Asthma & Children

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• QHow can I help my child adjust to an asthma diagnosis?

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  A Intermountain Registered Dietitians , Nutrition & Dietetics, answered on behalf of Intermountain Healthcare

  If having asthma makes your child feel “weird,” you’ll need to address this feeling—or risk having your child resist treatment. Here are a few things you can do to help your child adjust:

  • Do everything you can to understand your child’s asthma and get comfortable with your child’s treatment. If you act like asthma is a tragedy—or if you question the need for treatment—your child will do the same.
  • Arrange for your child to take medication at a time and in a way that other kids won’t notice.
  • Give your child the words for talking to their friends about the need for medication.
  • Visit your child’s school and explain asthma to the students and teachers.

  If you find that your child isn’t taking medication properly, you need to talk about why. Keep the tone positive and encouraging. Start by pointing out what is working, and then go on to explore the following possible problems together:

  • If your child actively resists taking medication, find out why. Work with your child and your child’s healthcare providers and teachers to find ways to minimize these problems.
  • Make sure your child understands when and how to take various medications. Have your doctor or asthma educator reinforce your child’s technique for taking inhaled medications. If your child has a hard time taking pills, try having her practice by swallowing tiny bread balls to get used to the feeling.
  • There are lots of reasons why children might think they don’t need medication. First, they might have become used to poor lung function and think that it’s normal. They could be practicing “wishful thinking”—deciding that their asthma has gone away. Or perhaps they’re not getting much benefit from their medication—in which case, they need to have their treatment adjusted. Make an appointment with your child’s doctor to review and agree upon an asthma action plan.

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• QCan acetaminophen cause asthma in children?

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  A UCLA Health answered

  Circumstantial evidence suggests a possible connection between the use of acetaminophen and the increasing rate of childhood asthma over the past three decades. Research on the biochemistry of acetaminophen suggests that the drug could contribute to or exacerbate asthma symptoms in some individuals. It can, for example, decrease an antioxidant known as glutathione, and glutathione deficiency can predispose some people to more inflammation of the airways. And studies done more than a decade ago by British researchers indicated that children with asthma were more likely than non-asthmatic children to have used acetaminophen. Other studies since then have reached similar conclusions.

  However, experts caution that there’s not enough proof of a link to advise that parents should stop giving the drug to their infants and children. “These have been observational studies in which the conditions are not controlled,” notes UCLA pediatric pulmonologist Sande Okelo, M.D. “You can establish an association, but it might be that people with asthma are simply using acetaminophen more because they have more colds and fevers.”

  More rigorous studies are necessary to determine whether there is a direct link between acetaminophen use and greater asthma risk, Dr. Okelo says. Other important questions need to be answered as well. For example, if there is a link, how much acetaminophen is necessary to produce the effect? The previous studies suggested that the association between acetaminophen and asthma was most significant in high-frequency users of acetaminophen; it could be, Dr. Okelo notes, that low-frequency users would not be affected.

  Childhood asthma rates have been on the rise since the 1980s. The increase began about the time parents began switching from aspirin to acetaminophen for their children to lower fevers.

  “The link between aspirin and Reye’s syndrome in children caused a rethinking that led pediatricians in the 1980s to recommend acetaminophen as the first-line drug for fevers,” says Eric Curcio, M.D., a pediatrician at Mattel Children’s Hospital UCLA. While asthma rates started to go up, “it is important to note that many other things were happening at that time, so we can’t say for sure, based on that evidence alone, that that’s the cause.”

• QDoes diet have an impact on asthma risk in children?

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  A Jodie Shield , Healthcare, answered on behalf of Academy of Nutrition and Dietetics

  

  Asthma is a lung disease in which the airways become blocked or narrowed and results in breathing difficulty. Overweight children, particularly boys, seem to be at a greater risk of developing asthma, and being overweight seems to aggravate the symptoms in kids who already have asthma. Obese children with asthma tend to use more medicine, wheeze more and visit the emergency room more often than their peers with asthma who are not obese.

  

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• QIf I have asthma are my children at greater risk for this condition?

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  A HealthyWomen answered

  Studies have shown that children of parents with asthma are at greater risk for developing the condition. It would be wise to discuss your children's health with their pediatrician.

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• QHow can I establish a good asthma treatment routine for my toddler?

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  A Intermountain Registered Dietitians , Nutrition & Dietetics, answered on behalf of Intermountain Healthcare

  Children have special challenges in taking daily medications. Below are some tips to help you and your child establish a good routine and work together to solve problems.
  
  • Prepare and practice together. Give very simple explanations of what you’re doing and why (“I’m going to put this mask on you to help you breathe better”). First “practice” the procedure on yourself, a doll, or a stuffed animal — then let your child have a turn at practice. Give toddlers as much control as possible by giving them choices (for example, where to have a treatment, or whether to sit on the bed or a parent’s lap).
  
