Information for parents

It is difficult to diagnose asthma in small children. Colds and infections in the bronchi of the lungs ( bronchitis) are common in this age group. The cough caused by these viral infections is sometimes accompanied by slight whistling or rattling noises. It can be difficult to tell the difference between bronchitis and early signs of asthma in young children. Asthma-like symptoms in bronchitis tend to become less common as children get older, though.

A doctor can do specific breathing tests with your child to find out whether asthma is causing the symptoms. Lung function tests such as peak flow measurement or spirometry can be used to see if your child's lungs are working properly, and whether air that has been breathed in can flow freely through their bronchi (lung airway passages). These tests only work with the child's help, so they are usually only suitable for somewhat older children.

Asthma is a chronic (long-lasting) condition in many people. But not everyone who has asthma as a child will also have it later on as an adult. Nobody knows why that is. It's also not known whether a particular treatment can help children “grow out of” the disease.

Asthma comes and goes in phases, so your child might have long symptom-free phases. Sometimes the symptoms disappear completely after puberty. But even when this happens, the airways are usually still sensitive, and certain triggers still make them become narrower, causing asthma symptoms.

So asthma doesn't necessarily keep getting worse – especially if you get the right treatment. Asthma can also be very mild or moderate. Severe asthma is rare in children.

If a child has moderate or severe asthma, it can be quite a burden for the family. Seeing your child struggle to breathe properly can be worrying or even frightening. And it's sometimes difficult to keep up the treatment. Small children often don't understand why they have to take medication regularly. Having to deal with a chronic disease can be very demanding for children, who would prefer to have the kind of carefree childhood some of their friends have.

If you are the parent or guardian of a child who has asthma, there are several things you can do to make it easier for them to cope with the disease. The goal is to relieve the symptoms as much as possible and to help the child have a fairly normal life. One thing you can do is help your child to take medicine properly. It's also important to try to make sure that he or she feels “normal” amongst friends, family and neighbors, and at school. Many children don't know how to deal with the diagnosis at first. They may feel embarrassed and try to keep it a secret. Many children also tend to constantly worry about asthma attacks. Supportive parents are then a great help.

If you can make sure that your child grows up in a smoke-free environment, you can protect them from a major cause of asthma. Cigarette smoke damages your child's lungs and makes asthma symptoms worse. There are various treatments that can help make quitting a bit easier for you or other family members.

It is important that the child’s emotional well-being and social environment are taken into consideration in the therapy. There are also patient education courses designed to teach parents and children how to manage asthma. These courses are offered for different age groups so that they are appropriate for the child's stage of development.

Two groups of medications are used in the treatment of asthma:

• Reliever ("rescue") medication: These medications quickly open up the airways and relieve acute symptoms. They help your child during an asthma attack, but may also be used to help prevent an asthma attack, for instance before doing physical exercise.
• Controller ("preventer") medication: These medications reduce the inflammation in the bronchi of the lungs, which prevents asthma symptoms over the long term. Controllers usually have steroids in them, and are generally used every day – even if the child doesn't have any symptoms.

The medication options will depend on how well the symptoms can be managed. In mild asthma, people usually only need to use medication when they have acute symptoms. More severe symptoms can generally only be kept under control by using one or several medications every day.

In children who have allergic asthma, a treatment known as allergen-specific immunotherapy may also help relieve the symptoms. This kind of therapy takes several years and can make a child less sensitive to the allergy-related asthma triggers.

If the doctor recommends that their child take corticosteroids, many parents worry about possible side effects. For people with severe asthma, though, asthma attacks are much more dangerous than the side effects of controller medication. Most asthma medications, including corticosteroids, can be inhaled. When inhaled as a spray or powder, these drugs have far fewer side effects than when used as tablets or injections.

There are concerns that long-term use of corticosteroids in children could impair their growth. But steroid inhalers are very unlikely to permanently affect children's height. Research has shown that they grow a little more slowly in the first year of treatment, but develop normally after that. This suggests that they grow to the same final adult height as other children with asthma who don't inhale corticosteroids. Still, to be on the safe side, young patients are usually only prescribed the lowest possible doses of steroids and, if possible, only steroids which are inhaled.

