Asthma in children

What is asthma?

Asthma happens in the airways – the breathing tubes which carry air from the nose to the lungs.

It causes the muscles in the tubes to tighten and the inside to become swollen and make sticky mucus. This causes the tubes to become narrow and makes it hard to breathe. It can also cause coughing, wheezing, shortness of breath and chest tightness.

Asthma is one of the most common reasons that children visit doctors, miss days at school or have to go to hospital. In fact, around one in 10 Australian children have asthma. If your child’s asthma is well controlled, they should be able to lead a healthy, active life.

Causes of asthma in children

We don’t know the exact reason some children get asthma. Children are more likely to get asthma if they:

• have family members with asthma or allergies
• are premature or born with a low birth weight.
• are around air pollution such as bushfires, mould or second hand cigarette smoke.

What you need to know about your child’s asthma

There are many things to think about and plan for when your child has asthma. It is important to learn as much about it as you can. Your doctor and pharmacist are there to help you. Talk to them about any concerns you may have about your child’s asthma.

To help your child with asthma you need to know:

• what makes their asthma worse
• what signs tell you they are having trouble breathing
• what medicine they need to take and how to use it correctly
• what to do if they have a serious flare up or asthma attack – know and follow asthma first aid.

Make sure you have an updated written asthma action plan and understand how to use it.

Asthma patterns in children

Asthma is different for every child. Some children have asthma that only shows up once in a while or after exercise or a cold. Others have it every day. There are different ways to manage each type of asthma.

No matter how often your child gets asthma, they can still have a serious flare up that needs urgent treatment.

Triggers for asthma in children

Asthma triggers are things that can cause asthma symptoms. The most common triggers are:

• cigarette smoke
• cold or flu
• indoor and outdoor air pollution
• allergies, such as dust mites , animals, pollen or mould
• cold, dry air
• exercise.

Triggers for asthma are different for each child. Symptoms can happen hours after being around the trigger. This can make it hard to figure out if a child has asthma.

Children can have more than one trigger, and other children may have different triggers to your child. Once you know your child's triggers it’s easier to stay away from them.

Symptoms of asthma in children

Common asthma symptoms include:

• chest tightness or pain (young children might complain of a ‘sore tummy’)
• shortness of breath
• difficulty breathing
• wheezing – whistling noise when breathing
• coughing.

Your child may have all of these symptoms or just a few. Symptoms are often worse at night, in the early morning, during exercise or due to other triggers.

Diagnosis of asthma in children

Diagnosing asthma in children younger than 5 years can be difficult because children cough or wheeze for many different reasons.

Take your child to the doctor if:

• the wheezing happens more than once – with or without an illness
• constant coughing or bouts of coughing become worse at night
• you are concerned about any breathing problems in your child.

Keep a record of your child’s symptoms

Keep a record of symptoms to discuss with your doctor. This could include:

• recording your child's breathing on your mobile phone
• when the symptoms happen
• how bad the symptoms are and how often they happen
• how long the symptoms remain and whether they change with time
• whether the symptoms are worse after exercise, playing or after colds or flu
• whether the symptoms are worse after being around animals, pollens or mould.

What to expect when you visit the doctor

Your doctor might ask whether anyone in your family has a history of asthma, eczema or hay fever.

They might also ask about when and how often symptoms are happening. This is where keeping a record can help. Your doctor will use this information to help them decide how to help your child.

Your doctor might order a breathing test called spirometry. This test is only for school aged children because it's too hard for younger children to do. It involves breathing hard and fast into a machine which measures how well the child's lungs are working. It isn't painful.

Your doctor may also refer you to a children’s asthma specialist.

Managing your child's asthma

The aims of asthma treatment are:

• to keep lungs as healthy as possible
• to keep symptoms under control
• to stop asthma from interfering with school or play
• to prevent flare-ups or attacks.

Your doctor will help you to make a plan to manage your child’s asthma. This will include medication, follow up appointments and an asthma action plan to keep the symptoms under control and help your child to enjoy a full and active life.

Asthma action plans for children

An asthma action plan is a set of instructions for managing your child's asthma.

Everyone with asthma should have an action plan.

You and your doctor will write the plan together and you will take a copy home to keep. Your school or day care may also ask for a copy. Your doctor should review your action plan once a year.

