Breathing is so automatic that most of us don't even think about it — unless you notice your child struggling for air. Whether it's wheezing, allergies or a persistent cough, these and other symptoms could point to a case of asthma, which often starts before age 5.[1] In fact, 1 in 12 children in the U.S. (or about six million) have this disease.[2]
While this chronic condition can be dangerous, the vast majority of childhood asthma cases can be managed with proper treatment. Read on to learn what asthma is exactly, along with how to identify asthma symptoms in kids and the treatment options in case your tot develops it.
What is asthma?
Asthma is a condition in which a person's breathing tubes (called bronchial airways) occasionally become inflamed, swollen and filled with mucus, often in response to an allergen or other irritation to the airways.
Asthma flare-ups can cause shortness of breath, tightness in the chest, coughing and/or wheezing — and when it happens to your toddler, it can be downright frightening for both of you.
Asthma symptoms in children
Keep in mind that asthma signs can vary and range in severity. And while some symptoms may seemingly point to asthma, a different respiratory condition may in fact cause them. Common symptoms of asthma in kids include:
- Coughing, especially at night or in the morning. It can also be constant, irregular or sometimes linked to physical activity.
- Whistling or wheezing while breathing
- Chest tightness
- Shortness of breath, rapid breathing or gasping for air
- Fatigue
- Irritability
- Dark circles under the eyes
- Trouble eating or, for babies, suckling
- Recurring bouts of bronchitis or pneumonia
Causes of asthma in children
Asthma is the most common chronic disease in children — and its causes are likely linked to a child's genes and living conditions.[3] Here are some of the hereditary and environmental risk factors that can predispose a child to developing asthma:
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- A family history of asthma or allergies
- Being obese
- Having eczema or other allergic conditions
- Having certain types of viral airway infections while very young
- Living with a smoker or exposure to smoke while in the womb
- Living in an area with air pollution
- Low birth weight
- Being male, as asthma is more common in boys (though in the teen years, it's girls)
Asthma triggers in children
Several factors can trigger asthma in toddlers, though the causes of flare-ups can differ from person to person. Asthma may even appear without an obvious trigger. Here are the most common ones:
- Allergens such as dust mites, mold and pet dander
- Pollen from grass, trees and weeds
- Waste from pests like mice and cockroaches
- Irritants such as secondhand cigarette smoke, pollution, perfume and paint fumes
- Viral infections like the common cold, COVID-19 or the flu
- Cold air or other changes in the weather
- Physical exercise
- Intense emotions, like a temper tantrum or lots of laughing
- Gastrointestinal reflux
You may wonder if a case of COVID-19 can cause asthma — and it's true that respiratory viruses are among the main triggers of asthma flare-ups.[4] Since most people who get the coronavirus will experience some respiratory illness, COVID-19 can indeed lead to worsening cough and asthma symptoms. Your best bet: Have your child regularly vaccinated and boosted for COVID-19.
How is asthma diagnosed?
It's often not easy to diagnose asthma in toddlers because lung function tests (in which a child blows into a machine that measures how quickly and how much air she can exhale) aren't accurate in kids under 6.
That means the doctor will rely on the symptoms you notice in your child. Bring careful notes to your appointment about the frequency of asthma signs and the conditions under which they occur.
The doctor will also ask you about your family's medical history as well as the type of home environment you have. He or she might want to know whether you or your partner have allergies, where you live and if there's a smoker or a pet in the house to try to determine if your toddler is genetically predisposed to developing asthma and if there's some environmental condition that's a possible contributing factor.
Asthma treatments for toddlers
For kids younger than 3, some doctors will suggest holding off on asthma medication for as long as possible (i.e., until asthma symptoms get worse) as these drugs are powerful, and experts aren't sure about the long-term effects they may have on young children. But if your toddler has severe flare-ups and the benefits would outweigh any potential risks, the doc may prescribe it and watch for improvement.
