Your Primer on Asthma in Kids
Fish swim, birds fly, children get sick. Ailments range from seasonal allergies and the common cold to the unavoidable chicken pox.
One illness many parents have to help their children manage is asthma. Of course, how difficult a child's asthma is to manage depends on the severity of the condition. Because asthma has the potential to be life-threatening, it's vital for parents to be informed.
How does asthma manifest in kids?
Asthma is a chronic inflammatory disorder that obstructs airflow. Researchers are still exploring why some people develop childhood asthma and others do not, but they have found associations with genetics, early childhood lung damage, environmental factors and allergies.
Airways in children are like upside-down trees, starting with the trachea, or windpipe, which has two major branches that continuously branch into smaller airways within the lungs. The lining of these airways can get irritated, or triggered, from exposure to different particles in the air we breathe.
Some triggers (children may have multiple) are colds, dust, pollen, smoke, exercise, playing, roaches, strong odor, stress, mold, temperature changes, anxiety and animal dander. Triggers cause an inflammatory response in the lungs, which causes the bronchi to narrow, compromising airflow in the lungs. Asthma and its symptoms can present in a child as early as 5 years old.
The key to managing asthma is knowing your child's triggers and avoiding or controlling exposure to them.
Common asthma symptoms in kids include wheezing, coughing, dyspnea (fast breathing or shortness of breath after exercise) and chest tightness, because of the narrowing of airways from inflammation. Pamela Cummings, a respiratory therapist, warns that a child may present only one symptom at first, and also that symptoms may worsen over time.
Parents are encouraged to be observant of symptoms as well as what may have triggered the episode. It is very hard to conclusively diagnose a child with asthma before 5 years old, because testing includes following instructions a young child may not comprehend and be able to follow. Diagnosis in this age group is usually done when asthma-like symptoms respond to regular treatments.
Rochelle, a mother of three boys ages 19 months to 7 years, the eldest two of which have asthma, first noticed symptoms before the boys' first birthdays: coughing, wheezing and flaring of the nostrils. They were diagnosed with asthma and are now both on a maintenance regimen and see a pediatric pulmonologist at least twice per year. Their father's asthma diagnosis indicates a potential genetic link.
Information for the foster parent
Knowing a child's complete medical history isn't always possible, as in the cases of foster children, especially those who have been placed via emergency removal. Social worker Philisa Campbell called it a "gigantic task," but explained steps are in place to ensure foster parents are equipped to handle potential medical hurdles.
As Campbell outlined, by the time Child Protective Services has deemed it necessary to remove a child from a given home, a licensed social worker must complete due diligence to obtain and relay all relevant information to the impending foster parent.
Additionally, state law mandates a child removed from the primary home and placed in foster care must be evaluated by a doctor and dentist, and complete a psychological evaluation within 30 days. This is a concerted effort to ensure foster parents have all the medical information they need to care for the child.
Managing asthma in children
Asthma has no cure, but Cummings said there is a highly effective treatment.
"Asthma is a chronic disorder but can be controlled," Cummings said. "Uncontrolled, it could become an emergency situation with harsh results."
The illness can change over time, so it is very important for parents to engage with a medical professional to track and monitor the child's condition as they get older. Doctors may give children a handheld device called a peak flow meter, which measures how well the child's lungs are functioning by how quickly they can expel air from their lungs.
The key to managing asthma is knowing your child's triggers and avoiding or controlling exposure to them. Treatment for asthma will vary based on the severity and frequency of episodes. A child with infrequent but severe episodes may be prescribed quick-relief asthma medicine. These are short-acting bronchodilators/inhalers that provide immediate relief of asthma symptoms and last up to six to eight hours. The most commonly used one is albuterol, a prescription medicine; common name brands are ProAir HFA and Ventolin HFA.
A child who has frequent and severe asthma attacks will often be prescribed long-term control medication, known as maintenance medication because they are taken every day over a long period of time. They can be inhaled steroids that contain anti-inflammatory drugs. Common brands include Flovent HFA, Pulmicort Flexhaler, Qvar RediHaler, Alvesco, Omnaris and Asmanex HFA. Leukotriene modifiers such as Singulair, Accolate and Zyflo can also be used alone or as an addition to treatment with inhaled corticosteroids.
Know the risks
These medications are not without risk. In rare cases, montelukast and zileuton have been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away if your child has any unusual psychological reaction.
In some cases, combination inhalers contain an inhaled steroid and a long-lasting beta agonist (LABA). Examples of these are Advair HFA, Symbicort, Breo, Ellipta and Dulera. These combination inhalers have also been linked to severe asthma attacks. LABA medications should only be given to children combined with a corticosteroid in a combination inhaler. This reduces the risk of a severe asthma attack. If your child's situation is more complex, visit your doctor.
A biologic like the Nucala, an injectable, is given to a patient every four weeks to help control severe asthma. Children age 6 and older may benefit from the addition of this therapy to their current treatment plan. However, the treatment is newer so talk to your doctor about its effectiveness and whether it's a possibility for your child.
As with other childhood illnesses, successfully managing a child's asthma requires effort and adherence to medical advice.
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