Childhood asthma

Date Updated: 03/13/2021

Overview

In childhood asthma, the lungs and airways become easily inflamed when exposed to certain triggers, such as inhaling pollen or catching a cold or other respiratory infection. Childhood asthma can cause bothersome daily symptoms that interfere with play, sports, school and sleep. In some children, unmanaged asthma can cause dangerous asthma attacks.

Childhood asthma isn't a different disease from asthma in adults, but children face unique challenges. The condition is a leading cause of emergency department visits, hospitalizations and missed school days.

Unfortunately, childhood asthma can't be cured, and symptoms can continue into adulthood. But with the right treatment, you and your child can keep symptoms under control and prevent damage to growing lungs.

Symptoms

Common childhood asthma signs and symptoms include:

Frequent coughing that worsens when your child has a viral infection, occurs while your child is asleep or is triggered by exercise or cold air
A whistling or wheezing sound when breathing out
Shortness of breath
Chest congestion or tightness

Childhood asthma might also cause:

Trouble sleeping due to shortness of breath, coughing or wheezing
Bouts of coughing or wheezing that get worse with a cold or the flu
Delayed recovery or bronchitis after a respiratory infection
Trouble breathing that hampers play or exercise
Fatigue, which can be due to poor sleep

Asthma signs and symptoms vary from child to child, and might get worse or better over time. Your child might have only one indication, such as a lingering cough or chest congestion.

It can be difficult to tell whether your child's symptoms are caused by asthma. Periodic or long-lasting wheezing and other asthma-like symptoms can be caused by infectious bronchitis or another respiratory problem.

When to see a doctor

Take your child to see the doctor if you suspect he or she has asthma. Early treatment will help control symptoms and possibly prevent asthma attacks.

Make an appointment with your child's doctor if you notice:

Coughing that is constant, is intermittent or seems linked to physical activity
Wheezing or whistling sounds when your child breathes out
Shortness of breath or rapid breathing
Complaints of chest tightness
Repeated episodes of suspected bronchitis or pneumonia

If your child has asthma, he or she may say things such as, "My chest feels funny" or "I'm always coughing." Listen for coughing, which might not wake your child, when he or she is asleep. Crying, laughing, yelling, or strong emotional reactions and stress also might trigger coughing or wheezing.

If your child is diagnosed with asthma, creating an asthma plan can help you and other caregivers monitor symptoms and know what to do if an asthma attack occurs.

When to seek emergency treatment

In severe cases, you might see your child's chest and sides pulling inward as he or she struggles to breathe. Your child might have an increased heartbeat, sweating and chest pain. Seek emergency care if your child:

Has to stop in midsentence to catch his or her breath
Is using abdominal muscles to breathe
Has widened nostrils when breathing in
Is trying so hard to breathe that the abdomen is sucked under the ribs when he or she breathes in

Even if your child hasn't been diagnosed with asthma, seek medical attention immediately if he or she has trouble breathing. Although episodes of asthma vary in severity, asthma attacks can start with coughing, which progresses to wheezing and labored breathing.

Causes

Childhood asthma causes aren't fully understood. Some factors thought to be involved include:

Inherited tendency to develop allergies
Parents with asthma
Some types of airway infections at a very young age
Exposure to environmental factors, such as cigarette smoke or other air pollution

Increased immune system sensitivity causes the lungs and airways to swell and produce mucus when exposed to certain triggers. Reaction to a trigger can be delayed, making it more difficult to identify the trigger. Triggers vary from child to child and can include:

Viral infections such as the common cold
Exposure to air pollutants, such as tobacco smoke
Allergies to dust mites, pet dander, pollen or mold
Physical activity
Weather changes or cold air

Sometimes, asthma symptoms occur with no apparent triggers.

Risk factors

Factors that might increase your child's likelihood of developing asthma include:

Exposure to tobacco smoke, including before birth
Previous allergic reactions, including skin reactions, food allergies or hay fever (allergic rhinitis)
A family history of asthma or allergies
Living in an area with high pollution
Obesity
Respiratory conditions, such as a chronic runny or stuffy nose (rhinitis), inflamed sinuses (sinusitis) or pneumonia
Heartburn (gastroesophageal reflux disease, or GERD)
Being male
Being black or Puerto Rican

Complications

Asthma can cause a number of complications, including:

Severe asthma attacks that require emergency treatment or hospital care
Permanent decline in lung function
Missed school days or getting behind in school
Poor sleep and fatigue
Symptoms that interfere with play, sports or other activities

Prevention

Careful planning and avoiding asthma triggers are the best ways to prevent asthma attacks.

