Asthma affects 20% of children in Ireland. Up to one in three under fives have had at least one attack of wheezing. This means that a number of parents have been told that their child has asthma and have seen for themselves what asthma can do.

Most often asthma is mild and easily controlled by medicines but sometimes children may have attacks that can be frightening and very distressing. Most young children with wheezing episodes outgrow their asthma by school age. For parents it is always worrying to see their child suffer, no matter how mild the asthma may be.

Describing Asthma
Children with asthma cough a lot, partly because their airways are irritable, but also because they produce a lot of mucus (phlegm). Some children with asthma may also have other related conditions such as eczema, hay fever (allergic rhinitis) and itchy, streaming eyes (conjunctivitis). When visiting your doctor, it is important to discuss all your child’s conditions.

The cause of asthma
The tendency to develop allergies, including allergic asthma, often runs in the family but there are a number of other causes. It is known, for instance, that smoking during pregnancy increases the likelihood for childhood asthma and that children with asthma whose parents smoke will have more severe symptoms.

Smoking seems to be an important cause but not the only one. In the first few years of life asthma may consist of acute attacks when the child has a cold. It occurs in response to virus infections and does not seem to be related to allergies.

How asthma is diagnosed
The typical symptoms of asthma in young children are wheezing and troublesome coughing. It is the pattern of symptoms that develop over time, which shows whether a child has asthma or not. It is important that a child receive regular monitoring and proper treatment.

It is a good idea to keep a record of your child’s symptoms and when they occur. This is very helpful for diagnosis and then subsequently for treatment and monitoring. Symptoms can vary and a record may show a particular pattern. Children tend to develop their own pattern and severity of symptoms.

Spotting asthma in very young children
It may be difficult to spot asthma in very young children for three reasons:

1. Thirty per cent of all children will have at least one period of wheezing during their first five years of life. Most of these children will never have breathing problems again, so doctors may not want to use the term ‘asthma’.

2. Doctors use a variety of words to describe asthma; wheezing, wheezy bronchitis, chesty coughs, colds that move onto the chest.

3. It is not easy to measure how well a young child’s lungs are working, because the device that is normally used for school children and adults (the peak flow meter) can only be used by children who are over six years old.

It may take a number of visits to doctor to get to the bottom of your child’s breathing problems.

Patterns to look for:
Repeated attacks of wheezing and coughing, usually with colds.
A cough that won’t go away or keeps coming back.
Restless nights due to wheezing and/or coughing between colds, especially after exercise or excitement, or an exposure to cigarette smoke and allergic triggers such as dust, pets, pollens or feathers.

It is important to note that for many young children a dry, irritating cough may be the only symptom of asthma, even though most people think that wheezing is the only asthma symptom. Healthy children do not cough. Children under one are most likely to suffer from asthma, which is set off by virus infections such as colds and a runny nose.

Different degrees of asthma
Doctors often use the words ‘mild’, ‘moderate’ and ‘severe’ to describe asthma. Below are some guidelines explaining what they mean.

Mild: Coughs and wheezes but plays happily and feeds well

Moderate: Walking at night, can’t run around or play without cough or wheeze

Severe: Too restless to sleep, unwilling to play at all, too breathless to talk or feed, lips may turn blue.

Management of childhood asthma
Unfortunately there is no cure for asthma yet. But the aim of modern asthma management is to reduce symptoms and allow children to lead a healthy, active life, unaffected by their asthma. Regular visits to the GP or practice nurse are very important.

Asthma management plan
Your doctor or practice nurse can develop an asthma management plan with you, which will explain when to use the preventer and reliever and what to do if your child’s symptoms get worse. The plan should be written down for you to keep at home.

Using inhalers
Most asthma medicines are breathed in (inhaled). As they go straight into the lungs they can be given in low doses and have the smallest possible side effects. Even in infants, inhaled medicines are much more effective than oral treatments.

Spacers and puffers
All young children should be prescribed a spacer to fit their aerosol puffer. Spacers are important because they make it possible to give very young children inhaled medicines, provided they are prescribed with a face mask. They also ensure that the medicine reaches the lungs rather than lodging in the throat or in the mouth. There are several different brands of spacer, which fit different puffers. They do not all come with a mask.

