How to Recognize an Asthma Attack in Children
Pay attention to any mention of breathing trouble., Take complaints of chest pain seriously., Recognize children’s limitations., Assess breathing rates., Be aware of environmental triggers., Monitor the child's behavior., Treat respiratory...
Step-by-Step Guide
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Step 1: Pay attention to any mention of breathing trouble.
An older child or a child who has had previous asthma attacks may be able to feel an attack coming on.
If a child tells you directly that she “can’t breathe” or is having trouble breathing, don't ignore it! During milder phases of an asthma attack, the child may wheeze, although in the severe stages this may or may not be present. -
Step 2: Take complaints of chest pain seriously.
A child having an asthma attack may also report chest pain or a tight feeling in the chest.
Chest pain is common during asthma attacks because as air gets trapped in narrowed airways, the pressure in the chest can rise.
Because the airway is constricted, you might also notice decreased breath sounds. , A young child or one who's never had an attack before may not know how to describe or report shortness of breath or chest pain.
Instead, she might panic and describe symptoms vaguely: "I feel strange" or "sick." Watch asthmatic children closely for observable clues of an attack, like shallow breathing or wheezing.
Don't assume that a child is not having an asthma attack just because she doesn't report breathing trouble or chest pain. , Infants and very small children (from birth through 6 years of age) have higher metabolisms.
This, in turn, results in higher respiratory rates.
Because children this age can't communicate symptoms well, observe their breathing closely.
Any suspicion of abnormal breathing is enough to prompt further exploration of symptoms.
The average breaths per minute in this age range can vary greatly, but the general guidelines are:
Infant (birth–1 year) 30–60 breaths/min Toddler (1–3 years) 24–40 Preschooler (3–6 years) 22–34 , Most children with asthma begin showing signs by the age of 5, when they will start reacting poorly to their asthma triggers.An asthma trigger is anything that can cause symptoms to flare up.Triggers can vary from child to child, so be aware of the things that can cause an attack for your child, especially when you suspect one coming on.
Some triggers (like dust mites and pet fur) can be eliminated, but others (like air pollution) have to be monitored as best as possible.
Common triggers include:
Pet fur: either vacuum or damp-mop regularly to remove fur from your home.
Dust mites: use mattress and pillow covers to protect the child from dust mites, wash bedding often, avoid putting stuffed animals in your child's room, and avoid pillows or quilts that use down feathers.
Cockroaches: cockroaches and their droppings are a common asthma trigger.
To discourage cockroaches in your home, don't leave food or water out.
Sweep up all crumbs and food particles immediately, and clean the home regularly.
Consult an exterminator for pest control advice.
Mold: mold is caused by humidity, so use a hygrometer to check how humid your home environment is.
Use a dehumidifier to keep the environment moisture and mold-free.
Smoke: any smoke — from tobacco to wood smoke — can trigger an asthma attack.
Even if you step outdoors to smoke, the smoke that lingers on your clothing and hair puts your child at risk.
Certain foods:
Eggs, milk, peanuts, soy products, wheat, fish, shellfish, salads, and fresh fruits are all known to trigger asthma attacks in children who are allergic to them.Air pollution or extreme changes in weather , Keeping the environment clean of asthma triggers might not be enough.
When children get highly emotional — whether sad, happy, frightened, etc. — they are at a higher risk of asthma attack.
Similarly, too much exercise might cause the child to get winded and take deep, gulping breaths that can trigger an asthma attack. , Viral or bacterial upper or lower respiratory infections can trigger asthma attacks.
Be sure to have your child evaluated by a pediatrician if she shows signs of a respiratory infection.
She may need medication to manage the symptoms of the infection or to help it go away more quickly.
Be aware that antibiotics treat bacterial infections.
Viral respiratory infections may need to be approached from a management perspective rather than a treatment perspective. , A normal respiratory rate in an adult is generally no more than 20 breaths per minute.
Depending on age, children can have faster resting respiratory rates.
It's best to watch for any general signs of abnormally fast breathing.Children between 6-12 years should take about 18-30 breaths per minute.
Children 12-18 years should take about 12-20 breaths per minute. , A child who is breathing normally mainly uses the diaphragm to breathe.
A child having an asthma attack, though, may have to use other muscles in her effort to move more air.
