Sierra Nevada Children's Services

Asthma is the most common chronic disease of childhood, and yet many parents know little about it. The numbers of young people and children with asthma is rising. Nearly five million children under age 18 have asthma. Between 1980-1994, asthma among children under five years old increased by 160%.

Asthma is an illness in which the airways become blocked or narrowed. These effects are usually temporary, but they cause shortness of breath, wheezing, coughing, breathing trouble and other symptoms. If an asthma attack is severe, a person may need emergency treatment to restore normal breathing. Although asthma can cause severe health problems, in most cases treatment can control it and allow a child to live a normal and active life.

What Causes Asthma Attacks?

Things in the environment trigger an asthma attack. These triggers vary from person to person, but common ones include secondhand smoke, cold air, exercise, allergens (things that cause allergies) such as dust mites, mold, pollen, animal dander or cockroach debris, and some types of viral infections.

Here is how the process occurs. When the airways come into contact with an allergen or trigger, the tissue inside the bronchi and bronchioles becomes inflamed (inflammation). At the same time, the muscles on the outside of the airways tighten up (constriction), causing them to narrow. A thick fluid (mucus) enters the airways, which become swollen. The breathing passages are narrowed still more, and breathing becomes very difficult.

Why are Some Infants and Toddlers More Susceptible to Getting Asthma?

The process just described can be normal, up to a point. Everyone’s airways constrict somewhat in response to irritating substances like dust and mold. But in a person with asthma, the airways are hyperreactive. This means that their airways overreact to things that would just be minor irritants in people without asthma.

How is Asthma Diagnosed in Babies and Toddlers?

Diagnosing asthma in very young children is difficult. Since they are not able to communicate, they cannot describe how they are feeling. A baby’s fussy behavior could mean many things; however, toddlers and preschoolers often continue to be fairly active in spite of increasing chest tightness or difficulty with breathing.

Asthma symptoms can look like symptoms of other illnesses or diseases such as croup, bronchitis, pneumonia, upper respiratory tract viruses, or even a foreign body inhaled by the child, all have some of the same symptoms of asthma.

To help the pediatrician make a correct diagnosis, parents must provide information about family history of asthma or allergies, the child’s overall behavior, breathing patterns and responses to foods or possible allergy triggers. Lung function tests, often used to make a definitive asthma diagnosis, are very hard to do with young children. Instead, the physician may see how the child responds to medications to improve breathing. Blood tests, allergy testing and x-rays may be done to gather additional information.

Who Gets Asthma and What Triggers It?

Some traits make it more likely that a child will develop asthma. These risk factors can alert you to watch for signs of the disease so that your child can be treated promptly.

To some extent, asthma seems to run in families. Children whose brothers, sisters, or parents have asthma are more likely to develop the illness themselves. If both parents have asthma, the risk is greater than if only one parent has it. For some reason, the risk appears to be greater if the mother has asthma than if the father does.

What Are Some Asthma Triggers?

It is important to be aware of the things in your environment that tend to make asthma worse. These factors vary from person to person. Some of the more common factors or triggers are described here:

Allergens. Some allergens (substances that cause allergies) are more likely to trigger an asthma attack. For instance, babies in particular may have food allergies that can bring on asthma symptoms.

A baby with a food allergy may have diarrhea and vomiting. He or she is also likely to have a runny nose, a wet cough, and itchy, flaky skin. In toddlers, common allergens that trigger asthma include house dust mites, molds and animal hair. In older children, pollen may be a trigger, but indoor allergens and molds are more likely to be a cause of asthma.

Tobacco smoke. Today most people are aware that smoking can lead to cancer and heart disease. What you may not be aware of, though, is that smoking is also an important risk factor for asthma in children and a common trigger of asthma for all ages.

It may seem obvious that people with asthma should not smoke, but they should also avoid the smoke from others’ cigarettes. Secondhand smoke can trigger asthma symptoms in people with the disease.

Other irritants in the environment can also bring on an asthma attack. These irritants may include paint fumes, smog, aerosol sprays and even perfume.

Viral infections. Some types of viral infections can also trigger asthma.

Exercise. Exercise, especially in cold air, is a frequent asthma trigger. The symptoms of exercise-induced asthma usually go away within a few hours. With proper treatment, a child with exercise-induced asthma does not need to limit his or her overall physical activity.

Other triggers. Cold air, wind, rain and sudden changes in the weather can sometimes bring on an asthma attack. The ways in which children react to asthma triggers vary. In addition, asthma attacks do not always occur right after exposure to a trigger. Depending on the type of trigger and how sensitive this child is to it, asthma attacks may be delayed. Each case of asthma is unique to that particular child. It is important to keep track of the factors or triggers that you know to provoke asthma attacks in your child. Because the symptoms do not always occur right after exposure, this may take a bit of detective work.

What Are the Symptoms of Asthma?

Wheezing is a high-pitched, whistling sound that your child may make during an asthma attack.

If you hear this sound as your child breathes, be sure to let your doctor know. Not all people who wheeze have asthma, and not all those who have asthma wheeze. In fact, if asthma is really severe, there may not be enough movement of air through a person’s airways to produce this sound.

Chronic cough, especially at night and after exercise or exposure to cold air, can be a symptom of asthma.

Shortness of breath, especially during exercise, is another possible sign. All children get out of breath when they’re running and jumping, but most resume normal breathing very quickly afterward. If your child doesn’t, a visit to your doctor is in order.

Tightness in the chest is a symptom that you may have to ask your child about. If you notice any of the signs just described, it’s a good idea to ask your child whether he or she feels a tight, uncomfortable feeling in the chest.

What Can be Done to Reduce Asthma Symptoms?

You can reduce asthma symptoms by controlling allergy triggers in your child’s environment.
Concentrate on the bedroom, where very young children spend as much as 12-18 hours each day. Cover the pillows, mattress and box springs in allergen-proof casings. Wash bed linens weekly in 130-degree water. Use washable area carpets. Buy only washable stuffed animals.

Vacuum weekly or more. Don’t allow pets in the bedroom/house. Restrict smoking in the house (even if someone smokes in the basement of a multi-storied house, smoke filters through the vents to all parts of the house). Use air purifiers with a HEPA filter (only for animal dander for sensitive children if there is an animal in the home).

Asthma is an illness that is best understood, rather than feared. If your child has asthma, learn all you can about the disease and work with your doctor. This will afford your child the best chance of controlling asthma and allowing him or her to lead a normal, healthy and happy life.

Tips for parents of children with asthma

Learn the warning signs. Know your child’s particular asthma symptom pattern.

Develop an asthma care management plan with your child’s physician. Understand when your child’s symptoms require emergency care.

Follow your asthma care plan every day! Even if your child’s symptoms are gone, stick with the plan until you discuss changes with the doctor.

Get regular check-ups.

Teach your toddler or preschooler to tell you when they are not feeling well.

Work out an emergency plan of action to follow if your child has a serious asthma episode. What hospital will you use? (Be sure your doctor uses that hospital and it is in your health care plan.) Who will take care of your other children? How does your medical coverage provide for emergency care?

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