Understanding asthma in children

Children with asthma may have episodes of wheezing, coughing, shortness of breath or chest tightness. Cough may be more noticeable at night, with running or laughing, during a viral illness, or around a personal trigger. Symptoms can settle between episodes, so the pattern over time is often as useful as what is heard during one appointment.

A clinician considers the child's history, examination, response to treatment and, when the child is able, breathing tests. Not every cough or wheeze is asthma, particularly in young children, and assessment may need follow-up as the pattern becomes clearer.

Give medicines according to the child's written asthma action plan. A spacer with the correct mask or mouthpiece helps inhaled medicine reach the airways; ask a clinician or pharmacist to watch the child's technique. Preventer medicine is taken on the prescribed schedule, while reliever medicine is used for symptoms as the plan directs.

Record daytime symptoms, night waking, activity limits and reliever use. Reduce exposure to confirmed triggers such as smoke or irritating aerosols, but do not remove foods or restrict exercise without clinical advice. Tell school or nursery staff where the action plan and reliever are kept and who should help the child use them.

Seek emergency help if the child is struggling to breathe, cannot speak or feed comfortably, has marked pulling-in around the ribs or neck, becomes unusually sleepy or confused, develops blue or grey lips, or does not improve with reliever treatment given according to the action plan.

Contact the child's clinician promptly when symptoms wake them, interrupt play or school, return frequently, or require the reliever more often than their plan allows. A review can check the diagnosis, technique, medicine schedule and exposure to triggers.

Ask which symptoms should trigger each action-plan step, how to tell a reliever from a preventer, which spacer fits the child, and when technique should be rechecked. Also clarify what school staff should do during symptoms and where follow-up will occur after an urgent episode.