Look for signs that the child’s neck, chest, and stomach muscles are working harder than usual.
A child who is struggling to breathe might assume a hunched posture, with her arms braced on the knees or a table.If you notice this posture, the child may be having an asthma attack. , Children having asthma attacks often make a soft whistling, vibrating sound when they breathe.
This usually happens when they exhale, as air is forced through a narrowed passageway.You may be able to hear wheezing during both inhaling and exhaling.
Note, though, that in mild attacks or early in severe attacks, you may only hear the wheezing when the child breathes out. , Asthma is the most common cause of chronic childhood cough.
Coughing causes the pressure in the airway to rise.
This, in turn, forces narrowed airways open and temporarily allow better airflow.
So while coughing helps the child breathe, it's a symptom of a larger problem.
Children might also cough when the body tries to expel environmental triggers that may have caused the attack.A cough can also be a sign of a respiratory infection, which can trigger asthma.
Persistent night coughing is a common symptom of mild to moderate persistent asthma in children.
However, if the child coughs repeatedly for a long time, she is probably having an attack. , Retractions are a visible “pulling-in” between and just below the ribs or at the collarbone as the child breathes.
They occur as the muscles work hard to pull air, but the air can’t move quickly enough to fill the space because of blocked airways.
If the retractions between the ribs seem mild, take your child to the doctor as soon as you can.
If they are moderate to severe, call for emergency medical attention., When a child is working very hard to breathe, you will often notice the nostrils flaring.
This is a particularly useful sign of an asthma attack in babies and very young children.
Children of that age may not be able to report their symptoms or assume the hunched posture typical of older children. , This happens in severe cases, when airways get so blocked that there isn't even enough airflow to produce wheezing. "Silent chest" calls for immediate emergency medical attention.The child may be so exhausted from the effort it takes to breathe that she can't expel carbon dioxide or take in enough oxygen.
Another sign that your child is not getting adequate oxygen and needs medical attention is if she is unable to speak in full sentences. , A peak flow meter is a simple device used to measure the child's "peak expiratory flow rate" (PEFR).
Take daily readings to figure out the child's normal PEFR.
Abnormal readings will serve as early warning signs and help you predict asthma attacks.
The normal ranges of PEFR depend on the age and height of the child; you should talk to your doctor about the numbers for each "zone" and what actions you should take if your child is in the red or yellow zone.
As a general rule, though:80-100% of the child's personal best PEFR puts her in the "green zone" (lower risk of attack) 50-80% of her personal best puts the child in the "yellow zone" (moderate risk; continue to watch her and give her whatever care your doctor has prescribed for this zone.) Less than 50% of her personal best means there's a high risk the child will suffer from an attack.
Give her quick-relief medication and seek medical attention. , Children having asthma attacks often struggle so hard to breathe that you'll be able to see it.
If have any feeling that the child is struggling to breathe or that “something is wrong,” trust your instincts.
Give the child her inhaler or other prescribed immediate relief medication and seek medical attention if possible. , When children have asthma attacks, their bodies have to work hard just to breathe.
As a result, the skin may appear sweaty or damp.
But instead of looking flushed and pink as it would from exercise, it will appear pale or white during an asthma attack.
Blood turns red only when exposed to oxygen, so if a child isn't getting enough oxygen, you won't see the pink flush of normal blood flow., If you notice a blue tinge to the skin, or if the lips and fingernails become blue, the child’s attack is very serious.
She is severely oxygen-deprived and needs immediate medical help., If the child has had previous attacks, she likely has prescribed asthma medication, probably in the form of an inhaler.
If so, administer that medication immediately in the case of an asthma attack.
While inhalers are simple, you can still use them improperly and decrease their effectiveness.
To correctly use an inhaler:
Remove the cap and shake the inhaler hard.
Prime the inhaler if necessary.
If it's new or hasn't been used in a long time, release some of the medicine into the air before using it.
Have the child exhale completely, then inhale as you administer one puff of medication.
Ask the child to continue inhaling as slowly and as deeply as she can for 10 seconds.
Always use a spacer or chamber, which helps the medicine go into the lungs instead of the back of the throat, when using an inhaler for children.
Ask your doctor about how to use it properly. , The label will tell you if you have to wait before administering another dose.
If using a β2-agonist such as albuterol, wait a full minute before giving the child another dose.
