Many children are diagnosed with asthma each year, and over half of them develop symptoms before age 5. If your child has breathing problems you think might be caused by asthma, see a doctor. Early diagnosis of asthma in children is important. Proper treatment not only improves day-to-day breathing and reduces asthma flare-ups — it may also help prevent damage to your child's growing lungs.
Asthma in children varies by age group. Infants, toddlers and 4-year-olds are diagnosed and treated differently than teens and adults are. Asthma in children also varies from child to child, and symptoms may get better or worse at certain times. In some children, asthma symptoms get better with age. While asthma can't be cured, it can be managed by following the treatment plan you develop with your child's doctor.
Asthma symptoms in children under 5
The most common asthma symptoms in children under 5 include:
Coughing
Wheezing
Difficulty breathing
Recurring pneumonia
Some children have few day-to-day symptoms, but have bad asthma attacks now and then. Other children have regular, mild symptoms or symptoms that get worse with activity or other triggers ranging from cigarette smoke to seasonal allergies.
If your child is an infant, you may notice slow feeding or shortness of breath during feeding.
If your child is a toddler or older, you may notice a decreased desire to run and play due to breathlessness. Your son or daughter may become fatigued easily and cough when exercising.
For many children under 5, asthma attacks are triggered or worsened by colds and other respiratory infections. You may notice that your child's colds last longer than they do in other children, or signs and symptoms include a lot of coughing that may get worse at night.
Asthma emergencies For some children, severe asthma attacks can be life-threatening and require a trip to the emergency room. Signs and symptoms of an asthma emergency in children under 5 years old include:
Gasping for air
Trying so hard to breathe that the abdomen is sucked under the ribs when he or she breathes in
Trouble speaking because of restricted breathing
Tests to diagnose and monitor asthma in young children
While your child's doctor may identify asthma as the cause of your child's symptoms right away, diagnosis in young children can be tricky. In children under 5, diagnosis is usually based on symptoms reported by parents, and what the doctor finds in a physical exam.
In older children and adults, doctors often measure lung function with tests called spirometry or peak flow measurement. As your child gets older, these tests might help. Generally, children fewer than 5 are unable to do these tests.
If it's available, your child's doctor may be able to check the inflammation in your child's airways with a newer test that measures nitric oxide levels in your child's breath. In general, higher levels of nitric oxide mean your son or daughter's lungs aren't working as well as they should be — and asthma isn't under control.
Asthma treatment in young children
The doctor will want your child to take just the right amount and type of medication needed to control his or her asthma. This will help prevent side effects. Based on your record of how well your child's current medications seem to control signs and symptoms, your child's doctor may "step up" treatment to a higher dose or add another type of medication. If your child's asthma is well controlled, the doctor may "step down" treatment by reducing your child's medications. This is known as the "step-wise" approach to asthma treatment.
If your child's asthma symptoms are severe, your family doctor or pediatrician may refer your child to see an asthma specialist.
Long-term control medications Known as maintenance medications, these are generally taken every day on a long-term basis to control persistent asthma. In some cases, these medications are taken seasonally if your child's asthma symptoms become worse during certain times of the year.
Types of long-term control medications include:
Inhaled corticosteroids are the most common medications for asthma, and the ones proved to work best in younger children. These anti-inflammatory drugs include fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid) and beclomethasone (Qvar).
Leukotriene modifiers, which include montelukast (Singulair) and zafirlukast (Accolate), are sometimes prescribed for mild persistent asthma. These medications are considered a secondary addition to treatment with inhaled corticosteroids.
Cromolyn, which may help prevent mild to moderate asthma attacks. Cromolyn needs to be taken two to four times a day and is usually taken along with an inhaled corticosteroid.
Theophylline, a daily pill that opens the airways (bronchodilator). It relaxes the muscles around the airways to make breathing easier. This medication is not used as often now as in past years.
Quick-relief 'rescue' medications These medications — called short-acting bronchodilators — provide immediate relief of asthma symptoms and last four to six hours. The most commonly used short-acting bronchodilator for asthma is albuterol. Other short-acting bronchodilators include pirbuterol and levalbuterol. But, while these medications work quickly, they can't keep your child's symptoms from coming back. If your child has frequent or severe symptoms, he or she will need to take a long-term control medication as well.
Using quick-relief medications more often than your child's doctor recommends is a sign that your child's asthma is not under control. Record your child's use of these medications and share information about short-term asthma control medications with your child's doctor at every visit.