  • Help your child relax. Try swaddling -- not just with a blanket, but also with your body. Make a soothing “sh-sh-sh” sound, or talk in a calm, soothing voice. Listen to lullabies or other relaxing music. Try rocking, bouncing, swaying, or walking with your child in your arms.
  
  • Distract your child. Offer musical or light-up toys, pop-up books, bubbles, or other distractions while you’re giving medication.
  
  • Give immediate rewards. After giving medication, follow up with a treat such as a special activity or book. Praise your child for taking the medication (even if it has been a struggle).
• QHow can I help my teen with an asthma treatment routine?

  1 Answer

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  A Intermountain Registered Dietitians , Nutrition & Dietetics, answered on behalf of Intermountain Healthcare

  • Explain asthma and asthma treatment fully. Don’t assume that your teen knows the whys and hows of taking medication. Explain why some medications will be more effective if taken routinely. Also explain the consequences of not taking medication -- for example, your child may risk missing school or a special event.
  
  • Agree on a plan. First, work with your teen to create a plan that will help your teen to remember to take medications. Next, problem solve together. If your teen routinely forgets medication or resists taking it, try to tackle the problem together. Ask, “What don’t you like about taking your medication?” and “What can we do to make this easier?”
  
  •Offer rewards if necessary. Teens don’t usually need rewards or treats to take their medication -- but you might try them if your teen is having trouble staying motivated.
• QWhen does my child need to see an allergist for asthma?

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  A Dr. Paul M. Ehrlich, MD , Allergy & Immunology, answered

  Asthma and allergy referral guidelines have been developed by a joint committee of the two leading, relevant academic institutions: The American College of Allergy, Asthma & Immunology, and the American Academy of Allergy, Asthma & Immunology.
  
  The guidelines state that referral to an allergist for asthma treatment is indicated under the following conditions, which includes:
  
  - When the patient's asthma is unstable. Uncontrolled asthma may be associated with widely variable pulmonary functions and possibly high morbidity and mortality. Early comprehensive intervention may prevent these unfortunate events. Such intervention should include development of a long-term treatment plan.
  
  - When the patient's response to treatment is limited, incomplete, or very slow, and poor control interferes with the patient's quality of life
  
  - When, in spite of taking anti-inflammatory medications regularly, the patient must use an inhaled beta-agonist such as albuterol frequently, exclusive of its use in exercise-induced asthma. Albuterol simulates beta-2 neurotransmitters and relaxes the bronchial muscles.
  
  
  - If there is a need for frequent adjustments of therapy because of unstable asthma
  
  - For identification of allergens or other environmental factors that may be causing the patient's disease. Patients with asthma must have access to a thorough etiologic evaluation. (Etiologic is a fancy name for the process of determining the cause of a disorder. For example, an etiologic evaluation of an allergy might reveal that there is a cat at home.)
  
  - When allergen immunotherapy is a consideration
  
  - When the patient and the primary caregiver need intensive education in the role of allergens and other environmental factors
  
  - When family dynamics interfere with patient care and/or there is a need for further family education about asthma
  
  - When a patient has a chronic cough that is refractory, or irresponsive, to usual therapy
  
  - When coexisting illnesses and/or their treatment complicate the management of asthma
  
  - When the patient has recurrent absences from school or work due to asthma
  
  - When the patient is experiencing continuing, nocturnal episodes of asthma

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• QHow often do children with asthma get proper treatment?

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  A Dr. Paul M. Ehrlich, MD , Allergy & Immunology, answered

  According to a study published in the New England Journal of Medicine, children with asthma got the appropriate care just 46 percent of the time. This means that more often than not, they were deprived of appropriate care. Inadequately treated asthmatic children are more likely  to fail at school, more likely to lose out on sports and other activities, more likely to miss out on the fun and challenges of childhood, and more likely to be less productive as adults.

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• QWhat devices can help my child get the right dose of asthma medication?

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  A Greenville Health System answered

  Various devices are available for drug delivery of asthma medications, including nebulizers, dry powder inhalers (DPI) and metered dose inhalers (MDI) augmented with use of a valved holding chamber (spacer) with one-way valves to prevent patient exhalation into the device. Selection of the appropriate modality can be difficult, particularly in young children and toddlers, and errors in technique or insufficient instruction and training can hamper the benefits of effective medications.
  
  MDIs can be used in patients older than 4-6 months of age and allow more flexibility for drug selection and dosing; however, correct instruction and teaching are vital. Referral to an asthma specialist or pulmonologist with dedicated resources and time for teaching and review at each visit is recommended for patients not in optimal control.
  The contents of this website are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Nor does the contents of this website constitute the establishment of a physician patient or therapeutic relationship. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
• QShould my child get a flu vaccine if he has asthma?

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  A Dr. Tanya R. Altmann, MD , Pediatrics, answered

  

  All children should get a flu vaccine and for children with asthma, it's even more critical, says Tanya Altmann, MD, pediatrician. In this video, she says that catching the flu can be a cause of major respiratory distress for children with asthma.

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