Allergies & Anaphylaxis – pre-school
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Dr Anna Maw
Consultant pediatrician at Cambridge University NHS Trust in the UK. A child doctor specializing in brain development and neurology. She has three children.
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Toddler care & health


Asthma is the most common lung condition in children - affecting around 1 in 11 children in the UK. Asthma is a condition that affects the airways in the lungs by making them swollen (inflamed) and narrow. This can cause coughing, wheezing (a high pitched whistling sound) and breathing difficulty. Someone with asthma will be sensitive to certain triggers. Discovering your child's triggers can take a bit of detective work but common triggers include cigarette smoke, pollen, cold air, furry pets, exercise, colds or chest infections. Asthma can be very serious and needs to be managed by a doctor / specialist. There's no cure but with the right treatment it can usually be managed successfully.
In Short
Don't hesitate to call an ambulance if your child is having an asthma attack and not responding to their inhaler. STATE CLEARLY what is happening and that it is an EMERGENCY. Continue to give your child the inhaler until the ambulance arrives. Up to 10 puffs is OK - one every 30-60 seconds.

How is asthma diagnosed?

There isn’t a single test to see if your child has asthma and the causes vary from child to child.

Your health care professional will:

1 – Ask about your child’s symptoms, their medical history and whether they or anyone else in the family has allergies or eczema.

2 – Listen to your child’s chest to see if they can hear wheezing

3 – Measure how fast your child can breathe using a “peak flow meter” if they are over 5 years old. (A peak flow test is a simple test of how quickly you can blow air out of your lungs. Peak flow meters are available from most pharmacies or on prescription).

Your child may be given a trial of treatment. This means having very small doses of asthma medication to see if it improves their symptoms. If their breathing is better after treatment then it’s likely they have asthma.

Triggers for asthma

Triggers for asthma aren’t the “cause” of asthma, but they are the things that bring asthma on – they will vary from child to child. These triggers can include:

1. Irritants

These are things that irritate the airways when they are breathed in, such as smoke and air pollution.

2. Exercise

Physical activity can make asthma worse, particularly in cold weather. But exercise is important for your child’s health so they shouldn’t avoid it. They should take their reliever inhaler before exercise. If they still get symptoms while exercising, they should have a rest, have their inhaler and wait until they feel better before starting again.

3. Allergies

If your child is allergic to something, their allergy could trigger asthma symptoms. Common things that cause an allergic reaction are pollen, mould, dust mites and pets.

4. Colds and flu

Colds and flu are common triggers for asthma.

5. Weather conditions

Cold weather can bring on asthma, as well as very hot weather, damp weather and thunderstorms.

6. Over-excitement/ being upset

Children can have lots of emotions in one day, and strong emotions, such as the excitement around a birthday, can trigger symptoms.

How can your child’s asthma be managed?

1. Include your child’s school in your asthma action plan.

Let your child’s school know about their condition, give them a copy of your child’s asthma action plan, and talk them through it.

What is an asthma action plan?

It is important that everybody with asthma has a written action plan.

This covers what medicine your child usually needs to take for their asthma and what needs to be taken if they have an asthma attack.

Your GP or asthma nurse can provide you with this.

It’s a good idea to make copies for school, playdates and so on.

2. Know your child’s triggers and avoid them when possible.

Look out for what makes your child’s asthma worse. If you’re a smoker, you’ll find your child’s asthma is harder to manage and your child’s asthma medicine may not work as well. Being around tobacco smoke will make your child’s asthma symptoms worse.

3. Don’t smoke

Don’t smoke, don’t wear smokey clothes into the house, and don’t let other people smoke in the house, if at all possible.

4. Never ignore worsening symptoms.

The symptoms of an asthma attack can take 6 to 48 hours to become serious. Spotting them early could help your child avoid a serious attack. If your child wakes up with symptoms during the night or in the early morning, their treatment may need adjusting. Arrange to see your doctor or nurse as soon as possible. You should also arrange an appointment if your child is wheezy during the day and needs to use their reliever inhaler more than three times a week.

5. Follow your child’s written personal asthma action plan

Always give your child their medication as instructed in the plan from your doctor or specialist.

