Asthma in children

Asthma is a condition that causes cough, wheeze and shortness of breath. It is common, with 1 in 7 children in New Zealand taking medication for asthma. With treatment, asthma can be well managed and children can run and play as normal. Many also grow out of it as they get older.

This page focuses on asthma in children. See also asthma in adults for more information.

Key points

  1. Asthma is an inflammation of your airways. This leads to them becoming narrower, which makes it harder to breathe.
  2. Key symptoms of asthma are coughing, wheezing, a tight feeling in your chest and finding it hard to breathe.
  3. Asthma is very common in children, but many grow out of it as they get older.
  4. Asthma can be well managed through medication and managing triggers.
  5. If your child has severe asthma, follow the steps below and seek urgent medical help.

What is asthma?

In asthma, the small and medium-sized airways in the lungs, called breathing tubes or bronchi, become inflamed. This causes:

  • swelling of your airways
  • tightening of your airway walls
  • an increase in mucus (phlegm). 

These changes cause narrowing of your airways. This can lead to wheezing, coughing, breathlessness and a tight feeling in your chest.


image of narrowed airways due to asthma

Source: 123rf.com

What causes asthma?

Children with asthma have sensitive airways that react to certain triggers, such as allergens (substances that cause an allergic reaction), viruses, cold or humid weather, exercise, emotions such as anxiety and excitement,  and air pollutants, such as cigarette smoke. 

It is not clear why some children get asthma and others don’t. Asthma is more common in people who have eczema or allergies such as hay fever, so if you have these in your family your child may be more likely to develop asthma.

What are the symptoms of asthma?

Common symptoms of asthma include:

  • cough, which can be worse at night or in the morning, or with exercise
  • wheezing (a whistling, musical or squeaky noise in your chest)
  • difficulty breathing, feeling out of breath and as though you can’t get enough air out of your lungs
  • a tight feeling across your chest.

Some children have symptoms more often and need to be managed with preventative medication, while other children only have symptoms when they have a cold, are exercising or are exposed to some other trigger.

If your child has mild asthma symptoms, follow their asthma action plan and use their short-acting reliever. If symptoms don't settle you should see a doctor straight away. 

Keep an eye on your child's symptoms. If your child is getting wheezy more than 2 times a week, it may mean your child's asthma is not well controlled. See your doctor for a check-up.

Severe asthma symptoms

Sometimes some children experience severe asthma symptoms. You should follow your child's asthma action plan and give them their reliever inhaler if they have the following symptoms:

  • breathing fast, wheezing and having to use extra effort to breathe
  • breathless at rest
  • look pale and unwell, and is beginning to get tired
  • have trouble completing a sentence because of difficulty breathing.

See your doctor straight away if symptoms have not improved within a few minutes of using their reliever inhaler or if you are worried.

When to seek urgent medical help

Call 111 within New Zealand and ask for an ambulance if your child:

  • has severe difficulty breathing
  • is too breathless to talk
  • is floppy and very tired
  • is becoming less responsive
  • has blue lips and tongue
  • has periods of stopping breathing
  • reliever medication isn’t working.

While waiting for an ambulance follow your asthma action plan and use your child's short-acting reliever. Sit your child down and try to stay calm, give 6 puffs of reliever through a spacer, taking 6 breaths for each puff. Repeat this every 6 minutes until your child improves or until help arrives.

Allergy symptoms

If your child has symptoms of hay fever (also known as allergic rhinitis), such as a blocked or runny nose, talk to your doctor. They may recommend medication to treat these symptoms, such as antihistamines or steroid nasal sprays. Treating hay fever can improve asthma symptoms.

What are the common asthma triggers?

Learning what triggers your child’s asthma and finding ways to avoid or reduce the impact of these is an important part of managing your child’s asthma.

Examples of common asthma triggers
  • house dust mite
  • infections of the airways, such as colds and flu
  • pollen or mould
  • pets
  • cigarette smoke
  • weather, such as a change in temperature, cold weather or humid weather
  • exercise
  • stress and strong feelings
  • chemicals that irritate your airways, such as sprays, perfumes, cleaning fluids
  • some medications.