If not a β2-agonist, you may not have to wait before giving a second dose. , You should see results within minutes of using the inhaler.
If not, you may choose to give the child more medication.
Use the individual dosing recommendation found on the inhaler's label or follow your physician's advice, which may include additional puffs right away.
If symptoms don't get better with medication, you need to seek medical attention. , Mild symptoms may include coughing, wheezing, or mildly increased work with breathing.Contact your pediatrician if the attack is mild, but symptoms don't improve with medication.
The doctor may want to treat the child in the office or provide you with more specific instructions. , "Silent chest" or blue lips and fingernails suggest the child isn't getting enough oxygen.
A child with those symptoms needs immediate treatment to avoid the possibility of brain damage or death.If you have asthma medication for the child, you can administer it on the way to the emergency room.
But don't delay in taking the child to the emergency room.
Delayed emergency treatment during a severe attack can cause permanent brain damage and even death.
Call 911 immediately if your child has a blue color that does not go away with medication or that moves beyond just the lips or fingernails.
Call 911 immediately if your child loses consciousness or is difficult to rouse. , If your child's asthma was triggered by a food allergy, insect sting, or medication, call
911.
These types of reactions can progress quickly and lead to closed airways. , The doctor will recognize the signs and symptoms of asthma.
Once the child arrives at the ER, medical staff will give her oxygen if needed and may administer more medication.
If the asthma attack is severe, they may give the child corticosteroids through an IV.
Most patients will improve under expert care, and you'll be able to take them home soon.
But, if the child doesn't improve within several hours, they may keep her in the hospital overnight.
The doctor may perform a chest x-ray, pulse oximetry, or draw blood. -
Step 3: Recognize children’s limitations.
-
Step 4: Assess breathing rates.
-
Step 5: Be aware of environmental triggers.
-
Step 6: Monitor the child's behavior.
-
Step 7: Treat respiratory infections appropriately.
-
Step 8: Watch for rapid breathing.
-
Step 9: See if the child is working hard to breathe.
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Step 10: Listen for wheezing.
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Step 11: Note any coughing.
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Step 12: Look for retractions.
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Step 13: Check for flaring nostrils.
-
Step 14: Watch for a “silent chest.” If the child seems distressed
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Step 15: but you can't hear any wheezing
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Step 16: she may be suffering from "silent chest."
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Step 17: Use a peak flow meter to determine the severity of the attack.
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Step 18: Assess the child’s overall appearance.
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Step 19: Check for pale and clammy skin.
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Step 20: Check for blue-tinged skin.
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Step 21: Give asthma medication.
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Step 22: Check the inhaler’s label before administering a second dose.
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Step 23: See if the medication is working.
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Step 24: Call the child’s doctor if you see continued mild symptoms.
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Step 25: Go to the emergency room for continued severe symptoms.
-
Step 26: Call 911 for asthma attacks triggered by allergic reactions.
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Step 27: Know what to expect in the emergency room.
Detailed Guide
An older child or a child who has had previous asthma attacks may be able to feel an attack coming on.
If a child tells you directly that she “can’t breathe” or is having trouble breathing, don't ignore it! During milder phases of an asthma attack, the child may wheeze, although in the severe stages this may or may not be present.
A child having an asthma attack may also report chest pain or a tight feeling in the chest.
Chest pain is common during asthma attacks because as air gets trapped in narrowed airways, the pressure in the chest can rise.
Because the airway is constricted, you might also notice decreased breath sounds. , A young child or one who's never had an attack before may not know how to describe or report shortness of breath or chest pain.
Instead, she might panic and describe symptoms vaguely: "I feel strange" or "sick." Watch asthmatic children closely for observable clues of an attack, like shallow breathing or wheezing.
Don't assume that a child is not having an asthma attack just because she doesn't report breathing trouble or chest pain. , Infants and very small children (from birth through 6 years of age) have higher metabolisms.
This, in turn, results in higher respiratory rates.
Because children this age can't communicate symptoms well, observe their breathing closely.
Any suspicion of abnormal breathing is enough to prompt further exploration of symptoms.
