Diagnosis Of Asthma In Children
Diagnosing asthma in children younger than 5 years can be difficult because children cough or wheeze for many different reasons. Take your child to the doctor if:
- the wheezing happens more than once with or without an illness
- constant coughing or bouts of coughing become worse at night
- you are concerned about any breathing problems in your child.
How Can I Help My Child Live With Asthma
You can help manage your childs asthma by:
- Finding out your childs triggers and keeping him or her away from them.
- Giving your child medicine as directed to prevent symptoms.
- Creating and keeping an Asthma Action Plan.
- Closely watching asthma signs and symptoms to know when they are getting worse.
- Knowing what to do when asthma gets worse.
Work with your childs healthcare provider to find the best way to take care of your childs asthma. There are guidelines for children from newborn to age 4, ages 5 to 11, and ages 12 and older.
The more information a person with asthma has, the better the asthma can be controlled.
How Is Asthma Treatment Different For Older Children
Sometimes when asthma is suspected, the doctor will put your child on a trial of asthma medication to see if it helps. If your child gets better while taking the medicine, it can be a signal that your childs symptoms are due to asthma. The medication will depend on how severe your childs symptoms are and how often they occur.
The goal of treatment for children include:
- Managing the childs environment to avoid triggers
- Treating the airway inflammation and bronchospasm with medication
- Keeping asthma in control so activity does not need to be limited
- Teaching the child about asthma, their medications and how to be as healthy as possible in a way they can understand
When administering medication to your child, make sure to follow the instructions given to you by your doctor and on the package insert.
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How Is Asthma In Toddlers Treated
For kids younger than 3, some doctors will suggest holding off on asthma medication for as long as possible . Thats because asthma medications are powerful, and experts arent sure about the long-term effects they may have on young children. If, however, your toddler has severe flare-ups and it looks like she would really benefit from them , the doc may prescribe medication to see if your childs symptoms improve.
Depending on the nature of your childs asthma, the doctor might prescribe one or both of these types of medications:
- A quick-relief medication called a bronchodilator that quickly opens up your childs airways when they are swelling during an asthma attack.
- A preventive medication, like an anti-inflammatory corticosteroid, which your toddler would need to take daily to keep the airways from getting inflamed in the first place.
Unlike other medications that come in a liquid form, which kids can swallow, most asthma medications need to be inhaled so they’re delivered directly into your toddlers airways. Older children and adults can use an inhaler to do this . Since inhalers can be difficult for toddlers to use, youll probably need to put a little mask over your tots mouth and nose that will be attached to the inhaler or a nebulizer . The mask will make it easier for her to breath in the medicine correctly.
What Causes Asthma In Infants And Toddlers
We still do not know what causes some people to get asthma. If a child has a family history of asthma or allergies, a specific allergy or had a mother who smoked during pregnancy, they have a higher chance of getting asthma early in life.
A respiratory virus, an illness that occurs in the lungs, is one of the most common causes of asthma symptoms in children 5 years old and younger. Although both adults and children experience respiratory infections, children have more of them. Some preschool children get viral infections often. At least half of children with asthma show some sign of it before the age of 5. Viruses are the most common cause of acute asthma episodes in infants 6 months old or younger.
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How Is Asthma Diagnosed In Older Children
Asthma is typically diagnosed with a medical exam and a test that measures the airflow in and out of the lungs. Your child may have one asthma symptom, or several of them. You may think its just a cold or bronchitis. If the symptoms come back, thats a clue your child might have asthma. In addition, symptoms may worsen when your child is around asthma triggers, such as irritants in the air or allergens like pollen, pet dander and dust mites.
Tell your childs pediatrician if anyone in your family has asthma, allergies or atopic dermatitis. These conditions often run in families if they run in yours, its more likely your child will have them.
You may be referred to an allergist who may perform skin or blood tests to see whether your child has any allergies that can trigger asthma symptoms. These tests can be done at any age. You can help your childs doctor by completing a childhood asthma control test prior to your visit.
How To Diagnose Asthma In Children
Its not easy to diagnose asthma in children under five years old, as there are many different reasons for wheezing and coughing. They may also find breathing tests difficult.
A doctor will undertake a medical history and will ask parents about the childs symptoms. This could include:
- Cough
- Chest pain or chest tightness
- The childs behaviour
Read more information about diagnosing asthma.
To help arrive at an accurate diagnosis, your doctor will ask about your childs symptoms and what you noticed about them, including the timing, frequency and severity. They will ask about your childs overall health and the presence and/or likelihood of asthma and allergies in the family. A doctor will check your child physically, called a physical examination. To determine a possible diagnosis, the doctor will connect all the pieces of information from this consultation and determine the most likely explanation, or diagnosis.
