Childhood Asthma: Causes, Symptoms, Treatment and Management

Asthma is the most common lung condition in children. It’s a long-term condition that causes the inner lining of the airway to become inflamed and swollen and to produce excess mucus. It also makes the muscles around the airways tighten. When these things happen our airways become narrower (called bronchoconstriction) and we find it more difficult to breathe air in and out of our lungs.

Asthma affects about one in 11 children in the UK – this amounts to about 1.1 million kids living with the condition. In the USA about 6.1 million children have asthma.

People of any age can have asthma. However symptoms most often appear for the first time in childhood and usually before the child’s fifth birthday.

It’s likely that your child’s asthma symptoms will improve as they get older. About two out of three children find that their symptoms disappear when they become teenagers.

Asthma causes and triggers in children

We don’t know exactly what causes asthma but it’s probably a combination of environmental and genetic factors. Kids are more likely to develop asthma if they:

  • Have eczema or an allergy
  • Have a close relative who has eczema or allergies
  • Are exposed to cigarette smoke (or if their mother was exposed to cigarette smoke when she was pregnant)
  • Are exposed to other environmental pollutants
  • Live in a deprived, low-income community – this might be partly because of damp, mouldy housing and pollution
  • Are poorly with a respiratory virus infection – at least half of children who need to go to hospital with respiratory syncytial virus (RSV) later develop asthma
  • Had a low weight at birth.

Certain triggers make asthma symptoms worsen (flare up), commonly:

  • Respiratory infections – usually viral
  • Allergies – for example to house dust mite, pollen (i.e. hay fever), foods, cockroaches, fungal spores, animals and pets could trigger allergy-induced asthma
  • Cigarette smoke
  • Pollution – such as car exhaust fumes and other irritants in the air
  • Weather extremes – hot, cold, damp or thundery
  • Exercise
  • Stress and strong emotions such as feeling very upset or over-excited.

Triggers are personal and one or several of these factors that cause your child’s symptoms to flare up.

Asthma signs and symptoms in children

Symptoms of asthma in children include:

  • Coughing – especially if the cough is persistent or keeps coming back
  • Wheezing – this is a whistling sound when they breathe
  • Being short of breath
  • Chest tightness.

Your child won’t necessarily have symptoms all the time – it depends how well or poorly controlled their asthma is, and whether they’re exposed to any triggers. Their symptoms may be worse at night (sometimes referred to as nocturnal asthma) or first thing in the morning when they awaken, or after exercise or bursts of energy.

Recognising symptoms of asthma in children under 5

Coughing and wheezing are probably the easiest signs to recognise in children under five. If your baby or toddler is breathless they might be breathing faster than usual or using their body to breathe (for example lifting their shoulders up and down with each breath).

Children under five won’t describe how they’re feeling in the same way as an older child or adult. For example, instead of saying their chest feels tight they might say they have a tummy ache or you might notice they are rubbing their tummy or chest.

How to diagnose asthma in a child

If you are concerned that your child may have asthma, you should take them to see a doctor, who will most likely:

  • Ask about their medical history – any symptoms and possible triggers you’ve noticed recently, and when they occurred
  • Ask if your child or any family members have eczema or allergies
  • Do a physical examination – in particular they will listen to your child’s chest for any wheezing. No wheeze does not necessarily mean that your child doesn’t have asthma, though.

If your child is under 5 they may be diagnosed with suspected asthma on the basis of one simple assessment. To be certain it’s asthma, though, you’ll have to wait until they’re old enough to do some coordinated breathing tests.

Children between 5 and 16 should will be asked by their doctor to do one or more breathing tests:

  • Spirometry – your child is asked to blow into a mouthpiece as fast and for as long as they can to measure how well their lungs are working.
  • Bronchodilator reversibility (BDR) – if that first spirometry test suggests that your child is not breathing out very well, your doctor or asthma nurse will give them a one-off dose of bronchodilator medication. Two spirometry tests – one before and one after the medication – will measure for any improvement. A positive BDR test confirms an asthma diagnosis.
  • Fractional exhaled nitric oxide (FeNO) – measures the level of inflammation in your child’s airways.
  • Peak expiratory flow (PEF) monitoring – your child blows into a small tube to measure how fast they can breathe out. If PEF changes a lot from day to day that can indicate a diagnosis of asthma.