How do I know my child has asthma?

If you are concerned your child may have asthma take them to see their doctor, who will:

  • ask about your child’s asthma symptoms at present and in the past 
  • ask whether your child or any close family relatives have any allergies such as eczema or hay fever
  • listen to your child’s breathing with a stethoscope 
  • check how your child’s lungs are working with a device called a peak flow meter. This can be difficult to perform in children, depending on their age, as it needs maturity, cooperation and understanding from the child.

Asthma action plans

If your child is diagnosed with asthma, your doctor will help set up an asthma action plan for your child. This plan will be tailored to suit your child’s condition. It will provide advice on how to manage your child’s asthma on a daily basis and how to recognise and handle worsening symptoms.

Read more about asthma action plans for children.

How is asthma treated?

While asthma cannot be cured, the correct use of medication combined with other self-care measures means that symptoms can be well controlled in most children. Once a diagnosis of asthma is made, your doctor will assess which medication is right for your child. 

The main aims of asthma treatment are to:

  • keep symptoms under control
  • prevent asthma attacks or exacerbations (sudden worsening of symptoms)
  • keep lungs as healthy as possible
  • stop asthma from interfering with school
  • help your child enjoy a full and active life.

Asthma medications

There are many different types of asthma medicines. The choice of medication will depend on how severe and frequent your child's asthma symptoms are. Sometimes your child will have to take more than one.

Asthma medications fall into the main categories of relievers, preventers and corticosteroids (for severe asthma attacks).

Type of asthma medication Description
Relievers
  • Relievers are used for quick relief when your child has difficulty breathing. They are fast-acting and improve breathing immediately.
  • Relievers should only be used now and again. Using them too often means that your child's asthma is not well controlled.
  • Common relievers include:
  • Read more about relievers.
 Preventers
  • Preventers are used long term to prevent asthma symptoms from coming on.
  • Preventers must be taken every day, even when you are not having symptoms.
  • Preventers take days or weeks to work. They do NOT provide quick relief of asthma symptoms.
  • The main types of preventers commonly used are:
  • Montelukast tablets may be used in some children.  
  • Read more about preventers.
Corticosteroids
  • Are used for very severe episodes of asthma and works more intensely to reverse the swelling of the airways. 
  • Examples include prednisone (tablets) or prednisolone (liquid).
  • Read more about corticosteroids.

Read more about asthma medications.

Asthma inhalers and spacers

Asthma medication usually comes in an inhaler (puffer). An inhaler is a device used to get medicine into your lungs and airways. By getting medicine directly to your lungs, a smaller dose of medicine is needed, and it can start working more quickly. The main types of inhaler devices are:

  • metered dose inhalers (MDIs)
  • dry powder inhalers such as Turbuhalers, Accuhalers, and Handihalers.

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To make using an MDI easier and to ensure that more medicine gets into their lungs, children should always use it with a spacer – a clear plastic tube with a mouthpiece or mask on one end and a hole for their inhaler at the other. 

Read more about inhaler devices and spacers.

Support

Asthma New Zealand provides education, training and support to individuals with asthma/COPD and their families. Read more

Learn more

Learn about lungs Asthma & Respiratory Foundation, NZ
Asthma
KidsHealth, NZ, 2015
Asthma NHS Choices, UK, 2018

References

  1. Child and adolescent asthma guidelines: a quick reference guide Asthma and Respiratory Foundation NZ

Reviewed by

Teresa Demetriou is the head of education and research at the Asthma and Respiratory Foundation NZ and co-author of the Child and Adolescent Asthma Guidelines. As a registered nurse with a wide range of experience in primary health, respiratory healthcare and education, she is responsible for ensuring that evidence-based best practice is implemented into all of the Foundation’s training, guidelines and resources.
Credits: Health Navigator Editorial Team. Reviewed By: Teresa Demetriou, head of education and research, Asthma and Respiratory Foundation NZ