Sometimes to assist with an asthma diagnosis, a treatment trial is proposed. This involves starting asthma treatment and assessing whether it has been effective. This is usually a very safe approach using medicines with few or no side effects. It will potentially treat the symptoms and improve your childs condition.
We talk about what to expect and how to prepare for spirometry testing here.
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When Diagnosing Asthma Medical Histories Physical Exam And Lung Function Tests Come First
Whether youre visiting your primary care physician or a specialist, your doctor will likely take your personal and medical history, perform a physical exam, and take a lung function test to determine if asthma is the cause of your symptoms. These steps involve:
- A Personal and Medical History Personal and medical histories will include questions about your symptoms, when they occur, how long youve been dealing with them, if anything has made you feel better or worse, and whether any one in your family tree had asthma or breathing problems. Its helpful to your doctor if you keep a log or journal of your symptoms. Also, take some time to think about your family history, before your appointment.
- A Physical Exam Your doctor will listen to you breathe and listen to your heart . He or she will also examine your nose, mouth, and ears for signs of inflammation or irritation, which could signal either asthma or the presence of some other ailment. Your doctor will also check your skin for rashes, and signs of eczema, which causes redness and dryness and is associated with both allergies and asthma.
- A Pulmonary Function Test There are several different breathing tests, also known as pulmonary function tests , that a doctor may use to diagnose asthma. Types of lung function test are detailed in the next section.
Triggers For Asthma In Children
Asthma triggers are substances, conditions or activities that lead to asthma symptoms. These include :
- wheezing whistling noise when breathing
- coughing .
Your child may have all of these symptoms or just a few. Symptoms are often worse at night, in the early morning, during exercise or due to other triggers.
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How Is Asthma In Children Diagnosed
Asthma is often difficult to diagnose in infants. However, the disease can often be diagnosed in older children based on the child’s medical history, symptoms, and physical examination, and on certain tests:
- Medical history and symptom description: The healthcare provider will ask about any history of breathing problems your child may have, as well as a family history of asthma, allergies, a skin condition called eczema, or other lung diseases. Be sure to describe your child’s symptoms in detail, including when and how often these symptoms have been occurring.
- Physical exam: During the physical examination, the doctor will listen to your child’s heart and lungs.
- Tests: Many children will have a chest X-ray and pulmonary function tests, which measure the amount of air in the lungs and how fast it can be exhaled . The results will help the provider determine how severe the asthma is. Children younger than 5 are usually unable to perform pulmonary function tests, so doctors rely heavily on history, symptoms, and physical examination in making the diagnosis.
The doctor may order other tests to help identify particular asthma triggers, including allergy skin testing and blood tests.
Respiratory Exam And Medical History
A doctor asks about your childs respiratory symptoms, such as breathlessness, and recent illnesses. You may also discuss whether your child has allergies or a family history of asthma or allergies and whether he or she has been exposed to pets, cigarette smoke, or other possible triggers.
Our doctors look for signs that your child is having difficulty breathing, such as retraction, or sinking in, of the area between the ribs. They also listen for unusual breathing sounds, such as wheezing, which can be difficult to distinguish from other breathing noises.
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How Is A Spirometry Test Performed
Your healthcare provider will explain your results.
Some people who have asthma will have a normal spirometry test. If this is the case, you may be asked to take another test to confirm the diagnosis of asthma, like a methacholine challenge or exercise test.
*Infants and small children under 5-6 years old usually cannot do the spirometry test. Young childrens asthma is typically diagnosed based on signs and symptoms , family history, history of allergies, and their response to asthma medications.
Using Medicine As Prescribed Can Prevent Asthma Attacks
- Inhaled corticosteroids and other control medicines can prevent asthma attacks.
- Rescue inhalers or nebulizers can give quick relief of symptoms
- But . . . about half of children who are prescribed asthma control medicines do not use them regularly.
SOURCE: National Health Interview Survey, 2013.
The Federal government is
- Working with state, territorial, private and non-government partners to support medical management, asthma-self management education, and, for people at high risk, home visits to reduce triggers and help with asthma management. ,
- Providing guidelines, tools such as asthma action plans, and educational messages to help children, their caregivers, and healthcare professionals better manage asthma.
- Promoting policies and best practices to reduce exposure to indoor and outdoor asthma triggers such as tobacco smoke and air pollution.