The average breaths per minute in this age range can vary greatly, but the general guidelines are:
Infant (birth–1 year) 30–60 breaths/min Toddler (1–3 years) 24–40 Preschooler (3–6 years) 22–34 , Most children with asthma begin showing signs by the age of 5, when they will start reacting poorly to their asthma triggers.An asthma trigger is anything that can cause symptoms to flare up.Triggers can vary from child to child, so be aware of the things that can cause an attack for your child, especially when you suspect one coming on.
Some triggers (like dust mites and pet fur) can be eliminated, but others (like air pollution) have to be monitored as best as possible.
Common triggers include:
Pet fur: either vacuum or damp-mop regularly to remove fur from your home.
Dust mites: use mattress and pillow covers to protect the child from dust mites, wash bedding often, avoid putting stuffed animals in your child's room, and avoid pillows or quilts that use down feathers.
Cockroaches: cockroaches and their droppings are a common asthma trigger.
To discourage cockroaches in your home, don't leave food or water out.
Sweep up all crumbs and food particles immediately, and clean the home regularly.
Consult an exterminator for pest control advice.
Mold: mold is caused by humidity, so use a hygrometer to check how humid your home environment is.
Use a dehumidifier to keep the environment moisture and mold-free.
Smoke: any smoke — from tobacco to wood smoke — can trigger an asthma attack.
Even if you step outdoors to smoke, the smoke that lingers on your clothing and hair puts your child at risk.
Certain foods:
Eggs, milk, peanuts, soy products, wheat, fish, shellfish, salads, and fresh fruits are all known to trigger asthma attacks in children who are allergic to them.Air pollution or extreme changes in weather , Keeping the environment clean of asthma triggers might not be enough.
When children get highly emotional — whether sad, happy, frightened, etc. — they are at a higher risk of asthma attack.
Similarly, too much exercise might cause the child to get winded and take deep, gulping breaths that can trigger an asthma attack. , Viral or bacterial upper or lower respiratory infections can trigger asthma attacks.
Be sure to have your child evaluated by a pediatrician if she shows signs of a respiratory infection.
She may need medication to manage the symptoms of the infection or to help it go away more quickly.
Be aware that antibiotics treat bacterial infections.
Viral respiratory infections may need to be approached from a management perspective rather than a treatment perspective. , A normal respiratory rate in an adult is generally no more than 20 breaths per minute.
Depending on age, children can have faster resting respiratory rates.
It's best to watch for any general signs of abnormally fast breathing.Children between 6-12 years should take about 18-30 breaths per minute.
Children 12-18 years should take about 12-20 breaths per minute. , A child who is breathing normally mainly uses the diaphragm to breathe.
A child having an asthma attack, though, may have to use other muscles in her effort to move more air.
Look for signs that the child’s neck, chest, and stomach muscles are working harder than usual.
A child who is struggling to breathe might assume a hunched posture, with her arms braced on the knees or a table.If you notice this posture, the child may be having an asthma attack. , Children having asthma attacks often make a soft whistling, vibrating sound when they breathe.
This usually happens when they exhale, as air is forced through a narrowed passageway.You may be able to hear wheezing during both inhaling and exhaling.
Note, though, that in mild attacks or early in severe attacks, you may only hear the wheezing when the child breathes out. , Asthma is the most common cause of chronic childhood cough.
Coughing causes the pressure in the airway to rise.
This, in turn, forces narrowed airways open and temporarily allow better airflow.
So while coughing helps the child breathe, it's a symptom of a larger problem.
Children might also cough when the body tries to expel environmental triggers that may have caused the attack.A cough can also be a sign of a respiratory infection, which can trigger asthma.
Persistent night coughing is a common symptom of mild to moderate persistent asthma in children.
However, if the child coughs repeatedly for a long time, she is probably having an attack. , Retractions are a visible “pulling-in” between and just below the ribs or at the collarbone as the child breathes.
They occur as the muscles work hard to pull air, but the air can’t move quickly enough to fill the space because of blocked airways.
If the retractions between the ribs seem mild, take your child to the doctor as soon as you can.
If they are moderate to severe, call for emergency medical attention., When a child is working very hard to breathe, you will often notice the nostrils flaring.
This is a particularly useful sign of an asthma attack in babies and very young children.
Children of that age may not be able to report their symptoms or assume the hunched posture typical of older children. , This happens in severe cases, when airways get so blocked that there isn't even enough airflow to produce wheezing. "Silent chest" calls for immediate emergency medical attention.The child may be so exhausted from the effort it takes to breathe that she can't expel carbon dioxide or take in enough oxygen.