Asthma meds can come in liquid, pill and even intravenous forms, but most need to be inhaled so they're delivered directly to the airways. Older children and adults can use an inhaler, a handheld device that delivers medication via a mouthpiece, usually in the form of a mist.
Since toddlers can struggle with inhalers, you may need to put a little mask over your tot's mouth and nose that's attached to the inhaler or a nebulizer (which works the way an inhaler does but is bigger and isn't as easily portable). The mask makes it easier to breathe in the medicine correctly.
In an emergency (when certain fast-acting medications don't provide relief within 15 to 20 minutes), corticosteroids — anti-inflammatory medication that keeps the airways from swelling — in addition to albuterol can get your child's asthma under control.
Here are the types of medications that may help allergy-induced asthma, plus other ways to help control your child's asthma symptoms and flare-ups:
Long-term medicine
Your toddler may benefit from taking a preventive (long-acting) medication daily to keep the airways from getting inflamed and to prevent flare-ups. An anti-inflammatory corticosteroid and bronchodilator like Advair is one option.
Quick-control medicine
A quick-relief (short-acting) medication called a bronchodilator can quickly open up your child's airways when they swell during an asthma attack. Quick relief or rescue meds, such as albuterol, are used to stop the symptoms and relax the muscles tightening around the airways.
Allergy treatments
For asthma that flares or is made worse by an allergy, the pediatrician may prescribe allergy shots. These injections — done every two to four weeks — may ease the immune system's reaction to certain triggers like pollen, dust and pet dander.
Or the doctor may recommend allergy meds like oral or nasal spray antihistamines, decongestants or corticosteroids.
Peak-flow meters
If your older child is taking daily asthma medication and she's in grade school, she may get an easy-to-use peak-flow meter, which helps monitor how well the lungs are working.
The doctor will show her the proper technique for blowing into it and how to record the daily results. Sometimes the peak-flow number decreases hours or days before an asthma attack, so this info can help you (and her) adjust her treatment to prevent an oncoming flare-up.
Avoiding triggers
Whether or not your toddler takes asthma medication, it's also crucial to minimize allergens or irritants that can cause flare-ups.
That could mean removing carpet and stuffed animals in your child's room to fight dust and mold, skipping playdates at homes where there are cats, springing for hypoallergenic mattresses and pillows to ease the effects of mites, and nixing smoke at home (or anywhere around your child). Frequent vacuuming, fresh sheets and clean floors may help keep dander and pollen down indoors.
Regular appointments
Everyone responds differently to asthma meds, so to minimize side effects and complications, make all doctor visits a priority. Your little one will probably need to see the doctor or specialist several times a year based on the doctor's recommendation.
When to get emergency care for asthma
A severe flare-up or emergency asthma attack can appear quickly, so it's vital to know the following symptoms. Call an ambulance or head to the ER right away if:[5]
- Repeated uses of quick-relief meds don't relieve severe flare-ups after 15 to 20 minutes, or the attacks subside but then return again rapidly.
- There's a lasting cough or constant wheezing that doesn't respond to rescue medications.
- Your child's skin, nails or lips start to turn bluish or gray.
- She has trouble talking and can't speak in full sentences.
- There are visible retractions in the neck and below and between the ribs as she inhales.
Can children grow out of asthma?
It's mostly a myth that kids can outgrow asthma. In fact, most born asthmatics keep the condition for life.[6]
Still, some tots improve greatly with age, making it seem as if they've outgrown their asthma, but most often these kids don't have allergies nor a family history or their asthma was the result of an infection. Other children's symptoms may diminish over the years, but their asthma often returns in adulthood. Unfortunately, there are no tests to predict who will outgrow asthma and who won't.
While the prospect of asthma can seem scary at first, know that you're not alone. Millions of children are able to control their asthma with the right treatment and by keeping environmental allergens at bay. Your child's asthma may be a life-long condition, but with support from you and the right medications, she'll be on her way to a pretty normal life.
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