- Tracking asthma rates and assuring efficient and effective use of resources invested in asthma services.
Doctors, nurses, and other healthcare providers are
Some payers/health insurance plans are
Parents and children are
Schools are
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Will Your Child Outgrow Asthma
Once a person’s airways become sensitive, they remain that way for life. About half of the children who have asthma have a noticeable decrease in symptoms by the time they become adolescentsâtherefore, appearing to have “outgrown” their asthma. However, about half of these children will develop asthma symptoms again in their 30s or 40s. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life.
A note from Cleveland Clinic
Last reviewed by a Cleveland Clinic medical professional on 04/01/2019.
References
Diagnosing Asthma In Young Children
Healthcare providers are often reluctant to give a diagnosis of asthma to infants and very young children because children often cough and wheeze with colds, chest infections like bronchitis, and other conditions responsible for asthma-like symptoms.
Since there is no diagnostic test available for children younger than six years of age, making a diagnosis in this age group is more difficult than in older children. Over the age of about six it is possible for a child to have a spirometry test. This is a simple test that measures a childs airflow through the large and small airways. Results reveal if the childs airflow can be improved with medication. Reversibility of airway obstruction is a key feature of asthma. If administering a bronchodilator reverses airway narrowing significantly, the diagnosis is probably asthma.
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When To See Your Doctor
- severe trouble breathing, such as rapid breathing, indrawing of muscles between their ribs when inhaling, and grunting when exhaling
- blue lips or fingertips, darkened skin
- chest, throat or neck pain
- fever and constant coughing or wheezing that doesnt respond to prescribed medicines
- vomiting that wont allow them to take oral medicine.
Also see your doctor if your child has asthma and is uneasy, drowsy, confused or lethargic .
What To Expect When You Visit The Doctor
Your doctor may ask whether you have any family history of asthma, eczema or hay fever.
In children, doctors assess the severity of the asthma based on the pattern and frequency of the symptoms.
Lung function tests are difficult to perform in children younger than 5 years and so are usually only used to diagnose and assess severity in children 5 years and older.
It is recommended that a paediatrician or paediatric respiratory specialist diagnose and manage asthma in infants under 12 months. If your infant is wheezing your doctor should refer to you one of these specialists.
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How Is Asthma Diagnosed In Infants And Toddlers
It is hard to diagnose asthma in infants and toddlers. Since they are not able to talk well, they cannot describe how they are feeling. A fussy baby could mean many things. Toddlers and preschoolers are often active, even with chest tightness or trouble breathing.Parents should give the following information to their childs doctor:
- Family history of asthma or allergies
- The childs behavior
- Breathing symptom patterns
- Potential triggers and responses to foods or possible allergy triggers
Lung function tests often used to make a complete asthma diagnosis are hard to do with young children. Instead, the doctor may see how the child responds to medications to improve breathing. The doctor may order blood tests, allergy testing and X-rays to get more information.Using this information, the doctor can make the best diagnosis. Parents may need to take their child to a pediatric allergist or pulmonologist for special testing or treatment.
Asthma Patterns In Children
Every childs asthma is different. Some children have mild, occasional episodes of asthma or only show symptoms after exercising, or when they have a cold. Some experience daily symptoms, while others have symptoms continuously, which limit their level of activity.
Each pattern of asthma requires a different treatment approach. It is important to remember that children can still have a severe and even life-threatening attack, even if they generally have mild or occasional asthma.
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Contact Doctor During Office Hours
- Don’t have written asthma action plan from your doctor
- Use an inhaler, but don’t have a spacer
- Miss more than 1 day of school per month for asthma
- Asthma limits exercise or sports
- Asthma attacks wake child up from sleep
- Use more than 1 inhaler per month
- No asthma check-up in more than 1 year
- You have other questions or concerns
Childhood Asthma Risk Factors
Asthma is the leading cause of long-term illness in children. It affects about 7 million kids in the United States. Those numbers have been going up, and experts arenât sure why.
Most children have their first symptoms by age 5. But asthma can begin at any age.
Things that can make a child more likely to have asthma include:
- Exposure to secondhand tobacco smoke before or after birth
- African-American or Puerto Rican descent
- Being raised in a low-income environment
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What Can I Do To Reduce Asthma Symptoms
- Learn your childs triggers.
- Allergens like dust mites, pets, pests, molds and pollen can play a role in some childrens asthma. Discuss with your health care provider whether an evaluation by an allergist may be helpful.
- Follow your asthma management plan and give the medicines prescribed by your childs doctor.
- Avoid smoking near your child.