Developmental Considerations

Asthma in Children Under 5:

Many children develop asthma before age 5, and these infant, toddlers, and preschooler require different treatment than teens and adults.  Infants, toddlers and 4-year-olds are diagnosed and treated differently than are, and it may be impossible to obtain a diagnosis of asthma until a later age (Mayo, 2014). Older children and adults can confirm an asthma diagnosis by doing breathing tests (spirometry or peak flows) but most children under 5 can’t perform these tests yet (Mayo, 2014).  

Children in this age range may not be able to express to you verbally that they are having symptoms and will need help taking their medications.  Infants also tend to have less obvious symptoms of asthma because their chests are more flexible, but you may be able to see chest retractions (you may be able to see the outline of their ribs as they are trying hard to breath) (Hockenberry and Wilson, 2006).  They may feed slowly or get short of breath while feeding (Mayo, 2014).  Young children may sit in the Tripod Position (leaning forwards with hands on their knees) when attempting to breath better (Hockenberry and Wilson, 2006).  You may also notice shortness of breath, cough, and a decreased desire to run and play when your young child is having asthma symptoms (Mayo, 2014).   

Source: http://childrenshospitalblog.org/?s=asthma

For the child under 5, much of the stress of managing the disease falls on the parent(s) and may seem overwhelming.  Here are FIVE STEPS to help manage your infant, toddler, or preschooler’s asthma (Mayo, 2014):

1.  Learn about Asthma

• Understand your child’s medications, how they work, and when to give them
• Learn to recognize the signs and symptoms of asthma and to keep a record of symptoms
• Know what to do when your child's asthma gets worse

2.  Develop a Written Asthma ACTION PLAN (Find them here)

• Create this plan WITH your child's doctor
• An action plan outline the steps needed to manage asthma symptoms
• Everyone providing care to the child, including preschool teachers, should have a copy

3.  See the Doctor to Make Changes

• Every child is different, so your doctor will work with you to adjust medication types and dosages until you find what is most effective for your child’s asthma symptoms.
• Report any medication side effects (irritability, shaking, trouble sleeping or excitability)

4.  Control Asthma Triggers

• Learning to avoid asthma triggers is very important, but triggers vary from child to child, so the first step is identifying these triggers.  Once you have identified your child’s triggers, you can take step to avoid them.  
• Common asthma triggers are:
• Respiratory Infections/Colds
• Environmental Allergens (dust mites, pollen)
• Pets
• Exercise
• Cold Weather
• Cigarette Smoke
• Heartburn

5. Stick to the Plan!

• The best way to keep asthma under control is to follow your child's asthma action plan and update it when it isn’t working. You should carefully track changes in your child’s symptoms so that medication changes can be made BEFORE a severe attack occurs.

Asthma in Children Ages 5-11:

Physical Activity and Being a Kid:

Children with asthma that is well controlled should be able to run and play and participate in normal activities with other children, although they may need to take some precautions (Hockenberry  and Wilson, 2006).  Many children with asthma have exercised induced asthma (EIB), which means that symptoms are brought on by rigorous activity (Mayo, 2014). Exercise induced asthma is caused by the loss of heat and water from the lungs during exercise and occurs during or just after vigorous exercise (Sadaf and Kaslovsky, 2011). It should reach its peak 5-10 minutes after stopping exercise, and symptoms should resolve within 30 minutes (Sadaf and Kaslovsky, 2011).  

At this age, children can become very anxious about their condition and may fear dying, peer rejection for being "different,” and adverse drug affects (UpToDate, 2014). This may lead children to self-limit their activity; however, this does NOT need to be the case (Mayo, 2014).  If a child is receiving appropriate asthma treatment, physical activity doesn’t need to be restricted, and your child can participate in any type of sport at any level, even the Olympics (Mayo, 2014)!  However, without proper treatment, exercised induced asthma can result in negative physical outcomes, including poor overall fitness, decreased stamina, a sedentary lifestyle, and exercise avoidance (Mayo, 2014).

By the time a child is five years old, he should be able to be an active participant in controlling his asthma.  A pre-adolescent child should learn to use his rescue medication, avoid allergens, and practice good hand hygiene.  Children who take inhaled medication, such as through a nebulizer or metered dose inhaler (MDI), can be taught to use the device themselves (See How to use your Inhaler Post), but young children who cannot use the MDI correctly should use a spacer to make sure they all the medication into the lungs (Hockenberry and Wilson, 2006). Most children, 5 years of age or older, can also learn to use a peak expiratory flow meters (PEFMs), although they should be supervised while learning to use it (Hockenberry and Wilson, 2006). Children in the age range may sit in the Tripod Position (leaning forwards with hands on their knees) when attempting to breath, although older children may also sit upright with shoulders hunched and arms outstretched on a bed or chair (Hockenberry and Wilson, 2006).

Source: http://childrenshospitalblog.org/?s=asthma

Concerns About Growth:    

There is a concern that some asthma medications can impact growth when taken during the age range of 5-11 years of age, or children who have not yet gone though puberty (NIH, 2012).  A study published in 2012, found that children with asthma who took high doses of corticosteroids were shorter by half an inch than other children (NIH).  Other researchers argue that these children will catch up in height later.  Parents should discuss the risks and benefits of any medication with their child’s provider.  There are definite benefits gained by taking inhaled steroids (like Advair), including better asthma control and fewer, shorter hospitalizations;  inhaled steroids are generally considered the safest and most effective means of controlling asthma available (NIH, 2012).

Asthma in Children Ages 12 and older: 

Source: http://childrenshospitalblog.org/?s=asthma

For many people with asthma, symptoms can improve with adolescence and adulthood.  Some children’s asthma symptoms go away during their teen year, but for about two-thirds of kids, their asthma will continue into adulthood (Hockenberry and Wilson, 2006).  In general, when symptoms are frequent and severe, this is an indication they will continue into adulthood, and even children who “outgrow” having asthma attacks can continue to have overly reactive airways and a cough as adults (Hockenberry and Wilson, 2006). 

However, teens with asthma are actually at high risk for serious disease complications (Sadaf and Kaslovsky, 2011).  This is because many teens will deny the severity of their disease, underreport symptoms, stop taking their medication correctly, and engage in risk-taking behaviors that can greatly aggravate asthma like smoking tobacco and marijuana and using cocaine (Sadaf and Kaslovsky, 2011).  Many teens begin to view the strict treatment schedule necessary to control asthma as interfering with their newly emerging sense of independence (Sadaf and Kaslovsky, 2011).  Many teens with asthma also experience a number of psychiatric conditions at a higher rate than other teens, including depression, anxiety, ADHD, behavioral and learning disorders, and even posttraumatic stress disorder, especially in those who have experienced life threatening asthma complications (Sadaf and Kaslovsky, 2011). 

As children grow up, the balance of influences from friends, family, and their healthcare providers will change.  In early and middle adolescence, however, teens are often very concerned about how having asthma will affect their friendships and popularity with peers, but as teens progress from early to middle to late adolescence, they should eventually begin to think more like adults and begin to understand the importance of taking their medication again regardless of peer influence (Sadaf and Kaslovsky, 2011).  As adolescents begin to think like adults, it is important to let them speak to their doctor alone and take on the primary role in planning and evaluating their asthma therapy (Sadaf and Kaslovsky, 2011).  For parent, this is the time period in which the role transitions to being more of a supportive one.  Adolescents will also need guidance in making the transition into the adult healthcare world, as they often have significant financial barriers to getting care arise at this stage (Sadaf and Kaslovsky, 2011).