Asthma in children
Pediatric asthma; Asthma - pediatric; Wheezing - asthma - childrenAsthma is a disease that causes the airways to swell and get narrow. It leads to wheezing, shortness of breath, chest tightness, and coughing.
Asthma
Asthma is a chronic disease that causes the airways of the lungs to swell and narrow. It leads to breathing difficulty such as wheezing, shortness o...
Causes
Asthma is caused by swelling (inflammation) in the airways. During an asthma attack, the muscles surrounding the airways tighten. The lining of the air passages swells. As a result, less air is able to pass through.
Asthma is often seen in children. It is a leading cause of missed school days and hospital visits for children. An allergic reaction is a key part of asthma in children. Asthma and allergies often occur together.
In children who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens, or triggers.
Allergens
An allergen is a substance that can cause an allergic reaction. In some people, the immune system recognizes allergens as foreign or dangerous. As ...
Triggers
It is important to know what things make your asthma worse. These are called asthma "triggers. " Avoiding them is your first step toward feeling bet...
Common asthma triggers include:
- Animals (hair or dander)
- Dust, mold, and pollen
- Aspirin and other medicines
- Changes in weather (most often cold weather)
- Chemicals in the air or in food
- Tobacco smoke
- Exercise
- Strong emotions
- Viral infections, such as the common cold
Common cold
The common cold most often causes a runny nose, nasal congestion, and sneezing. You may also have a sore throat, cough, headache, or other symptoms....
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Symptoms
Breathing problems are common. They can include:
- Shortness of breath
- Feeling out of breath
- Gasping for air
- Trouble breathing out (exhaling)
- Breathing faster than normal
When your child is having a hard time breathing, the skin of the chest and neck may suck inward.
Other symptoms of asthma in children include:
- Coughing that sometimes wakes the child up at night (it may be the only symptom).
- Dark bags under the eyes.
- Feeling tired.
- Irritability.
- Tightness in the chest.
- A whistling sound made when breathing (wheezing). You may notice it more when your child breathes out.
Wheezing
Wheezing is a high-pitched whistling sound during breathing. It occurs when air moves through narrowed breathing tubes in the lungs.
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Your child's asthma symptoms may vary. Symptoms may appear often or develop only when triggers are present. Some children are more likely to have asthma symptoms at night.
Exams and Tests
Your health care provider will use a stethoscope to listen to your child's lungs. The provider may be able to hear asthma sounds. However, lung sounds are often normal when your child is not having an asthma attack.
Asthma attack
If you do not know whether or not you have asthma, these 4 symptoms could be signs that you do:Coughing during the day or coughing that may wake you ...
The provider will have your child breathe into a device called a peak flow meter. Peak flow meters can tell how well the child can blow air out of the lungs. If the airways are narrow due to asthma, peak flow values drop.
Peak flow meter
A peak flow meter is a small device that helps you check how well your asthma is controlled. Peak flow meters are most helpful if you have moderate ...
You and your child will learn to measure peak flow at home.
Your child's provider may order the following tests:
- Allergy testing on the skin, or a blood test to see if your child is allergic to certain substances
Skin
Allergy skin tests are used to find out which substances cause a person to have an allergic reaction. These substances are called allergens....
ImageRead Article Now Book Mark ArticleBlood test
An absolute eosinophil count is a blood test that measures the number of one type of white blood cells called eosinophils. Eosinophils become active...
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Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
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Lung function tests
Lung function tests
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning.
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Treatment
You and your child's providers should work together as a team to create and carry out an asthma action plan.
This plan will tell you how to:
- Avoid asthma triggers
- Monitor symptoms
- Measure peak flow
- Take medicines
The plan should also tell you when to call the provider. It is important to know what questions to ask your child's provider.
Questions to ask your child's provider
Asthma is a problem with the airways that bring oxygen to your lungs. A child with asthma may not feel symptoms all the time. But when an asthma at...
Children with asthma may need a lot of support at school.
Support at school
Children with asthma may need extra support at school. They may need help from school staff to keep their asthma under control and to be able to do ...
- Give the school staff your asthma action plan so they know how to take care of your child's asthma.
- Find out how to let your child take medicine during school hours. (You may need to sign a consent form.)
- Having asthma does not mean your child cannot exercise. Coaches, gym teachers, and your child should know what to do if your child has asthma symptoms caused by exercise.
Symptoms caused by exercise
Sometimes exercise triggers asthma symptoms. This is called exercise-induced asthma (EIA). The symptoms of EIA are coughing, wheezing, a feeling of ...
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ASTHMA MEDICINES
There are two basic kinds of medicine used to treat asthma.
Long-term control medicines are taken every day to prevent asthma symptoms. Your child should take these medicines even if no symptoms are present. Some children may need more than one long-term control medicine.
Types of long-term control medicines include:
Control medicines
Control medicines for asthma are medicines you take to control your asthma symptoms. You must use these medicines every day for them to work well. ...
- Inhaled steroids (these are usually the first choice of treatment)
- Long-acting bronchodilators (these are almost always used with inhaled steroids)
- Leukotriene inhibitors
- Cromolyn sodium
Quick relief or rescue asthma medicines work fast to control asthma symptoms. Children take them when they are coughing, wheezing, having trouble breathing, or having an asthma attack.
Quick relief
Asthma quick-relief medicines work fast to control asthma symptoms. You take them when you are coughing, wheezing, having trouble breathing, or havi...
Some of your child's asthma medicines can be taken using an inhaler.
Inhaler
Using a metered-dose inhaler (MDI) seems simple. But many people do not use them the right way. If you use your MDI the wrong way, less medicine ge...
