Is your child at risk for asthma?
with Tobias Enright, M.D., allergy/immunology specialist
with Advanced Healthcare
With statistics showing a rise in pediatric asthma, many parents are concerned about the risk, symptoms and treatments for this illness.
Kids at risk
If a parent or close relation has allergies or asthma, parents should be more on the lookout for symptoms in their child. Asthma, however, also is caused by other factors. The majority of children with asthma live in the city. Hispanic and African American children seem more likely to develop asthma and to have more serious cases.
The most important things a parent can do is be aware of the symptoms, seek help as soon as a problem is suspected and work with the child's physician to develop a plan of treatment to minimize the attacks and treat the underlying symptoms.
The good news is, when symptoms and the underlying condition are properly treated and parents work to reduce the asthma triggers in their homes, children have a better chance of outgrowing their asthma.
Symptoms of asthma in children
Children are prone to infections. Their immune systems, not yet fully developed, even seem to need those common bouts of childhood sniffles to become fully mature. "A one- to two-year-old can have eight colds a year. Unfortunately for parents who have to deal with the illness, this is normal," said Tobias Enright, an allergy/immunology specialist with Advanced Healthcare.
These infections cause coughing and congestion, and this is also normal. "However, children should not be coughing on a chronic basis, especially at night. If coughing has been going on for weeks, it may be a tip-off that this is something more than a cold. It could be asthma, what we sometimes label as cough variant asthma. And any time there is a diagnosis of chronic bronchitis, I think the antenna must go up and we should suspect asthma," Dr. Enright said.
Chronic coughing is the most common symptom of asthma in children, but there are others. Small children may complain of difficulty breathing, or pain in the chest or may be less active than normal. But with infants, parents must watch for the signs.
Among these is an increase in an infant's respiratory rate. However, infants have higher respiratory rates than older children and adults. "If parents notice changes, they should ask their pediatrician what is a normal rate for their child," Dr. Enright said.
A third symptom, a sign of acute respiratory distress, is labored breathing, particularly if the parents can see the ribcage when a child inhales. This is a sign that a child is fighting for breath and should be immediately treated.
Tests to determine asthma
When parents and the family physician suspect asthma, a physician will usually take a family history to see if there is a genetic reason for suspecting asthma. A physical exam will likely be done including breathing tests and possibly a chest X-ray to rule out an external cause. Allergy tests also may be done so that parents will understand what triggers they should avoid.
The breathing tests for asthma are non-invasive but do require a child being able to follow directions. "With smaller children, these tests are more difficult. That's where family history comes into play. If mom or dad or grandparents, aunts and uncles have a history of asthma, it's more likely the child has asthma. Also, if there is a history of seasonal colds or eczema, it's a strong sign of asthma," Dr. Enright said.
Asthma treatment...the action plan
There are many causes of asthma in children. Some will have asthma seasonally. Common examples would be a reaction to pollen or mold in spring or fall. Dust mites and animal danders cause symptoms all year. Once triggers are identified, parents can begin to minimize exposure to them.
Parents should also work with a physician to develop an action plan for their children. This is a written set of instructions that will tell them what to do if the asthma gets worse and when to seek help.
Older children should be able to use their maintenance and rescue medications on their own, or judge the severity of an attack through the use of a peak flow meter. Parents will need to watch for the symptoms in infants. Infants may need an aerochamber or a breathing machine with a mask for delivering maintenance and rescue medications. Today there are many new treatments and delivery systems available for even the smallest children.
"The key is that asthma can be controlled. Children should be able to be physically active. We want them to be active and the vast majority of children with asthma can engage in sports and do so very well," Dr. Enright said.
