What parents should know about their children's behavior

That cold evening, while I was sipping hot tea in my room, the door to our clinic suddenly rang. When I opened the door, Shalini, one of my best friends, was very worried. She was holding her little son, Dinuka.

Dinuka seemed to be gasping for breath, her chest moving up and down with great difficulty. As a doctor, I had seen many such patients in the clinic, but seeing my own friend's child in such a difficult situation made me feel very scared. I immediately took them in.

"Doctor Priya, Dinuka usually coughs during colds. But tonight it got worse. She's struggling to breathe. I'm scared, doctor," Shalini said in a tearful voice.

When Dinuka was examined, he was diagnosed with childhood asthma, a common condition among children. So today, let's talk about what childhood asthma is, its symptoms, and what parents should do immediately if their child has an asthma attack.

What is asthma?

Asthma is a long-term respiratory disease caused by inflammation and sensitivity of the small airways in our lungs.

When these airways become swollen and narrow and filled with mucus, air entering and leaving the lungs is blocked. That's what happened to Dinuka. "Shalini, it's like breathing through a flexible tube. If someone presses on the tube in the middle, you won't be able to breathe, right? Dinuka's body is also going through something similar," I explained simply to Shalini.

Is it normal for children to develop asthma?

Yes. Asthma is the most common chronic disease in children. On average, one in four or five children will develop asthma symptoms during childhood.

It is especially common in children between the ages of 2 and 8. Some children outgrow their asthma as they grow older, while others may continue to have it into adulthood. However, with proper medical treatment and management, a child can be able to play and live an active life as usual.

Childhood Asthma Symptoms

Here are the main signs that can help you identify whether a child has asthma:

• Persistent Coughing: A dry cough that occurs especially at night, in the early morning, or when the child is tired from playing.
• Wheezing: A subtle "whoosh" or "whoosh" sound from the chest, similar to a flute, when the child exhales.
• Shortness of Breath: Rapid breathing and difficulty breathing.
• Chest Tightness: The child may describe the chest as being sore or tight (younger children may also describe this as a stomach ache).
• Fatigue: Not wanting to exercise or play and getting tired quickly.

Triggers for an asthma attack

There are several triggers that can irritate the airways of a child with asthma:

• Colds and flu: Viral infections cause increased swelling of the airways.
• Allergens: House dust mites, cat/dog dander, pollen, and mold.
• Weather changes: Cold weather, fog, or a sudden drop in ambient temperature.
• Air pollution: cigarette smoke, red powder/dust, mosquito coil smoke, and strong perfumes.

🚨 Red Flags that require immediate hospitalization

If a child has an asthma attack and the following symptoms appear, they should call 1990 immediately and take them to the hospital without delay:

• Difficulty breathing: When the child breathes, the skin between the ribs and at the base of the neck pulls in (Chest Retractions).
• Difficulty speaking: The child may not be able to speak several words at a time due to shortness of breath.
• Bluish skin: The area around the baby's lips, tongue, or fingernails turns blue or gray (a sign of low oxygen levels).
• Drowsiness: The child becomes lethargic and weak, and has difficulty keeping awake.
• No relief despite using the blue inhaler (Reliever).

First aid in case of an asthma attack (Asthma Action Plan)

If a child is having difficulty breathing, as Shalini's Dinuka did with her son, follow these first aid steps immediately:

1. Sit the baby upright: Don't let the baby sleep. Sitting the baby upright makes it easier to breathe.
2. Calm down: If you get nervous, the baby will become more frightened and the airways will narrow further. Calmly reassure the baby.
3. Give the blue inhaler (Reliever - Ventolin) with the spacer device:

• Shake the inhaler well and attach it to the spacer.
• Place the mask tightly on the child's face and puff once .
• Let the child take 4 normal breaths through the spacer.
• In this way, give 4 puffs (one each separately) within 4 minutes .

4. Wait 4 minutes: If the child's breathing does not return to normal, repeat the steps above and give 4 more puffs.
5. Take to the hospital: If the condition does not improve, call 1990 immediately and take to the hospital. While on the way to the hospital, give the inhaler 4 puffs every 4 minutes.

Long-term medical treatment and control

Doctors mainly recommend two types of inhalers to control asthma:

• Reliever inhalers (usually blue): Used only when breathing is difficult during an asthma attack (e.g. Ventolin/Salbutamol).
• Preventers (usually brown, red or orange): These should be used daily at a prescribed dose as directed by a doctor to control asthma. They gradually reduce the swelling and mucus in the airways.

Let's create an asthma-friendly home (Home Care)

• Ban smoking completely: Do not allow anyone to smoke inside the house or in places where the child hangs out.
• Control dust: Minimize the use of thick curtains and carpets in the home. Wash and dry your child's bedding once a week in hot water at around 60 degrees Celsius.
• Pets: Prevent dogs and cats from entering the child's bedroom.

Do's & Don'ts

Scientific sources (References)

• 📚 Asthma - NHS
• 📚 Diagnosis and management of asthma in children - PMC