Limit exposure to asthma triggers. Help your child avoid the allergens and irritants that trigger asthma symptoms.
Don't allow smoking around your child. Exposure to tobacco smoke during infancy is a strong risk factor for childhood asthma, as well as a common trigger of asthma attacks.
Encourage your child to be active. As long as your child's asthma is well-controlled, regular physical activity can help the lungs to work more efficiently.
See the doctor when necessary. Check in regularly. Don't ignore signs that your child's asthma might not be under control, such as needing to use a quick-relief inhaler too often.

Asthma changes over time. Consulting your child's doctor can help you make needed treatment adjustments to keep symptoms under control.
Help your child maintain a healthy weight. Being overweight can worsen asthma symptoms, and it puts your child at risk of other health problems.
Keep heartburn under control. Acid reflux or severe heartburn (gastroesophageal reflux disease, or GERD) might worsen your child's asthma symptoms. He or she might need over-the-counter or prescription medications to control acid reflux.

Diagnosis

Asthma can be hard to diagnose. Your child's doctor will consider the symptoms and their frequency and your child's medical history. Your child might need tests to rule out other conditions and to identify the most likely cause of the symptoms.

A number of childhood conditions can have symptoms similar to those caused by asthma. To complicate the issue further, these conditions also commonly occur with asthma. So your child's doctor will have to determine whether your child's symptoms are caused by asthma, a condition other than asthma, or both asthma and another condition.

Conditions that can cause asthma-like symptoms include:

Rhinitis
Sinusitis
Acid reflux or gastroesophageal reflux disease (GERD)
Airway abnormalities
Dysfunctional breathing
Respiratory tract infections such as bronchiolitis and respiratory syncytial virus (RSV)

The following are tests your child might need.

Lung function tests (spirometry). Doctors diagnose asthma with the same tests used to identify the disease in adults. Spirometry measures how much air your child can exhale and how quickly. Your child might have lung function tests at rest, after exercising and after taking asthma medication.

Another lung function test is brochoprovocation. Using spirometry, this test measures how your lungs react to certain provocations, such as exercise or exposure to cold air.
Exhaled nitric oxide test. If the diagnosis of asthma is uncertain after lung function tests, your doctor might recommend measuring the level of nitric oxide in an exhaled sample of your child's breath. Nitric oxide testing can also help determine whether steroid medications might be helpful for your child's asthma.

The asthma tests used, however, aren't accurate before 5 years of age. For younger children, your doctor will rely on information you and your child provide about symptoms. Sometimes a diagnosis can't be made until later, after months or even years of observing symptoms.

Allergy tests for allergic asthma

If your child seems to have asthma that's triggered by allergies, the doctor might recommend allergy skin testing. During a skin test, the skin is pricked with extracts of common allergy-causing substances, such as animal dander, mold or dust mites, and observed for signs of an allergic reaction.

Treatment

Initial treatment depends on the severity of your child's asthma. The goal of asthma treatment is to keep symptoms under control, meaning that your child has:

Minimal or no symptoms
Few or no asthma flare-ups
No limitations on physical activities or exercise
Minimal use of quick-relief (rescue) inhalers, such as albuterol (ProAir HFA, Ventolin HFA, others)
Few or no side effects from medications

Treating asthma involves both preventing symptoms and treating an asthma attack in progress. The right medication for your child depends on a number of things, including age, symptoms, asthma triggers and what seems to work best to keep his or her asthma under control.

For children younger than age 3 who have mild symptoms of asthma, the doctor might use a wait-and-see approach. This is because the long-term effects of asthma medication on infants and young children aren't clear.

However, if an infant or toddler has frequent or severe wheezing episodes, a medication might be prescribed to see if it improves symptoms.

Long-term control medications

Preventive, long-term control medications reduce the inflammation in your child's airways that leads to symptoms. In most cases, these medications need to be taken daily.

Types of long-term control medications include:

Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex HFA), ciclesonide (Alvesco), beclomethasone (Qvar Redihaler) and others. Your child might need to use these medications for several days to weeks before getting the full benefit.

Long-term use of these medications has been associated with slightly slowed growth in children, but the effect is minor. In most cases, the benefits of good asthma control outweigh the risks of possible side effects.
Leukotriene modifiers. These oral medications include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). They help prevent asthma symptoms for up to 24 hours.
Combination inhalers. These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include fluticasone and salmeterol (Advair Diskus, Advair HFA), budesonide and formoterol (Symbicort), fluticasone and vilanterol (Breo Ellipta), and mometasone and formoterol (Dulera).