Immunotherapy for allergy-induced asthma Allergy-desensitization shots (immunotherapy) may help if your child has allergic asthma that can't be easily controlled by avoiding asthma triggers. Your child will begin with skin tests to determine which allergens trigger asthma symptoms. Once your child's asthma triggers are identified, he or she will get a series of injections containing small doses of those allergens. Your son or daughter will probably need injections once a week for a few months, then once a month for a period of three to five years. Your child's allergic reactions will gradually diminish, lessening symptoms of allergy-induced asthma.
Medication delivery devices Most asthma medications are given with a device that allows a child to breathe medication directly into the lungs. Depending on the type of medication, your child's medication may be delivered with one of these devices:
Metered dose inhaler. Small hand-held devices, metered dose inhalers are a common delivery method for asthma medication. Along with his or her inhaler, your child will probably also need a hollow tube (spacer) with a mouthpiece. If your child is less than 4 years old, he or she will need a face mask. This device attaches to the spacer and delivers medication while your son or daughter breathes normally.
Dry powder inhalers. For certain asthma medications, your child may have a dry powder inhaler. This device is generally used in children older than 4 years old, as it requires a deep, quick inhalation to get the full dose of medication.
§ Nebulizer. Nebulizers are devices that turn medications into a fine mist your child breathes in through a face mask. This mist can deliver larger doses of medications into the lungs than can medications that are delivered in other ways. Young children often need to use a nebulizer because it's difficult or impossible for them to use other inhaler devices.
HFA inhalers: A recent change The chlorofluorocarbon (CFC) propellant in quick-relief asthma inhalers is being replaced with a called hydrofluoroalkane (HFA). Unlike CFCs propellant, HFAs don't harm the environment. The spray from the new inhalers may taste different. Although the spray from an HFA inhaler may not seem as strong, your child is still getting the full dose of medication.
Asthma control: 4 basic steps for children under age 5
Managing your child's asthma can seem like an overwhelming responsibility. Following a few structured steps makes it a lot easier.
Step 1: Monitor symptoms with a written plan. A written plan is an important tool to track your child's asthma and check how well treatment is working. You and your child's doctor will come up with a plan to:
Measure how much your child's symptoms affect normal activities such as play and sleep
Note how often your child has asthma flare-ups (exacerbations)
Track how well medications seem to reduce symptoms and note any side effects
Regularly check how well your child's lungs are working with a hand-held device called a peak flow meter (when your child is old enough to use it)
Adjust medications as directed by the action plan when symptoms get worse
Step 2: Learn about asthma. A critical part of managing your child's asthma is learning exactly what steps to take on a daily, weekly, monthly and yearly basis. It's also important that you understand the purpose of each part of monitoring and treatment. You and your child, as well as caretakers (such as child care providers and preschool teachers) need to:
Understand the different types of medications for asthma, which include long-term medications (such as inhaled corticosteroids) and sort acting "rescue" medications (such as albuterol)
Keep a written record of signs and symptoms and medication use
Know what to do when your child's asthma gets worse
Step 3: Control outside triggers. Your child's asthma symptoms may be triggered or worsened by environmental factors. For many children, taking active steps to avoid triggers is an important part of controlling symptoms. Asthma triggers vary from child to child. Work with your child's doctor to identify triggers, and what steps you need to take to help your child avoid them. Common asthma triggers include:
Colds or other respiratory infections, a common cause of asthma attacks in children
Allergens such as dust mites or pollen
Exercise
Cold weather
Cigarette smoke and other irritants in the air
Step 4: Monitor medications. Effective asthma treatment requires tracking how well medications are working on an ongoing basis. You (and your child, when he or she is old enough) will need to:
Work with the doctor to determine what types and doses of medications work best for your child, and make adjustments needed.
Watch for side effects such as irritability, shaking, trouble sleeping or excitability, and report them to your child's doctor.
The key to asthma control: Follow the action plan
Following your child's asthma action plan may be the single most important thing you can do to keep your child's asthma under control. Carefully track your child's lung function and symptoms, and make medication changes as soon as they're needed. If you act quickly, your child is less likely to have a severe attack and you won't need as much medication to control asthma symptoms.
Diligently using an asthma plan can make a big difference in asthma control — and keep asthma symptoms from becoming a serious and disruptive problem. With monitoring and careful management, your child should be able avoid flare ups enjoy life with minimal symptoms.
