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2019 Nov

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Does your child wheeze or have trouble breathing? If so, read this.

As a toddler, my daughter was often ill. Anytime she played in cold air or caught a cold, she would start coughing and wheezing. The cough was worse at night or with activity. We’d go into the doctor’s office and they would send me home with albuterol in a “puffer” with a mask and sometimes steroids. I wondered why we couldn’t prevent her episodes. 

Finally, I met a wonderful pediatric nurse practitioner—thanks, Susie!—who took the time to educate me. My child was given a diagnosis of asthma and a treatment plan to include daily prevention medicine: an inhaled corticosteroid, which she would take twice daily. Her symptoms improved, and we had far fewer flares. I wish that she had been diagnosed and treated sooner. Have you ever wondered if your child has asthma?

Asthma is a chronic condition that makes it difficult to breathe. During an asthma episode or “flare,” the small airways in the lungs swell and fill with mucus, making it harder to breathe. There is shortness of breath, like breathing through a straw. An asthma flare gives symptoms including a whistling noise (wheezing), a lot of coughing, and a tight feeling in the chest. Asthma can be serious. According to the American Academy of Allergy, Asthma and Immunology (AAAAI), there were 219 pediatric deaths in 2015 due to asthma.

Is all wheezing asthma? No, asthma is more than just wheezing. Wheezing is a common symptom in infants: 50 percent will have wheezing in the first year of life. One third of children less than 3 years of age will have at least one episode of wheezing, according to UpToDate. Wheezing may be just a self-limiting symptom or part of a bigger respiratory disease, but how do you know? 

Children may have different triggers which cause their flares. Some children flare when exposed to smoke—cigarette smoke, vape smoke, or smoke from a campfire. Others may flare to allergens, like pollen, dust, animal dander, or mold. Exercise can cause some kids to trigger. Sometimes a viral illness like a cold or a flu can cause a flare. Therefore, it’s vital for asthmatics to get their flu shot. 

What are the risk factors for a child developing asthma? A family history of asthma is a significant risk factor. Children with known allergies, either environmental or food allergies, have a higher risk of developing asthma. Also, children with skin sensitivity or eczema (atopic dermatitis) have an increased risk of asthma. 

In order to diagnose a child with asthma, the healthcare provider will look at past medical history and family history and complete a thorough examination. If your child is old enough, a breathing test called a spirometry is very helpful.

In order to treat asthma, you must try to help your child avoid triggers as well as take any preventative medication that your healthcare provider prescribes. Things that may help include avoiding dust, keeping pets out of your child’s bedroom, staying inside with the A/C on during high pollen days, and driving with the A/C on and the car windows shut. Children with an exercise trigger may be given medicine to use before exercise. We can’t always avoid triggers, so preventative medication is very important.

There are two types of asthma medication. One is emergent and one is preventative. The emergency medication is a bronchodilator: albuterol. It opens the lungs immediately. The other type of medication is a controller, which is used daily to prevent flares. Always take your medicine as directed by your healthcare provider. 

A spacer (tube with a mask or mouthpiece) helps your child get a full dose of their asthma medication. Some prefer a nebulizer (machine), but it is not portable and needs electricity, so it’s no good on the soccer field. According to studies, when used correctly a puffer and spacer works as well as the nebulizer.

Although asthma is considered a chronic condition, many kids find that their asthma symptoms improve significantly as they get older. Asthma does not have to slow your child down. With the proper medication and precautions a child with asthma can remain active and healthy. See your pediatric healthcare provider for more information. Be sure to get an asthma action plan and flu protection this fall. .

Melanie J. Wilhelm, DNP, CPNP

Dr. Melanie J. Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice, and a Certified Pediatric Nurse Practitioner as well as core faculty member at Walden University. Her book, Raising Today’s Baby: Second Edition, is available on


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