An asthma action plan includes:

• a list of your child's usual asthma medicines
• instructions on what to do when your child's asthma is getting worse
• signs of worsening asthma and what to do if you see them
• when to give more reliever medicine
• when to see a doctor or go to the emergency department
• what to do in an asthma emergency
• the name of the person who prepared the plan
• the date.

Asthma medication

The main types of asthma medications are relievers and preventers. Almost all asthma medication comes in the form of an inhaler (or puffer).

Relievers:

• taken when your child is showing signs or symptoms
• should be available to your child at all times.

Preventers:

• taken daily to prevent asthma symptoms and flare-ups
• not required for all young children who have asthma. Your doctor will be able to tell you if they think your child needs a preventer.
  

Your doctor can talk to you about which medication is best for your child. Never reduce the dose of medication without speaking with your doctor first.

There are many different types of asthma medication. Asthma Australia has more information about asthma medication.

Spacers

All people with asthma should use a spacer, especially young children. It is impossible to give young children asthma medicine without using a spacer.

A spacer:

• is an empty container that attaches to a puffer
• has it's own mouthpiece to breathe through
• helps more medicine reach deep inside the lungs.

Your child breathes the medicine through the spacer.

Watch a video from the National Asthma Council to see how to use a spacer.

Babies and young children may need a special face mask attached to help them breathe through the spacer. These fit tightly around your child’s mouth and nose to make sure none of the medicine leaks out.

Watch this Asthma Australia video to see how to use a spacer with a face mask.

If you're having trouble getting your child to take their asthma medicine, don't stress. Talk to your pharmacist about ways to encourage your child to take their asthma medications.

Side effects

Doctors have prescribed most asthma medicines to children all over the world for many years. This means we know a lot about possible side effects. If you are worried, speak to your doctor. Do not stop or change the dose of medicine for your child without speaking with your doctor first.

Common side effects from preventers:

• hoarse voice
• sore mouth and throat
• thrush in the mouth and throat.

Using a spacer and rinsing the mouth after use greatly lower the risk of these side effects.

In children, preventer tablets such as Montelukast can cause:

• sleep problems or nightmares
• behaviour changes or tantrums
• children to feel sad.

If you notice any of these side effects, talk to your doctor.

Common side effects from relievers:

• headache
• trembling
• fast heartbeat.

Asthma emergencies

Symptoms of an asthma attack can worsen and develop into an asthma emergency. To prepare for an asthma emergency, make sure your child has an asthma action plan.

Have a copy of your child's asthma action plan somewhere easy to access at home. Send a copy to anyone who cares for your child. Their school, kinder or childcare service will also need a copy.

You may like to take a photo of their asthma ction plan so you always have a copy with you.

Symptoms of asthma emergencies in children

Symptoms on an asthma emergency include:

• finding it very hard to breathe or not breathing at all
• trouble speaking or stopping every few words to breathe
• blue lips
• symptoms get worse very quickly
• reliever medicine is not working or none is available
• drowsiness.

Treatment for asthma emergencies in children

An asthma attack can quickly become an asthma emergency. If you take quick action, you can reduce the risk of this happening. If the symptoms of an asthma attack appear, follow your child’s asthma action plan.

If your child is experiencing a severe or life-threatening asthma attack, call triple zero (000) for an ambulance and then start asthma first aid.

Asthma information for childcare, kinder or school

To help childcare and preschool workers and school teachers look after your child with asthma:

• Tell them that your child has asthma (even if it is mild).
• Give them a copy of your child’s asthma action plan.
• Make sure you update the plan every year or if your child's medicine changes. The school or childcare centre will need this to enrol your child.
• Make sure the school or centre has a spacer and reliever medicine for your child.
• Tell staff if your child’s asthma changes.
• Tell the staff if you have any concerns.

Where to get help

• Your GP (doctor)

Need treatment today?

Need treatment today, but it's not life-threatening and you can't get a GP appointment, there are services available:

• Urgent Care Clinics – provide care for conditions that require treatment today but not an emergency response (extended hours)
• Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Emergency care

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital

More information

• Asthma Australia Tel. 1800 ASTHMA (1800 278 462)
• National Asthma Council Australia Tel. 1800 032 495
• Allergy and Anaphylaxis Australia Tel. 1300 728 000
• The Royal Children's Hospital – videos to help you better understand and manage your child's asthma