Getting your child to take inhaled medicine properly is the most important part of asthma management. The following suggestions may help you to give your child the medicines they need:

Make sure that your doctor, practice nurse or chemist (pharmacist) shows you how to use the inhalers and spacer that you have been prescribed. You should also be told how to clean and when to replace them.

Always give your child the medicine using an aerosol puffer fitted with a spacer (unless your child has been prescribed a nebuliser by a hospital consultant).

Introduce your child to the spacer and puffer as toys. Use them yourself (without firing the puffer) to demonstrate. Try putting stickers on the spacer to make it look more interesting and try to turn giving the medicine into a game.

Giving your child spacer or nebuliser treatment when asleep is an option to consider. This can be done by holding the spacer and mask over the sleeping child’s face, so the medicine is inhaled.

If your child is in distress and you want to give the medication quickly, remember the treatment can still be inhaled even when the child is crying.

Keeping a watchful eye:
Signs that your child’s asthma is slipping from control and worsening include:
Wheeze and cough first thing in the morning
Increased symptoms after exercise or exertion
Waking at night with a cough or wheeze
Increased use of reliever therapy

It is important to agree with your child’s doctor, in advance what to do if the asthma is getting worse. This should form a part of your child’s asthma management plan and may include stepping up preventer treatment.

An asthma attack
During an asthma attack coughing, wheezing or breathlessness worsens quickly until breathing becomes difficult. Some children become too breathless to talk or eat during an attack. An attack can take anything from a few hours to a few days to develop and in young children it usually follows a cold. An asthma attack can be life threatening and therefore needs to be taken seriously. It can be frightening but knowing what to do can help you to stay calm and help your child.

The pattern of each attack tends to repeat itself and individual children. Sometimes this gives enough warning to allow a course of steroid tablets to be given to prevent the attack building up.

Steroid tablets
A short course of steroid tablets (one to four days) is sometimes needed to treat an asthma attack, in addition to the preventers and relievers. They are like the steroids that our body makes naturally but are very different to anabolic steroids. Your child should not experience side-effects from steroid tablets that are taken occasionally, except for possible temporary hyperactivity.

In an emergency:
Most parents learn to recognise an asthma attack. Follow an emergency plan that you have already agreed with your doctor, which will be along these lines:

Give your child their reliever treatment immediately, wait five to ten minutes and repeat until their breathing improves or until help arrives. Give you child steroid tablets if they have been prescribed by your doctor.

Hold or sit the child in an upright position. Lying down is less comfortable.

Call your doctor or an ambulance (which ever is quicker in your area), or take your child to the nearest hospital.

If your child does go to the hospital make sure that your own doctor is kept informed and that your child has a follow-up appointment either at the hospital or with your own doctor.

Asthma and sleep
It is not normal for children with asthma to wheeze and cough during the night; the presence of such symptoms means that the asthma is not under control. This can mean disturbed sleep for both child and parents. Sleeping problems can have a major affect on quality of life; children can become tired and listless during the day and parents can become short-tempered and have difficulty coping.

Every effort should therefore be made to get rid of night-time symptoms (as with all asthma symptoms) and to allow a normal sleeping pattern to develop. If night-time symptoms persist talk to your doctor who may want to alter your child’s asthma management.

What next?
All parents would like to know if their child will grow out of asthma, but no one can predict the future. In general terms the younger the children are when they develop asthma, the more likely they are to grow out of it by the time they start school. Children who develop asthma later (aged three to five) or who have a strong family history of allergies, tend to experience asthma during primary school but may grow out of it by their teens. Of those children who still have asthma at the age of 14, the majority will carry a tendency towards asthma into adult life.

For more information, contact the Asthma Society of Ireland on freephone, 1850 44 54 64.

Back to "Basics"

Back to Homepage

Basics | Exploring Treatments | Advanced Resources | News | Contact Us | Disclaimer

	Copyright © 2008. All rights reserved.
	We subscribe to the principles of the Health On the Net Foundation