- Children who use an inhaler should use a spacer device. This helps them get the medicine into the lungs properly.
Spacer device
Metered-dose inhalers (MDIs) usually have 3 parts:A mouthpieceA cap that goes over the mouthpieceA canister full of medicine If you use your inhaler ...
Read Article Now Book Mark Article - If your child uses the inhaler the wrong way, less medicine gets into the lungs. Have your provider show your child how to correctly use an inhaler.
- Younger children can use a nebulizer instead of an inhaler to take their medicine. A nebulizer turns asthma medicine into a mist.
Nebulizer
A nebulizer is a small machine that turns liquid medicine into a mist that can be easily inhaled. You sit with the machine and breathe in the medici...
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GETTING RID OF TRIGGERS
It is important to know your child's asthma triggers. Avoiding them is the first step toward helping your child feel better.
Keep pets outdoors, or at least away from the child's bedroom.
No one should smoke in a house or around a child with asthma.
Smoke
Things that make your allergies or asthma worse are called triggers. Smoking is a trigger for many people who have asthma.
- Getting rid of tobacco smoke in the home is the single most important thing a family can do to help a child with asthma.
- Smoking outside the house is not enough. Family members and visitors who smoke carry the smoke inside on their clothes and hair. This can trigger asthma symptoms.
- Do not use indoor fireplaces.
Keep the house clean. Keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches, which can trigger asthma attacks. Cleaning products in the home should be unscented.
MONITOR YOUR CHILD'S ASTHMA
Checking peak flow is one of the best ways to control asthma. It can help you keep your child's asthma from getting worse. Asthma attacks usually do not happen without warning.
Children under age 5 may not be able to use a peak flow meter well enough for it to be helpful. However, a child should start using the peak flow meter at a young age to get used to it. An adult should always watch for a child's asthma symptoms.
Outlook (Prognosis)
With proper treatment, most children with asthma can live a normal life. When asthma is not well controlled, it can lead to missed school, problems playing sports, missed work for parents, and many visits to the provider's office and emergency room.
Asthma symptoms often lessen or go away completely as the child gets older. Asthma that is not well controlled can lead to lasting lung problems.
In rare cases, asthma is a life-threatening disease. Families need to work closely with their providers to develop a plan to care for a child with asthma.
When to Contact a Medical Professional
Contact your child's provider if you think your child has new symptoms of asthma. If your child has been diagnosed with asthma, call the provider:
- After an emergency room visit
- When peak flow numbers have been getting lower
- When symptoms get more frequent and more severe, even though your child is following the asthma action plan
If your child is having trouble breathing or having an asthma attack, get medical help right away.
Emergency symptoms include:
- Difficulty breathing
- Bluish color to the lips and face
- Severe anxiety due to shortness of breath
- Rapid pulse
- Sweating
- Decreased level of alertness, such as severe drowsiness or confusion
A child who is having a severe asthma attack may need to stay in the hospital and get oxygen and medicines through a vein (intravenous line or IV).
References
Jackson DJ, Lemanske RF, Bacharier LB. Management of asthma in infants and children. In: Burks AW, Holgate ST, O'Hehir RE, et al, eds. Middleton's Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 50.
Liu AH, Spahn JD, Sicherer SH. Childhood asthma. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 169.
Lugogo N, Que LG, Carr TF, Kraft M. Asthma: diagnosis and management. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 62.
National Heart, Lung, and Blood Institute website. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. www.nhlbi.nih.gov/resources/2020-focused-updates-asthma-management-guidelines. Updated December 2020. Accessed May 2, 2023.
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What causes wheezing?
Animation
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Inhaler with spacer - child
Animation
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Inhaler with no spacer - child
Animation
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Normal versus asthmatic bronchiole - illustration
During an asthma attack smooth muscles located in the bronchioles of the lung constrict and decrease the flow of air in the airways. The amount of air flow can further be decreased by inflammation or excess mucus secretion.
Normal versus asthmatic bronchiole
illustration
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Peak flow meter - illustration
A peak flow meter is commonly used by a person with asthma to measue the amount of air that can be expelled from the lungs. If the airways become narrow or blocked due to asthma, peak flow values will drop because the person cannot blow air out of the lungs as well. A peak flow meter can be a useful aid in monitoring a person's asthma over time and can also be used to help determine how well a patient's medications are working.
Peak flow meter
illustration
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Lungs - illustration
The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
Lungs
illustration
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Common asthma triggers - illustration
Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.
Common asthma triggers
illustration
-
What causes wheezing?
Animation
-
Inhaler with spacer - child
Animation
-
Inhaler with no spacer - child
Animation
-
Normal versus asthmatic bronchiole - illustration
During an asthma attack smooth muscles located in the bronchioles of the lung constrict and decrease the flow of air in the airways. The amount of air flow can further be decreased by inflammation or excess mucus secretion.
Normal versus asthmatic bronchiole
illustration
-
Peak flow meter - illustration
A peak flow meter is commonly used by a person with asthma to measue the amount of air that can be expelled from the lungs. If the airways become narrow or blocked due to asthma, peak flow values will drop because the person cannot blow air out of the lungs as well. A peak flow meter can be a useful aid in monitoring a person's asthma over time and can also be used to help determine how well a patient's medications are working.
Peak flow meter
illustration
-
Lungs - illustration
The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
Lungs
illustration
-
Common asthma triggers - illustration
Many of the same substances that trigger allergies can also trigger asthma. Common allergens include pollen, dust mites, mold and pet dander. Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays. Asthma symptoms can be substantially reduced by avoiding exposure to known allergens and respiratory irritants.
Common asthma triggers
illustration
Review Date: 4/25/2023
Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
All rights reserved.