6. Have regular asthma reviews.

Your child should have a review with their doctor, nurse or specialist every 6 months. This is to check they’re getting the right treatment – and this may change over time. If you think your child’s asthma action plan isn’t working, arrange a review sooner.

7. Check your child’s inhaler technique.

Make sure you and your school/ family/ carers – understands how your child should use the inhaler and spacer. Ask your doctor, nurse or specialist to show you if you’re not sure. Check your child’s technique regularly. This means you need to know it as well.

8. Monitor your child’s symptoms.

It’s really important the whole family takes your child’s asthma seriously and understands what to look out for. If your child is older, teach them how to recognise the symptoms too. Keep a diary of your child’s symptoms.

If your child is 5 or over, your doctor or nurse may ask you to measure your child’s peak flow (see above) regularly. Know what your child’s peak flow should be and what to do if it’s low.

How is asthma treated?

Inhalers, sometimes tablets, are usually prescribed to help manage the symptoms. There are many different types of inhalers available and the one prescribed for your child will depend on their age, ability to use a certain device and the severity of their symptoms.

Relievers (blue-salbutamol/ Ventolin)

These should be taken only when needed, such as during colds, when coughing, wheezing or having difficulty breathing.

They help to open the airways and help your child to breathe.

Sometimes, after an asthma attack, you may be told by your doctor to give your child the reliever inhaler regularly and wean down gradually.

Preventer treatments

These need to be taken everyday – even when your child is well.

Inhalers – (brown-beclometasone or orange-flixotide)

These are steroid inhalers that help control the inflammation in your child’s airways and help to prevent further asthma attacks.

Preventer granules or chewable tablet (montelukast, singulair)

These also help to control the inflammation in your child’s airways but they are not steroids.

Using spacers and relievers

All children susceptible to asthma should have a spacer device and reliever inhaler to use during an asthma attack.

At every asthma visit or review, your doctor or nurse will check you are happy using your inhaler, so take it with you to every appointment.

A spacer will help deliver the inhaler medicine deep into your child’s airways.

Each puff of the inhaler must go into the spacer separately and breathe in and out at least 6 times for each puff.

How to manage an asthma attack?

If your child has a cough, cold or wheeze, their chest feels tight or they feel out of breath.

Give the blue inhaler through the spacer – 2-6 puffs up to 4 hourly.

If your child needs their blue inhaler every 4 hours, is coughing all the time or feels too wheezy or breathless to play ot eat, then give an extra 2 puffs of the blue inhaler every 2 minutes until they feel better – up to a maximum of 10 puffs.

When should I take my child to hospital?

Most people can manage asthma at home and don’t need to go to hospital, but sometimes the symptoms can flare up in response to triggers, even when you follow your child’s asthma plan – this is called an asthma attack and your child may need to go to hospital.

How to spot an asthma attack

  • your child is wheezing
  • they might be complaining of a tummy ache
  • their symptoms are getting worse and worse
  • their usual reliever inhaler isn’t helping
  • they’re breathing very quickly and seem short of breath. If your child is older, you may notice that they can’t complete a sentence in one breath. If you have a baby, you may find that he or she is having difficulty breastfeeding or taking their bottle
  • their lips and tongue have a blue tinge

If you notice any of these signs:

  • Get them to sit up straight.
  • Give them their reliever inhaler. They normally only take 2 puffs, but if you think they’re having an attack, it’s OK to give them up to 10 puffs. You should space these out – 1 puff at a time every 30-60 seconds
  • If their symptoms improve, you can call 111 for help and advice. Make an urgent appointment with your GP or specialist to have your child’s treatment plan reviewed.
  • If their symptoms don’t improve, call 999 for an ambulance. State VERY CLEARLY that your young child is having an asthma attack and that they are not responding to their inhaler. State VERY CLEARLY that this is an URGENT situation. Keep giving your child their inhaler until the ambulance arrives.
  • If the ambulance is taking longer than 15 minutes to arrive, you can give them their reliever inhaler again in the same way as before.

It’s very important for you get help quickly if your child is having an asthma attack. Don’t hesitate to call 999. If you have to go to A&E, take their written asthma action plan with you.

Source – all the information above is from the Children’s asthma clinic at St Thomas’ hospital in London, and the British Lung Foundation.

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This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.