In some situations, long-acting beta agonists have been linked to severe asthma attacks. For this reason, LABA medications should always be given to a child with an inhaler that also contains a corticosteroid. These combination inhalers should be used only for asthma that's not well-controlled by other medications.
Theophylline. This is a daily pill that helps keep the airways open. Theophylline (Theo-24) relaxes the muscles around the airways to make breathing easier. It's mostly used with inhaled steroids. If you take this drug, you'll need to have your blood checked regularly.
Immunomodulatory agents. Mepolizumab (Nucala), dupilumab (Dupixent) and benralizumab (Fasenra) might be appropriate for children over the age of 12 who have severe eosinophilic asthma. Omalizumab (Xolair) can be considered for children age 6 or older who have moderate to severe allergic asthma.

Quick-relief medications

Quick-relief medications quickly open swollen airways. Also called rescue medications, quick-relief medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your child's doctor recommends it.

Types of quick-relief medications include:

Short-acting beta agonists. These inhaled bronchodilator medications can rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex HFA). These medications act within minutes, and effects last several hours.
Oral and intravenous corticosteroids. These medications relieve airway inflammation caused by severe asthma. Examples include prednisone and methylprednisolone. They can cause serious side effects when used long term, so they're only used to treat severe asthma symptoms on a short-term basis.

Treatment for allergy-induced asthma

If your child's asthma is triggered or worsened by allergies, your child might benefit from allergy treatment, such as the following, as well:

Omalizumab (Xolair). This medication is for people who have allergies and severe asthma. It reduces the immune system's reaction to allergy-causing substances, such as pollen, dust mites and pet dander. Xolair is delivered by injection every two to four weeks.
Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid, cromolyn and ipratropium nasal sprays.
Allergy shots (immunotherapy). Immunotherapy injections are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your child's immune system reaction to specific allergens.

Don't rely only on quick-relief medications

Long-term asthma control medications such as inhaled corticosteroids are the cornerstone of asthma treatment. These medications keep asthma under control and make it less likely that your child will have an asthma attack.

If your child does have an asthma flare-up, a quick-relief (rescue) inhaler can ease symptoms right away. But if long-term control medications are working properly, your child shouldn't need to use a quick-relief inhaler very often.

Keep a record of how many puffs your child uses each week. If he or she frequently needs to use a quick-relief inhaler, take your child to see the doctor. You probably need to adjust the long-term control medication.

Inhaled medication devices

Inhaled short- and long-term control medications are used by inhaling a measured dose of medication.

Older children and teens might use a small, hand-held device called a pressurized metered dose inhaler or an inhaler that releases a fine powder.
Infants and toddlers need to use a face mask attached to a metered dose inhaler or a nebulizer to get the correct amount of medication.
Babies need to a use a device that turns liquid medication into fine droplets (nebulizer). Your baby wears a face mask and breathes normally while the nebulizer delivers the correct dose of medication.

Asthma action plan

Work with your child's doctor to create a written asthma action plan. This can be an important part of treatment, especially if your child has severe asthma. An asthma action plan can help you and your child:

Recognize when you need to adjust long-term control medications
Determine how well treatment is working
Identify the signs of an asthma attack and know what to do when one occurs
Know when to call a doctor or seek emergency help

Children who have enough coordination and understanding might use a hand-held device to measure how well they can breathe (peak flow meter). A written asthma action plan can help you and your child remember what to do when peak flow measurements reach a certain level.

The action plan might use peak flow measurements and symptoms to categorize your child's asthma into zones, such as the green zone, yellow zone and red zone. These zones correspond to well-controlled symptoms, somewhat-controlled symptoms and poorly controlled symptoms. This makes tracking your child's asthma easier.

Your child's symptoms and triggers are likely to change over time. You'll need to observe symptoms and work with the doctor to adjust medications as needed.

If your child's symptoms are completely controlled for a time, your child's doctor might recommend lowering doses or stopping asthma medications (step-down treatment). If your child's asthma isn't as well-controlled, the doctor might want to increase, change or add medications (step-up treatment).

