The management of asthma in young children is tricky. Children are more difficult
to properly diagnose, there is less research on the effectiveness of different
treatment regimens, and it is more difficult to determine whether their symptoms
are getting worse. Young children with exercise-induced asthma can be hard
to manage because they are so spontaneously active. Nevertheless, great strides
have been made in improving asthma treatment in infants and young children.
It's estimated that up to 80% of children with asthma develop their first
symptoms before age 5. That underscores the importance of early diagnosis and
treatment. Many children under age 5 with asthma have NOT been properly diagnosed.
Some children should receive asthma treatment, even if they do not yet have
asthma in order to prevent it from developing (see below).
Diagnosis can be difficult -- other conditions that may have similar symptoms
include bronchitis, pneumonia, gastroesophageal reflux, colds, and other conditions.
Because wheezing and coughing can be due to these other conditions, it is important
not to jump to the conclusion that the child has asthma and begin unnecessary
long-term asthma therapy. A trial run of asthma medication may help determine
whether asthma is the cause of wheezing, cough, or breathlessness.
Treating asthma attacks
Any child, regardless of age, who is having an asthma attack needs relief
medicine to open the airways. The preferred treatment is a short-acting
beta agonist. Small children are unlikely to be able to use an inhaler by
itself properly. Therefore, they need to use either a nebulizer (which has
a mask and hose connected to a machine that aerosolizes the medicine) or
an inhaler with a mask-spacer attached to it. Some companies even make nebulizer
masks with fun characters on them to make the experience a little more tolerable
for small children.
Should my child use control medicine
An expert panel organized by the National Institutes of Health recommended
that long-term, daily control medication should
be considered for children age 5 or under who:
- Need their asthma symptoms treated with relief medication more than 2 times
- Have asthma symptoms more than 2 nights per month
- Have severe episodes less than 6 weeks apart
In addition, young children should be considered for daily control, whether
or not they have been diagnosed with asthma, in order to prevent or delay the
development of asthma. Children most likely to benefit are those who have had
more than 3 episodes of wheezing in the past year (which lasted more than a
day and disrupted the child's sleep) and if they have any of these risks for
- Child has atopic dermatitis
- A parent has or had asthma
- Child wheezes when the child doesn't have a cold and has allergic rhinitis,
or evidence of allergies on a blood test
Recommendations for asthma control in infants and young children
can be found in the National Institutes of Health Expert
Panel Executive Summary (Note: File requires Adobe
Acrobat). A chart is on page 4 and dosing information is
on page 6. This expert panel report is intended for physicians
and written at a clinical level, but some parents may find the
detailed information useful.
The safety of long-term medication
Studies have investigated the impact of long-term inhaled steroid use on growth,
bone mineral density, and other factors in children. While some unwanted effects
have been seen, the evidence to date indicates that these effects tend to be
uncommon and reversible.
If a child appears to be having a slow rate of growth, the benefits of continuing
asthma medication should be weighed. It is likely the child will eventually
reach a normal height. For children with persistent asthma, inhaled steroids
are very effective and the benefit of preventing asthma attacks usually outweighs
a risk of growth delay. Also, keep in mind that children who take control medicine
need lower doses of relief medicine, and thus have fewer side effects from
Monitoring asthma in young children
Children age 5 and under are often unable to use a peak flow meter correctly.
Therefore, it is largely up to the parent to watch for signs that the child's
asthma is growing worse. These include wheezing, coughing, skin on the neck
and chest looking sucked in, and other signs of breathing difficulties. As
children get older, they are better able to recognize when their condition
is getting worse, and eventually will be able to use a peak flow meter with
the parent's help.
It's a good idea to teach a child under 5 how to use a peak flow meter, just
to get them into the habit of using it from an early age, but not to actually
rely on the meter for monitoring the child's condition.
Williams SG, Schmidt DK, Redd SC, Storms W. Key clinical activities for quality
asthma care: recommendations of the National Asthma Education and Prevention
Program. MMWR Recomm Rep. 2003 Mar 28;52(RR-6):1-8.
Review Date: 5/16/2007
Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
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