- Feelings of weakness or tiredness.
Not all children have the same asthma symptoms. Symptoms can vary from episode to episode in the same child. In addition, not all wheezing or coughing is caused by asthma.
If your child has problems breathing, take him or her to the pediatrician for an evaluation. Your child may be referred to a specialist, such as a pediatric pulmonary provider or a pediatric allergist.
Diagnosis and Tests
How is asthma in children diagnosed?
Asthma is often difficult to diagnose in infants. However, the disease can often be diagnosed in older children based on the child's medical history, symptoms, and physical examination, and on certain tests:
- Medical history and symptom description: The healthcare provider will ask about any history of breathing problems your child may have, as well as a family history of asthma, allergies, a skin condition called eczema, or other lung diseases. Be sure to describe your child's symptoms (cough, wheezing, shortness of breath with/without activity, increased work of breathing, chest pain or tightness) in detail, including when and how often these symptoms have been occurring.
- Physical exam: During the physical examination, the doctor will listen to your child's heart and lungs.
- Tests: Many children will have a chest X-ray and pulmonary function (lung) tests, which measure the amount of air in the lungs and how fast it can be exhaled (breathed out ). The results will help the provider determine how severe the asthma is. Children younger than 5 are usually unable to perform pulmonary function tests, so doctors rely heavily on history, symptoms, and physical examination in making the diagnosis.
The doctor may order other tests to help identify particular asthma triggers, including allergy skin testing and blood tests.
Management and Treatment
How is asthma in children treated?
Based on your child's history and how severe the asthma is, the healthcare provider will develop a care plan called an "Asthma Action Plan,” which describes:
- When and how your child should use asthma medication.
- What to do when asthma gets worse.
- When to seek emergency care for your child.
Make sure you understand this plan and ask your child's provider any questions you may have. The Asthma Action Plan is important to the success of asthma control. Keep it handy to remind you of your child's daily asthma management plan and to guide you when your child develops asthma symptoms. In addition to following the Asthma Action Plan, try to limit (and avoid, if possible) exposure to asthma triggers.
Asthma medications that adults and older children take can also safely be prescribed for toddlers and younger children. In the case of inhaled medications, a different delivery device based on the child's age and ability may be required.
If your infant or child is having asthma symptoms that require treatment with a rescue inhaler (a bronchodilator, such as albuterol/levalbuterol) more than twice a week, your provider may prescribe a daily controller therapy (such as an anti-inflammatory medication).
How do you give your child asthma medication?
You will be giving your child asthma medications using a valved holding chamber (VHC) device or a home nebulizer (also known as a breathing machine).
Your child may be able to use a metered dose inhaler (MDI) with a VHC. A VHC is a chamber that attaches to the MDI and holds the burst of medication. Talk with your child's provider to see if an MDI with VHC is right for your child.
The nebulizer delivers asthma medications by changing them from a liquid to a mist. Your child gets the medicine by breathing it in through a facemask or mouthpiece.
There are some asthma medications that are also breath-actuated, or come as a dry powder. These medications are given to older children who are able to demonstrate the appropriate technique for using them.
What should you do if your child has an asthma attack?
If your child is showing symptoms of an asthma attack:
- Give your child their reliever medicine according to the asthma action plan.
- Wait 15 minutes. If the symptoms go away, your child should be able to resume whatever activity they were doing. If symptoms persist, follow the Asthma Action Plan for further therapy.
- If your child fails to improve, or if you aren't sure what action to take, call your care provider.
The danger signs of an asthma attack are:
- Severe wheezing.
- Severe coughing.
- Trouble walking and/or talking,
- Blue lips and/or fingernails.
If your child has any of these danger signs/symptoms, go to the nearest emergency department or call 911.
Outlook / Prognosis
How will you know when your child's asthma is well-controlled?
You will know that your child's asthma is well-controlled if, while on medications, your child:
- Lives an active, normal life.
- Has few troublesome symptoms.
- Attends school every day.
- Performs daily activities without difficulty.
- Has had no urgent visits to the doctor, emergency department or hospital.
- Has few or no side effects from the medications.
Will your child outgrow asthma?
Once a person's airways become sensitive, they remain that way for life. About half of the children who have asthma have a noticeable decrease in symptoms by the time they become adolescents—therefore, appearing to have "outgrown" their asthma. However, about half of these children will develop asthma symptoms again in their 30s or 40s. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life.
A note from Cleveland Clinic
By learning about asthma and how it can be controlled, you take an important step toward managing your child's disease. Work closely with your child's asthma care team to learn how to avoid asthma triggers, what medications do, and how to correctly give them. With proper care, your child can live free of asthma symptoms and maintain a normal, healthy lifestyle.
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