Lifestyle and home remedies

Taking steps to reduce your child's exposure to asthma triggers will lessen the possibility of asthma attacks. Steps to help avoid triggers vary depending on what triggers your child's asthma. Here are some things that may help:

Maintain low humidity at home. If you live in a damp climate, talk to your child's doctor about using a device to keep the air drier (dehumidifier).
Keep indoor air clean. Have a heating and air conditioning professional check your air conditioning system every year. Change the filters in your furnace and air conditioner according to the manufacturer's instructions. Also consider installing a small-particle filter in your ventilation system.
Reduce pet dander. If your child is allergic to dander, it's best to avoid pets with fur or feathers. If you have pets, regularly bathing or grooming your pets also might reduce the amount of dander. Keep pets out of your child's room.
Use your air conditioner. Air conditioning helps reduce the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your child's exposure to dust mites. If you don't have air conditioning, try to keep your windows closed during pollen season.
Keep dust to a minimum. Reduce dust that can aggravate nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dustproof covers. Consider removing carpeting and installing hard flooring, particularly in your child's bedroom. Use washable curtains and blinds.
Clean regularly. Clean your home at least once a week to remove dust and allergens.
Reduce your child's exposure to cold air. If your child's asthma is worsened by cold, dry air, wearing a face mask outside can help.

Alternative medicine

While some alternative remedies are used for asthma, in most cases more research is needed to see how well they work and to determine possible side effects. Alternative treatments to consider include:

Breathing techniques. These include structured breathing programs, such as the Buteyko breathing technique, the Papworth method and yoga breathing exercises (pranayama).
Relaxation techniques. Techniques such as meditation, biofeedback, hypnosis and progressive muscle relaxation might help with asthma by reducing tension and stress.
Herbal remedies and supplements. A few herbal remedies have been tried for asthma, including black seed, fish oil and magnesium. However, further studies are needed to assess their benefit and safety.

Herbs and supplements can have side effects and can interact with other medications your child is taking. Talk to your child's doctor before trying any herbs or supplements.

Coping and support

It can be stressful to help your child manage asthma. Keep these tips in mind to make life as normal as possible:

Make treatment a regular part of life. If your child has to take daily medication, don't make a big deal out of it — it should be as routine as eating breakfast or brushing teeth.
Use a written asthma action plan. Work with your child's doctor to develop your child's action plan, and give a copy to all of your child's caregivers, such as child care providers, teachers, coaches and the parents of your child's friends.

Following a written plan can help you and your child identify symptoms early, providing important information on how to treat your child's asthma from day to day and how to deal with an asthma attack.
Be encouraging. Focus attention on what your child can do, not on limitations. Involve teachers, school nurses, coaches, relatives and friends in helping your child manage asthma.

Encourage normal play and activity. Don't limit your child's activities out of fear of an asthma attack — work with your child's doctor to control exercise-induced symptoms.
Be calm and in control. Don't get rattled if asthma symptoms worsen. Focus on your child's asthma action plan, and involve your child in each step so that he or she understands what's happening.
Talk to other parents of children with asthma. Chat rooms and message boards on the internet or a local support group can connect you with parents facing similar challenges.
Help your child connect with others who have asthma. Send your child to "asthma camp" or find other organized activities for children with asthma. This can help your child feel less isolated and gain a better understanding of asthma and its treatment.

Preparing for an appointment

You're likely to start by taking your child to your family doctor or your child's pediatrician. However, when you call to set up an appointment, you may be referred to an allergist, lung doctor (pulmonologist) or other specialist. Here's some information to help you get ready for your child's appointment.

What you can do

Make a list of:

Your child's symptoms, how severe they are and when they occur. Note when symptoms bother your child most — for example, if symptoms tend to get worse at certain times of the day; during certain seasons; when your child is exposed to cold air, pollen or other triggers; or when he or she is playing hard or participating in sports.
Key personal information, including any major stresses or recent life changes your child has had.
All medications, vitamins and supplements your child takes, including doses.
Write down questions to ask the doctor.

For asthma or asthma-like symptoms, questions to ask your doctor include:

Is asthma the most likely cause of my child's breathing problems?
What else could be causing my child's symptoms?
What tests does my child need?
Is my child's condition likely temporary or chronic?
What treatment do you suggest?
My child has these other health conditions. How can we best manage them together?
Are there restrictions my child needs to follow?
Should my child see a specialist?
Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your child's doctor

The doctor is likely to ask questions, including:

When did you notice your child's symptoms?
Does your child have difficulty breathing most of the time or only at certain times or in certain situations?
Does your child have allergies such as hay fever?
What, if anything, appears to worsen your child's symptoms?
What, if anything, seems to improve your child's symptoms?
Do allergies or asthma run in your child's family?