Another sign that your child is not getting adequate oxygen and needs medical attention is if she is unable to speak in full sentences. , A peak flow meter is a simple device used to measure the child's "peak expiratory flow rate" (PEFR).
Take daily readings to figure out the child's normal PEFR.
Abnormal readings will serve as early warning signs and help you predict asthma attacks.
The normal ranges of PEFR depend on the age and height of the child; you should talk to your doctor about the numbers for each "zone" and what actions you should take if your child is in the red or yellow zone.
As a general rule, though:80-100% of the child's personal best PEFR puts her in the "green zone" (lower risk of attack) 50-80% of her personal best puts the child in the "yellow zone" (moderate risk; continue to watch her and give her whatever care your doctor has prescribed for this zone.) Less than 50% of her personal best means there's a high risk the child will suffer from an attack.
Give her quick-relief medication and seek medical attention. , Children having asthma attacks often struggle so hard to breathe that you'll be able to see it.
If have any feeling that the child is struggling to breathe or that “something is wrong,” trust your instincts.
Give the child her inhaler or other prescribed immediate relief medication and seek medical attention if possible. , When children have asthma attacks, their bodies have to work hard just to breathe.
As a result, the skin may appear sweaty or damp.
But instead of looking flushed and pink as it would from exercise, it will appear pale or white during an asthma attack.
Blood turns red only when exposed to oxygen, so if a child isn't getting enough oxygen, you won't see the pink flush of normal blood flow., If you notice a blue tinge to the skin, or if the lips and fingernails become blue, the child’s attack is very serious.
She is severely oxygen-deprived and needs immediate medical help., If the child has had previous attacks, she likely has prescribed asthma medication, probably in the form of an inhaler.
If so, administer that medication immediately in the case of an asthma attack.
While inhalers are simple, you can still use them improperly and decrease their effectiveness.
To correctly use an inhaler:
Remove the cap and shake the inhaler hard.
Prime the inhaler if necessary.
If it's new or hasn't been used in a long time, release some of the medicine into the air before using it.
Have the child exhale completely, then inhale as you administer one puff of medication.
Ask the child to continue inhaling as slowly and as deeply as she can for 10 seconds.
Always use a spacer or chamber, which helps the medicine go into the lungs instead of the back of the throat, when using an inhaler for children.
Ask your doctor about how to use it properly. , The label will tell you if you have to wait before administering another dose.
If using a β2-agonist such as albuterol, wait a full minute before giving the child another dose.
If not a β2-agonist, you may not have to wait before giving a second dose. , You should see results within minutes of using the inhaler.
If not, you may choose to give the child more medication.
Use the individual dosing recommendation found on the inhaler's label or follow your physician's advice, which may include additional puffs right away.
If symptoms don't get better with medication, you need to seek medical attention. , Mild symptoms may include coughing, wheezing, or mildly increased work with breathing.Contact your pediatrician if the attack is mild, but symptoms don't improve with medication.
The doctor may want to treat the child in the office or provide you with more specific instructions. , "Silent chest" or blue lips and fingernails suggest the child isn't getting enough oxygen.
A child with those symptoms needs immediate treatment to avoid the possibility of brain damage or death.If you have asthma medication for the child, you can administer it on the way to the emergency room.
But don't delay in taking the child to the emergency room.
Delayed emergency treatment during a severe attack can cause permanent brain damage and even death.
Call 911 immediately if your child has a blue color that does not go away with medication or that moves beyond just the lips or fingernails.
Call 911 immediately if your child loses consciousness or is difficult to rouse. , If your child's asthma was triggered by a food allergy, insect sting, or medication, call
911.
These types of reactions can progress quickly and lead to closed airways. , The doctor will recognize the signs and symptoms of asthma.
Once the child arrives at the ER, medical staff will give her oxygen if needed and may administer more medication.
If the asthma attack is severe, they may give the child corticosteroids through an IV.
Most patients will improve under expert care, and you'll be able to take them home soon.
But, if the child doesn't improve within several hours, they may keep her in the hospital overnight.
The doctor may perform a chest x-ray, pulse oximetry, or draw blood.
About the Author
Deborah Smith
Dedicated to helping readers learn new skills in pet care and beyond.
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