Don’t worry if your young child doesn’t have the hand-to-breath coordination to do these tests – they can try again every six to 12 months.

Child asthma treatment

There are two main types of medicine used to treat asthma in children:

  • Reliever or rescue (bronchodilator) inhaler – use these occasionally to relieve your child’s symptoms when they happen. They are quick-acting within about 3 minutes. Reliever inhalers are usually blue.
  • Preventer (anti-inflammatory) inhaler – use these every day to prevent your child having symptoms.

Inhalers deliver the medicine as a spray or powder directly to where it is needed – the airways. Most children have well-controlled asthma if they use their inhaler(s) correctly. Connecting a spacer or nebuliser device to the inhaler can make it easier to use – especially for babies and young children.

Depending on how old they are, children with difficult-to-control asthma may also need to take a daily tablet or switch to a different inhaler.

Further specialist add-on treatments for children with severe asthma include theophylline (smooth muscle relaxant) and steroid tablets.

Child asthma treatment under 5

The treatment for a baby or toddler with suspected asthma are prescribed in steps:

  • If symptoms are mild and occasional your doctor may take a ‘watch and wait’ approach to see if there’s a pattern to their symptoms. For example, do they only appear after a cold then go away?
  • Add a reliever inhaler to use if the symptoms occur.
  • If the symptoms persist, prescribe a trial of a daily preventer inhaler then stop. If your child’s symptoms return within four weeks, it’s likely they have asthma. In this canse, they will be asked to start taking the daily preventer again and use a reliever inhaler as required.
  • Add a daily leukotriene receptor antagonist (LTRA) tablet (or syrup) for extra prevention if needed
  • If symptoms are severe or persist after all the above steps have been taken, they will be referred to a specialist.

Asthma treatment for children aged 5 to 16

If asthma has been positively diagnosed by a doctor after your child has performed the relevant breathing tests, treatment will be prescribed in the following steps:

  • Reliever inhaler
  • Add a daily preventer inhaler
  • Add a daily preventer LTRA tablet if needed
  • If symptoms persist, stop the LTRA and change to a long-acting preventer inhaler
  • If symptoms persist, change to a combination inhaler (both preventer and reliever)
  • Consider a trial of theophylline as a daily preventer
  • Refer to a specialist if necessary.

Tips to manage and keep asthma under control

  • Use and follow your child’s Personal Action Plan (PAP), sometimes called an Asthma Management Plan. Share it with teachers, carers and close family members.
  • Establish a daily routine for taking preventer medicine – it will help you and your child to remember.
  • Make sure your child has access to their reliever inhaler at all times and knows where it is.
  • Take your child for a review with their doctor or asthma nurse at least once a year.
  • Regularly check that your child’s inhaler (and spacer) technique is correct. See your asthma nurse or doctor for a reminder if you are unsure.
  • Monitor your child’s symptoms, keep a symptoms/reliever diary.
  • Record peak flow measurements regularly at home, if necessary.
  • Know what triggers your child’s symptoms and avoid these
  • If you or anyone in your household smokes, quit.
  • Encourage your child to exercise, eat a good diet and get enough sleep.
  • Know what to do if symptoms worsen and, if they do, act early.
  • When they are old enough, teach your child about asthma so that they understand how to manage their symptoms.
  • See your doctor or nurse if your child needs to use their reliever more than three times a week.

Information and support

You will find a wealth of further information about allergies and asthma on our website, and we hope you will explore it. Below are some recent articles. You can also get in touch with us – we would love to hear from you!

  • A paper co-authored by GAAPP President, Tonya Winders, was published in June 2020 JACI and outlines the international unmet needs in pediatric asthma. Read the paper here.
  • “A Worldwide Charter for All Children With Asthma” can be found here.
  • “Asthma: Working Together with your Health Care Team Guide” can be found here.