Asthma in children: how to tell when it’s an emergency
A paediatrician offers guidance for understanding the signs of an asthma emergency and what you should do when a child is in distress.
“All caregivers of children with asthma must be provided with clear, written instructions by their treating doctor outlining exactly what to do during an acute exacerbation – a severe and potentially life-threatening asthma attack,” says Dr Refiloe Moreke, a paediatrician practising at Netcare Garden City Hospital.
According to the Global Asthma Report, asthma is the most common non-communicable disease among children and adolescents in Africa, yet it remains largely underdiagnosed.
“Acute asthma attacks in children typically present with an expiratory wheeze and varying degrees of respiratory distress. It is important for parents and anyone responsible for caring for children with diagnosed asthma to recognise these signs early and seek medical help timeously,” she says.
Symptoms of respiratory distress:
- Fast breathing
- Shortness of breath
- Worsening cough
- Chest tightness
- Use of muscles in the neck, shoulders and chest that are not usually needed for normal breathing
- Feeling tired or weak
- Trouble feeding, especially in very young children.
What to do
“When a child’s parents or caregiver recognise the onset of an asthma attack, the first step is to administer the child’s quick-relief or bronchodilator medication immediately, and a second dose can be provided 20 minutes later,” Dr Moreke says.
“For severe attacks, parents or caregivers should immediately call for an ambulance or transport the child to the nearest emergency department for urgent medical care while initiating quick relief medication,” she advises.
Inform any caregiver
“Parents should alert their child’s school or other caregivers if their child has asthma and should share a clear action or treatment plan to be followed in case of an emergency. A list of possible triggers should also be provided, so that they can help the child and others who care for the child avoid possible exposure,” Dr Moreke advises.
“While immediate emergency instructions are vital, managing asthma daily requires a comprehensive written action plan. This plan details not only the medications your child needs and the correct way to use them but also ensures that caregivers – especially at school – are prepared with enough medication and know how to recognise early warning signs. An effective action plan will bridge the gap between emergency response and everyday care, providing essential protection when parents can’t be at their child’s side,” she says.
Asthma diagnosis in young children
“Diagnosing asthma in children can be very challenging, especially in very young children, because many of the symptoms overlap with other respiratory illnesses. Another factor is that younger children may not be able to perform certain diagnostic tests yet,” Dr Moreke explains.
“Providing the doctor with information including any family history of asthma or allergies, and a list of the child’s symptoms, like breathing patterns, wheezing, coughing – especially at night, after exercise, or following exposure to allergens like grass, mould, house dust mite or pets, and how long these have been noted, is most helpful,” she says.
Confirming an asthma diagnosis is usually based on the demonstration of reversible airflow obstruction with spirometry. “This is a test where the patient needs to exhale their full lung capacity through a tube to measure the volume of air and rate of flow as they breathe out. Unfortunately, spirometry cannot be performed in children under five years old, further complicating the diagnosis of such young patients,” Dr Moreke explains.
Identifying triggers
“Asthma is easier to manage when parents know what their child is sensitive to and are able to remove these triggers from the child’s environment,” Dr Moreke says.
Common asthma triggers
- Respiratory infections
- Allergens such as house dust, dust mites, mould, grass, pets, and tobacco smoke
- The weather or temperature changes, especially in winter or spring
- Physical activity
- Emotions and stress.
“Certain triggers can be identified through allergy testing or the appearance of symptoms after exposure to a particular trigger. For triggers that are difficult to avoid, like physical activity, environmental allergens, emotional triggers or upper respiratory tract illnesses, parents should be taught how to adjust their child’s asthma medication to help better manage potential flareups that could occur at any time.
“Informed parents, grandparents and caregivers are absolutely vital when it comes to ensuring the safety of asthmatic children. We can never assume someone will know exactly what to do in an emergency, which is why regular communication and clear guidance are essential. Staying prepared can make all the difference when it matters most,” concludes Dr Moreke.
Words: Netcare
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