Pediatric Asthma

As mentioned above, it can be difficult for parents (and for doctors) to properly diagnose asthma in a child because so many of the symptoms are shared with other common conditions such as colds. Here are some clues to be looking for ...

Wheezing
Wheezing can sometimes be overlooked because it isn't obvious. If you suspect wheezing, place your ear against your child's chest and listen. If you detect any wheezing or squeaking, it's time to have your child evaluated by your pediatrician. If there is no wheezing, that doesn't mean your child is asthma free. Although it can be an overt symptom, it's not always present in asthma cases.

Coughing
Coughing, particularly in the absence of a cold, is a red flag. If you notice your child coughing after or during physical exercise, after crying, or often at night when there are no other cold symptoms, it's time to have your child evaluated by your pediatrician. A racking cough can be one of the most obvious signs of childhood asthma.

Frequent Respiratory Illnesses
If your child, even your infant (yes, infants can be asthmatic, too) is constantly battling chest colds, pneumonia and episodes of bronchitis, it's time to have your child evaluated by your pediatrician. These can often be signs of a case of asthma that's gone undiagnosed.

Shortness of Breath
You may notice your child or infant breathing rapidly and shallowly. This is a sign of a shortness of breath. Other signs that your child may be having trouble catching a breath may include flared nostrils, an anxious or frightened expression on your child's face, the spaces between your child's ribs may deepen during breathing, or child may bend over at the waist to gather additional air.

Other Signs
As a parent, you'll also want to become aware of any irregular breathing, noisy or difficult breathing, or excessive throat clearing. Also, if your child used to be active but appears to have lost his or her interest, it could be that there's a shortness of breath or a tightness in the chest inhibiting your child from exertion. In young children, tightness in the chest may also cause irritability.

In younger children, asthma attacks are often triggered by viruses, however as children grow and tend to spend more time outdoors their asthma triggers can change. For instance, in later childhood, triggers are often allergy-related.

Identifying environmental triggers can help your child avoid or at the very least minimize the risk of an acute asthma attack. Here are some of the more common asthma triggers ...

Dust Mites
Dust mites are tiny insects that live on off dead skin cells and excrete a substance that aggravates an asthma condition. They breed and grow in mattresses, pillows, stuffed animals, carpets, draperies - any soft surface that offers them a place to burrow and hide. For severe asthma cases, you can control dust mites by using covers on mattresses and pillows, eliminating stuffed animals in bedrooms, and removing carpets and draperies.

Dust
Because it's a bronchial irritant, dust itself can be an asthma trigger. Wipe down surfaces with a damp cloth to keep from scattering dust when cleaning, and use a canister (or water-filtered) vacuum cleaner to avoid spewing dust from the carpet into the air when vacuuming.

Mold
When sensitive to mold spores, your child's immune system considers them to be dangerous intruders. In response, several chemical substances, known as antibodies, are set free in your child's body. The primary antibodies are chemical substances known as histamine and lgE. The first one causes the irritation of your child's skin, nose, and eyes. The lgE is responsible for the symptoms that show up in your child's respiratory tract. To keep the exposure to mold minimized, wipe down bathroom tiles regularly with bleach or a disinfectant, dry clean laundry immediately and reduce moisture in the air with a dehumidifier.

Cockroach Parts
Cockroach litter and parts contain an irritant that can trigger an asthma attack in sensitive children. While most people associate cockroaches with poor housekeeping, the truth is cockroaches are just as happy in very clean homes. Roach traps, insecticides or a pest control company can help eliminate most cockroach problems.

Pet Dander
Dead skin cells from pets can be a virulent asthma trigger. If you can't bring yourself to part with your pet, bathe it regularly and try to confine it to areas of the house other that family sleeping areas.

Pollen
At certain times of the year, pollen can become a pervasive asthma trigger. This is particularly true during hay fever season if you live in an area that also has poor air quality. Many newspapers and radio stations publish a daily air quality rating. Make a point of knowing when the air quality is unhealthy and avoid going outside, or at least engaging in any vigorous activity outdoors.

