Pediatric/Childhood Asthma

Asthma is the most common chronic disease in children.1 Children miss more days of school and have more emergency department visits and hospitalizations due to asthma than any other chronic disease.1

More than half of adults with asthma experienced their first asthma symptoms as children.1 In childhood, boys are more likely to have asthma than girls.2

Typical asthma symptoms are wheeze, cough, chest tightness, and breathlessness. Many young children wheeze, especially when they have colds.1Wheezing can be a sign of asthma, but not all children who wheeze have asthma.

How is asthma in children diagnosed?

The pattern of symptoms, risk factors, and physical examination are part of diagnosing asthma in children of all ages.1 Most children ages 5 and older can do spirometry, a test that measures lung function.3 No tests are available that can reliably diagnose asthma in children younger than 5 years.1 In young children, a trial of asthma medications may help to make the diagnosis.

Your child’s health care provider will ask about the symptoms your child has. Tell your provider about anything that seems to trigger symptoms: for example, laughing, crying, exercise, colds, of tobacco smoke exposure.1 Mention if you have noticed that asthma symptoms prevent your child from running and playing as much as other kids. Tell your child’s provider about how often your child wakes up at night because of asthma symptoms.

Risk factors
Allergic disease—in your child or close family members—is a risk factor for asthma. Children with eczema, hay fever (allergic rhinitis), or food allergies are more likely to have asthma.1 If siblings or either parent have allergic diseases or asthma, your child is more likely to have asthma.

Physical exam
The provider may listen to your child’s lungs and chest and look in your child’s nose. The provider may also examine your child’s skin for signs of eczema.

Spirometry (for older children)
Spirometry is done to see how much and how quickly your child can exhale air. Your child may be asked to perform this test twice – once before taking a medication that opens the airways and again after taking the medication.3

Medication trial (for younger children)
A trial of asthma medication can help to make the diagnosis of asthma.1 The trial typically lasts two to three months. Usually, children start on a low-dose inhaled corticosteroid. A rescue medication might also be prescribed for use when needed. Your child’s provider will want to see if your child’s symptoms get better with medication and get worse when the medications stop. It is important to follow-up with your child’s provider after two to three months on the medication.

What causes asthma in children?

In children younger than five years old, colds are the most common cause of asthma symptoms.3 Some children appear to “outgrow” their wheezing. For others, the symptoms continue throughout childhood. There is no way to predict what will happen with your child. However, frequent wheeze, family history of asthma, other allergic diseases, and wheezing apart from colds increase the chance that your child will continue to have asthma symptoms.3

Childhood asthma tends to run in families, so genetics probably play a role.4 Children whose mothers smoked during pregnancy are more likely to have asthma.

What are the goals of asthma treatment?

If asthma is under control, children should be able to participate in normal activities without having asthma symptoms.1,3 They should have few or no asthma attacks. If their asthma is well controlled, children should have normal or near-normal lung function and lung growth. Providers aim to prescribe enough medication to keep asthma under control, while minimizing medication side effects.

It is important that your goals are met, too.1 Tell your child’s provider if you have preferences about your child’s treatment. Long-term asthma control usually requires daily treatment. If you know that something will get in the way of the treatment plan your provider suggests, ask about alternatives.

How is childhood asthma treated?

One important step in treating asthma for people at any age is to avoid things that trigger asthma symptoms.1 These are often allergens or tobacco smoke.

The type of medication your child needs depends on how severe the asthma is. If it seems like the current medications are not doing enough, more may be added. Before adding more medication, it is important to be sure that:1

  • The inhaler is being used correctly.
  • The medication is being taken as frequently as prescribed.
  • The correct dose is being taken.

Children age 5 years and younger
For children who wheeze on occasion, a rescue medication may be prescribed.1,3 This medication is taken as needed. If a daily medication is necessary, a low-dose inhaled corticosteroid may be prescribed. For more severe asthma, a higher dose of inhaled corticosteroid or a second medication may be prescribed.1,3 Your child may also need to be evaluated by an asthma specialist.

Children ages 5 to 11 years
A rescue medication may be taken as needed for occasional asthma symptoms.3 If a daily medication is needed for asthma control, a low-dose inhaled corticosteroid is usually recommended first. For older children with more severe asthma, a higher dose inhaled corticosteroid may be prescribed, or a second medication may be added. For the most severe cases, some combination of high-dose inhaled corticosteroids, a second controller medication, and oral corticosteroids may be used.

Parents of school-age children should send a copy of the written asthma action plan to the school nurse.3 The asthma action plan should include instructions for treating asthma attacks, using long-term control medications, preventing exercise-induced asthma, and avoiding triggers.

What type of inhaler is best for children?

For children age 5 years and younger, the best choice is a pressurized metered inhaler with a valved spacer device.1 The valved spacer allows children to breath at their own pace and helps more medication get into the lungs.3 A face mask may be needed for children younger than four. Children ages four to five can usually use a mouthpiece. A nebulizer can be used as an alternative for children who cannot be taught to use a spacer.1 However, most children can learn to use a spacer. In fact, spacers should be used by people of all ages who use metered dose inhalers.3

Do asthma medications stunt growth?

One possible side effect of using inhaled corticosteroids is slower growth.3 This side effect is dose dependent. That means lower doses have less effect on growth. One study showed that regular use of low- or medium-dose inhaled corticosteroids slowed the rate of growth by 0.19 inches (0.48 centimeters) per year.5 One way to minimize the risk is to work with your child’s provider to find the lowest dose needed to keep your child’s asthma under control.3

It is important to consider that having poorly controlled asthma can also delay growth.3 Overall, experts believe that the benefits of using inhaled corticosteroids outweigh the risks.

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Written by: Sarah O'Brien | Last Reviewed: May 2016.