Asthma is sometimes triggered by substances in the air that also irritate the airways of people who don't have asthma, such as perfumes, smoke and other pollutants. These substances can cause severe symptoms in people with asthma. Other substances and environmental conditions that are normally harmless – like dust, pollen, animals or temperature fluctuations – sometimes irritate the airways of people who have asthma, leading to an overreaction.

To protect your child, you need to know what triggers their asthma. It can help to observe what things and situations make their symptoms arise or get worse. But it's important not to exaggerate. Wrongly assuming that something is a trigger can lead to unnecessary restrictions. Precautions that might protect your child, but also prevent them from doing everyday things – like meeting up with friends, following their interests, and going to kindergarten or school – could do more harm than good.

Animals can trigger allergies. You should avoid direct and indirect contact with animals. If your child has an allergic reaction to a beloved pet, you should keep the pet in a separate part of your home. Sometimes that doesn't help. You may then have to find a new home for it. But it's only a good idea to take these measures if you know that your child's asthma symptoms flare up when they come into contact with animals. Avoiding pets hasn't been proven to prevent asthma.

Asthma is a complex disease. Trying to avoid triggers may not be worth the effort and sacrifices involved for your child. For example, it's almost impossible to completely avoid all dust mites. Individual measures hardly make a difference. But combining different measures may help – for instance, cleaning the floor with a wet rag, using a dust-mite-proof mattress cover, regularly washing the child's bedding at more than 55°C (130°F), and removing any "dust traps" such as upholstered furniture and rugs.

In most cases, as long as children use their controller medication properly, triggers no longer have an effect.

If a child has asthma, it doesn't mean that they can't play with friends, or do sports at school or in a sports club. Physical activities are a major part of daily life for many children and teenagers who have asthma.

Getting a lot of exercise is important for a child's physical development. Exercise and sports can even have an extra benefit for children who have asthma. They can improve the performance of their lungs and their general level of fitness. Exercise and sports can also reduce the frequency of asthma attacks. Asthma should be treated (or “controlled”) in a way that makes it possible for the child to play and participate in sports at any time. You can talk with the doctor about whether it's a good idea for your child to use medicine before doing strenuous physical activities, to prevent asthma symptoms that are caused by physical exertion (exercise-induced asthma).

It is difficult to say for sure whether certain types of sports are better for children with asthma. But swimming, for example, is probably less likely to trigger exercise-induced asthma than winter sports are. This is mainly because cold, dry air tends to set off asthma attacks. The air around indoor swimming pools is warmer and more humid. The main thing is that your child enjoys the type of sport that he or she does.

By the way, a lot of top athletes have asthma. Knowing that could help encourage your child.

A child who has asthma will also want to do everything that other children do, including going on school trips or to summer camps. It is important that teachers, friends and your child are all well-informed about asthma, and know how to prevent asthma attacks and what to do in emergencies. That will help your child to deal with difficult situations when you aren't there too.

If your child has allergic asthma, you probably won't be able to prevent him or her being exposed to triggers on school trips. You can talk with the doctor about whether it would be a good idea for your child to use steroids on school trips to prevent asthma. A child who already uses controller medication regularly may forget about it while on a school trip. Then it can help if the adults accompanying your child are informed and can remind them, or – if symptoms occur – ask them whether they took their medication regularly.

Always carrying their treatment and emergency plan on them, with information about the disease and the medication they need, will make it easier for people to help your child in an emergency.

Puberty can be a time of conflict for all parents and their children. It is then often difficult for teenagers with asthma to follow the specific rules and demands associated with managing their condition.

Teenagers with asthma generally tend to take their symptoms less seriously than their parents do. But it is the other way around when it comes to quality of life: Parents often underestimate how much their teenage children feel limited by their asthma treatment.

The topic of smoking can be especially tricky. If their friends smoke, even quite confident teenagers may also pick up the habit. Then it can be difficult to make it clear that smoking is especially bad for someone who has asthma.

Puberty is commonly a time when many young people try out a lot of things, including things that they know aren't good for them. Researchers call this “adolescent risk behavior.” There is evidence that this behavior is particularly common in young people who have chronic illnesses. This means that young people with asthma may be even more tempted to start smoking than other people their age, even though it would be more harmful for them. Their family can influence whether or not they start smoking, though.

You can't protect your child from every type of harm they might expose themselves to. But if you manage to carry on talking openly with them, and perhaps with their friends too, it could help them and give them more self-confidence.