Cold Dry Air
Cold dry air can trigger an asthma attack in some people. It's believed this is because the cold tends to dry out bronchial tissues faster than warm moist air. In any case, wearing a scarf or face mask in cold temperatures, particularly if you're exercising, can help reduce the number of asthma attacks attributable to this trigger.

Today, doctors understand far more about the mechanics of asthma than ever before. Treatment is usually a multi-pronged approach. In most cases, your child's doctor will still prescribe a bronchodilator - sometimes referred to as a rescue inhaler - for treatment of those acute moments when your child can't catch a breath.

Most likely, your child's doctor will also prescribe a maintenance medication to help control the inflammation that triggers asthma attacks. Maintenance medications generally come in one of two forms - inhaled corticosteroids (ICS) and leukotriene receptor antagonists. Essentially, ICS are anti-inflammatory. They act directly on the bronchioles and bronchial passages to reduce inflammation and keep the air passages open. Leukotriene receptor antagonists block the production of leukotrienes, substances in the lungs that cause narrowing and swelling of the airways. The National Asthma Education and Prevention Program lists corticosteroids as the treatment of choice, with leukotriene antagonists as one of several alternative therapies.

The truth is, however, that different children react differently. Some do far better using ICS daily, while others have better results from the leukotriene inhibitors. In fact, recently researchers have found that children who had low lung function and high inflammation did especially well on inhaled corticosteroids. Younger children who have had asthma for a shorter period of time showed better results with the leukotriene receptor antagonist.

The most common method prescribed to treat asthma is administering medication through the use of an inhaler. An inhaler is a small device with a pump that delivers a measured dose of medication when the pump is depressed. Unfortunately, the inhaler needs to be depressed at the same time that a huge breath is taken into the lungs. This kind of coordination can be a challenge for young children.

Which is why the National Institute for Clinical Excellence in the United Kingdom and the American Academy of Pediatricians recommend that children under the age of five be prescribed an inhaler with a spacer and a face mask. When the inhaler is used with a spacer and a face mask, the medicine stays in the mask so that the child can inhale it over the span of several breaths instead of one big breath.

Another issue that's popped up in recent years has affected many schoolchildren with asthma. Because schools often have a well-intentioned zero-tolerance policy for drugs that requires all medications to be kept locked up, some children with asthma have been denied the right to carry the medicine that can save their lives. It's vital that you, as the parent of a child with asthma, insist on your child's absolute right to carry an asthma inhaler with him or her at all times. If your child has been prescribed a bronchodilator asthma inhaler, be sure you know the rules at your school regarding asthma inhalers.

Researchers have found there's a clear link between pediatric asthma and stress. But it might surprise you to know that the link may be spiral in nature, with asthma feeding the stress, then the stress feeding the asthma, and on and on. In addition, when a child has asthma, additional stress is placed on the entire household. This stress is added to the burden the child is already bearing simply by having asthma.

According to the American Academy of Allergy, Asthma and Immunology, many families with asthmatic children operate in a constant crisis mode. They coast along, pretending everything is fine, until an acute asthmatic episode strikes in the middle of the night and necessitates another trip to the emergency room. Then once the episode is brought under control, things settle down again for awhile, until the next one hits.

This not only puts undue stress on the child and the family, it puts the child's life at risk. By sticking with the treatment plan on a daily basis, whether there are symptoms or not, you can actually prevent the symptoms from showing up. When you drift away from the treatment regiment because your child hasn't experienced any recent attacks, you allow the symptoms to return, which then contributes new stress to the situation.

The best way to deal with pediatric asthma and the stress it causes is to get a working asthma treatment plan, says the AAAAI (American Academy of Allergy Asthma and Immunology). A plan should include management of the asthma and the environment, medication, and clearly defined steps to take in case of an emergency. A solid action plan gives you and your child the confidence to handle whatever situations arise, and the confidence to know you're controlling the asthma rather than the asthma controlling you.