By Camille Platt
Asthma is most likely to show up in kids by age 5, but young children can’t always verbalize difficulty breathing.
That means it’s up to parents and caregivers to watch for signs.
Asthma in infants and children is no different from asthma in adults, but it only takes a little bit of inflammation in a tiny set of lungs to restrict breathing. Children with asthma have hyperactive airways, meaning their respiratory systems overreact to irritants and allergens. The Centers for Disease Control and Prevention reports that more than 6 million people under age 18 in the United States currently have asthma. And while the severity of symptoms may fluctuate over time, or even seem to resolve, asthma cannot be cured. That’s why it’s important to know how to identify it and how to keep symptoms under control.
What Is Asthma?
One of the leading causes of emergency room visits in the United States, asthma is a chronic inflammatory disease. Children with asthma are sensitive to specific triggers that cause their lungs and airways to become inflamed. Basically, it’s either an allergic reaction – perhaps to mold, dust, or airborne pollen – or it’s a reaction to secondhand smoke, very cold air, exercise, a respiratory infection, or a physical and emotional outburst like crying or laughing. “Allergies to pollens, mold, cockroaches, indoor pets, and dust mites are the biggest triggers for asthma,” says Dr. Marc Cromie, allergist with Chattanooga Allergy Clinic. And unfortunately, when not managed well, asthma-related breathing issues can interfere with everyday activities like sleep, school, and physical activity.
According to Children’s National Health System, when exposed to a trigger, an asthmatic child will experience swelling in the lining of the airway and a tightening of the smooth muscles that surround the lung tissue. An asthma attack may also include the production of extra mucus, a sticky substance that is meant to protect the lungs from foreign particles. When overproduced, mucus further restricts airflow.
The cause of asthma is unknown, but certain risk factors make it more likely your child will present with symptoms. These risk factors include obesity, low birth weight, and being exposed to tobacco smoke, among others. Family history of asthma can also be an indicator. “If one parent has asthma, particularly the mother, the likelihood of the child developing asthma is 2.6 times the average risk,” says Dr. Joe Wisniewski, allergist with Covenant Allergy and Asthma Care. “If both parents have asthma, the likelihood is even higher at 5.2 times the average risk.”
In infants, the earliest sign of asthma is noisy, rapid breathing. The normal respiration rate for an infant, according to Asthma and Allergy Foundation of America, is 30 to 60 breaths per minute. At 1 year old, the rate drops to 20 to 40 breaths per minute. Cause for concern would be a respiration rate that is 50% above average or greater.
What to Look For
According to Mayo Clinic, the first sign of asthma in a young child is often not allergen-related. Rather, it’s wheezing when ill with a respiratory virus. Children with asthma may cough a lot, complain of chest pain or tightness, or make a whistling noise when they exhale. You may notice your child contracts bronchitis on the tail end of a respiratory infection, cannot sleep because of coughing or shortness of breath in the evenings, or self-limits exercise because of trouble breathing.
If any of these signs sound familiar, make your child an appointment for evaluation. Depending on your child’s age, the evaluation might differ. Children age 5 and under cannot accurately perform lung function tests, so for them, doctors will rely on family history and your detailed description of symptoms. For older children, testing methods include:
“Spirometry is the preferred method of diagnosing airflow obstruction,” says Dr. Wisniewski. “It measures the maximum amount of air from a forced exhale over one second.” The test can be done in the doctor’s office, and your child will wrap his or her lips around a tube, then inhale and exhale as deeply as possible. (Note: Nostrils must be pinched to prevent airflow through the nose.)
Peak Flow Monitoring:
A peak flow meter is similar to a spirometer, but perhaps less intimidating (no nostril pinching required!). It measures the maximum speed you can blow out air, giving information on how narrow your airways may be. This method alone can’t be used for diagnosis, though.
To identify specific allergens, your doctor may need to scratch the surface of your child’s skin with a concentrated liquid form of allergens. Within 15 minutes, the skin will react at locations that indicate an allergy. “Approximately 80% of children with asthma have an allergy when skin tested as opposed to only 50% of adults,” explains Dr. Wisniewski.
FeNO tests measure the amount of nitric oxide that’s released in one exhaled breath. “This test is almost like a breathalyzer for asthma,” says Dr. Cromie. “Higher than average FeNO levels indicate the presence of inflammation.”
To help manage asthma symptoms, your child may be prescribed long-term control medication (to reduce inflammation and prevent symptoms) as well as quick-relief medication (like an inhaler), also known as “rescue” medication. Knowing when to take the medication – and how to take the medication – will be key, as will knowing how to identify and avoid triggers.
At home, you want to limit exposure to allergens and irritants by restricting the amount of time spent outdoors when pollen counts are high and keeping pets with fur or feathers out of your home (or at least out of your bedrooms).
Change the filters in your air conditioning vents regularly, wrap pillows and mattresses in dust-resistant covers, wash bed linens in hot water once a week, consider replacing carpet with hardwood or laminate, and use a dehumidifier to pull dampness out of the air. Smoking should never be allowed in the home.
“Another essential component of asthma management is a written Asthma Action Plan developed by your child’s physician,” explains Dr. Michael Hollie, allergist with The Allergy & Asthma Group of Galen. “It explains which medications to take, details important steps for controlling an asthma exacerbation, and identifies when to call the doctor or go to the emergency room.” As every child’s case is unique, these plans should be individualized. “Some plans are symptom-based,” Dr. Hollie explains, “while others use symptoms and peak flow monitoring.” You may notice peak flow numbers decrease hours – or even days – before asthma symptoms present.
If allergies appear to be a primary trigger, immunotherapy (also referred to as allergy shots) is an effective option. “Immunotherapy is an all-natural vaccine approach designed to change your body’s reaction to everyday pollens, and it should be started in early childhood if possible,” says Dr. Cromie. “Altering the body’s response to allergens will reduce exacerbations.”
Is It an Emergency?
An asthma attack may be mild enough to treat at home, but your child may need emergency medical attention if:
•Shortness of breath has your child unable to speak beyond short phrases
•Wheezing or inability to breathe is severe
•Peak flow readings are very low
•Rescue medications offer little to no relief
Can It Be Cured?
As children get older, their bodies are often able to handle irritants and inflammation with fewer symptoms. In fact, about half of children seem to outgrow their asthma by adolescence. However, it’s possible symptoms will return in adulthood. In the meantime, consider your child’s treatment plan a critical part of daily life. When symptoms show up, stay calm. You’re the key to teaching your child how to understand the disease, protect him or herself from dangerous symptoms, and advocate for an environment that will maximize activity levels and overall health. “The goal of asthma management is obtaining optimal quality of life, which includes good sleep, regular school attendance, and exercise,” says Dr. Hollie. “With proper evaluation and management by an asthma specialist, these goals are easily achieved.” HS