calming asthmatic childAsthma is a frightening and debilitating disease in adults. It can be terrifying; shortness of breath, wheezing, coughing, tightness in the chest and so on. So imagine how much more frightening it is for a child. As an adult you can rationalise, you can fight the fear and calm yourself down, relax and allow the symptoms to subside. Children can suffer terribly with asthma, and they rely heavily on parents to provide the safety net and calm that they aren’t yet mature enough to provide for themselves. So as the parent of a child with asthma, are you ready? Do you recognise the signs? Do you know what to do during an attack? Are you aware of what triggers you should avoid and how to find out what they are? Do you have the right medicines and equipment on hand to deal with an attack, and most importantly, do you have a plan for when you should seek professional medical help? Knowing The Problem Asthma is a common so-called “chronic inflammatory disease of the airways” featuring recurring symptoms, including but not limited to wheezing, coughing, chest tightness, and shortness of breath. The disease can be very difficult to diagnose in children, partly due to the lack of feedback that children can give about exactly how they feel and where they feel it. Many pediatricians are reluctant to diagnose asthma in especially young children, partly due to the fact that children under 6 who experience what is termed “reactive airways disease” do not go on to develop full blown asthma, even if the disease as treated responds to asthma medication. Most commonly asthma is treated with corticosteroids, usually administered with an inhaler. Other medicines are prescribed for asthma but this is the one you will encounter the most. If your child has other allergies such as hay fever or is sensitive to other allergens, you will possibly be using other medications in addition to the inhaler. All cases are different and you should seek guidance from your doctor about dosages and application of medicines. Once a diagnosis of asthma has been established, the responsible parent will always be ready for action. Firstly you have to do something you will find very easy: know your child. There are risks with young children that if they get a lot of attention because of some ailment, there can be a tendency on the behalf of the child to use ill health to gain attention on demand. You have to be sensitive to that and know when your child is either seeking attention or genuinely in distress. Most parents know the difference. You should also consult your doctor on ways to discover the triggers that might be causing your child’s asthma, and take steps to avoid those triggers. It may be that you could improve the quality of your child’s life by merely purchasing a vacuum cleaner that filters out allergens. Your doctor will have concrete advice on household environments that relates directly to your child. Signs and Symptoms That established, you have to have a plan of action. The signs of an asthma attack vary wildly between children, but you will learn those that regularly apply to your child. There are different stages of severity and different ways to manage each stage. Not all children have the same symptoms, and they can even vary from attack to attack in the same child, so be aware and flexible too. Possible signs and symptoms can include: Frequent coughing spells, during play, at night, or while laughing or crying; chronic cough (which can sometimes be the only symptom); less energy during play; intermittent rapid breathing; chest tightness or chest "hurting", shortness of breath and most obviously the whistling sound of restricted airways that we commonly call wheezing. You may also notice see-saw motions (called retractions) in the chest from labored breathing. This is very noticeable and alarming, but as always, calmness is one of the best tools you can use to soothe your child during an attack. Look also for tightened neck and chest muscles, or perceived weakness or tiredness. What To Do Number 1: be calm. You child is already panicking by the time you get to them or they wouldn’t have called you. You need to be an oasis of calm and something they can focus on and anchor to. This helps immensely, and your child will draw a lot of strength from your calm and positive support. Number 2: check for the signs above. It’s possible if your child has a corticosteroid inhaler and knows how to use it, that it has been used already. Ask your child if they used their inhaler. Maybe they panicked and forgot, although if the child has suffered from asthma for a while this will be automatic. If the inhaler has been used already coach the child to take slow steady breaths. Panic attacks also cause shortness of breath, and it could be that the fear of an attack has caused a panic attack. Speak calmly and slowly and breathe along with your child. Slow and steady. Number 3: if the child doesn’t start to breathe more easily, then start “two for two”, two puffs on the inhaler every two minutes. Do this up to 10 times. Number 4: if after the two for two you feel after some time that your child is not improving or even getting worse you should call 911. In most cases, although frightening and difficult to remain calm, attacks will subside with this coaching and calm. Your child should calm down, the attack should pass and they should be relaxed and breathing more easily. It’s hard sometimes to keep your calm demeanor in the face of your child’s distress, but you must remain absolutely rock solid calm and keep a positive attitude. Say to yourself with conviction “This will subside." If it doesn’t ,then you calmly move to the next phase, and call 911. Assistance will arrive, and if it takes longer than about 10 minutes you can return to the two for twos for another 10 puffs or until they arrive. What Should You Have On Hand? At all times you need to have any inhalers that your child has been prescribed, and monitor the inhalers so you notice when they are getting empty. Make sure you have backups if possible. It is common for asthma sufferers to take multiple medications for their allergies, and these also need to be filled when empty. If your child uses a nebulizer or other kind of vaporizer, it needs to be in working order and used as prescribed. Also of key importance are knowledge and a plan. You and your child should know the disease as it affects you personally, symptoms and treatments that apply to you, and most important of all have a plan. Asthma Action Plan Stages Many people have an action plan as a chart that is printed out and placed somewhere prominently in the house. It is usually organized as zones. Green Zone: Doing Well No cough, wheeze, chest tightness, or shortness of breath; can do all usual activities. Take prescribed long term control medicine such as inhaled corticosteroids. Yellow Zone: Getting Worse Cough, wheeze, chest tightness, or shortness of breath; waking at night; can do some, but not all, usual activities. Add quick-relief medicine. Red Zone: Medical Alert! Very short of breath; quick-relief medicines don't help; cannot do usual activities; symptoms no better after 24 hours in Yellow Zone. Get medical help NOW. Living And Thriving Whatever your experience of asthma with your child, you can prepare for attacks and manage them calmly and effectively if you are aware of the disease and can explain it to your child. If you and your child are knowledgeable and aware you can, together, deal with it calmly and positively. You can help your child not only survive but thrive. Further Reading Examples of full action plans can be found at the CDC web site: Statistics about Asthma