Mayo Clinic Health Library

Treating asthma in children under 5

Updated: 01-12-2011

Most children with asthma develop symptoms before age 5. There are a number of conditions that can cause asthma-like symptoms in young children. But if your child's symptoms are caused by asthma, early diagnosis is important. Asthma treatment in children improves day-to-day breathing, reduces asthma flare-ups and helps reduce other problems caused by asthma.

Asthma in children varies by age group. Infants, toddlers and 4-year-olds are diagnosed and treated differently than teens and adults are. Asthma in children also varies from child to child, and symptoms may get better or worse at certain times. In some children, asthma symptoms improve with age.

Asthma can't be cured, but you can keep symptoms at a minimum by using a written asthma action plan you develop with your child's doctor to track symptoms and adjust treatment.

Asthma symptoms in children under 5

Common asthma symptoms in children under 5 include:

  • Coughing
  • Wheezing
  • Trouble breathing
  • Chest pain
  • Recurring bronchitis

Some children have few day-to-day symptoms, but have severe asthma attacks now and then. Other children have persistent mild symptoms or symptoms that get worse with activity or other triggers such as cigarette smoke or seasonal allergies.

  • If your child is an infant, you may notice slow feeding or shortness of breath during feeding.
  • If your child is a toddler or older, you may notice a decreased desire to run and play due to breathlessness. Your son or daughter may become fatigued easily and cough when exercising.
  • For many children under age 5, asthma attacks are triggered or worsened by colds and other respiratory infections. You may notice that your child's colds last longer than they do in other children, or that signs and symptoms include frequent coughing that may get worse at night.

Asthma emergencies
For some children, severe asthma attacks can be life-threatening and require emergency room treatment. Signs and symptoms of an asthma emergency in children under 5 years old include:

  • Gasping for air
  • Trying so hard to breathe that the abdomen is sucked under the ribs when he or she breathes in
  • Trouble speaking because of restricted breathing

Tests to diagnose and monitor asthma in young children

Diagnosing asthma can be tricky in young children. Wheezing, coughing and other asthma-like symptoms can occur with conditions other than asthma, such as viral infections. For this reason, it may not be possible to make a definite diagnosis of asthma until your child is older.

For older children and adults, doctors can use breathing tests (lung function tests) such as spirometry or peak flow measurement. As your child gets older, these tests may be used to help pinpoint an asthma diagnosis and track how well treatment's working. Generally, children under age 5 aren't able to do these tests.

Your child's doctor may be able to check for inflammation in your child's airways with a test that measures levels of nitric oxide gas in the breath. In general, higher levels of nitric oxide mean your child's lungs aren't working as well as they should be, and asthma isn't under control.

Asthma treatment in young children

If your child's asthma symptoms are severe, your family doctor or pediatrician may refer your child to see an asthma specialist.

Your child's doctor will want your child to use just the right amount and type of medication needed to control his or her asthma. This will help prevent side effects. Based on your record of how well your child's current medications seem to control asthma symptoms, your child's doctor may "step up" treatment to a higher dose or add another medication. If your child's asthma is well controlled, the doctor may "step down" treatment by reducing your child's medications. This is known as the stepwise approach to asthma treatment.

Certain medications aren't specifically approved for use in children by the Food and Drug Administration, but the doctor may prescribe them based on his or her judgment of what's likely to work best for your child.

Long-term control medications
Known as maintenance medications, these are generally taken every day on a long-term basis to control persistent asthma. These medications may be used seasonally if your child's asthma symptoms become worse during certain times of the year.

Types of long-term control medications include:

  • Inhaled corticosteroids are the most common medications for asthma, and the ones proved to work best in younger children. These anti-inflammatory drugs include fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid) and beclomethasone (Qvar).
  • Leukotriene modifiers, such as montelukast (Singulair), are considered a secondary addition to treatment with inhaled corticosteroids. In rare cases, leukotriene modifiers have been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away if your child has any unusual psychological reaction.
  • Cromolyn may help prevent mild to moderate asthma attacks. Cromolyn needs to be taken two to four times a day and is usually taken along with an inhaled corticosteroid.
  • Theophylline is a daily pill that opens the airways (bronchodilator). It relaxes the muscles around the airways to make breathing easier. This medication is not used as often now as in past years.
  • Combination inhalers. These medications contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include Advair (fluticasone and salmeterol), Symbicort (budesonide and formoterol) and Dulera (mometasone and formoterol). In some situations, long-acting beta agonists have been linked to severe asthma attacks. For this reason, LABA medications should only be given to children when they are combined with a corticosteroid in a combination inhaler.

Quick-relief 'rescue' medications
These medications — called short-acting bronchodilators — provide immediate relief of asthma symptoms and effects last four to six hours. The most commonly used short-acting bronchodilator for asthma is albuterol. Others include pirbuterol and levalbuterol. But, while these medications work quickly, they can't keep your child's symptoms from coming back. If your child has frequent or severe symptoms, he or she will need to take a long-term control medication such as an inhaled corticosteroid.

Your child's asthma is not under control if he or she often needs to use a quick-relief inhaler. Relying on a quick-relief inhaler to control symptoms puts your child at risk for a severe asthma attack and is a sign that your child needs to see the doctor about making treatment changes. Track the use of quick-relief medications, and share the information with your child's doctor at every visit.

Immunotherapy for allergy-induced asthma
Allergy-desensitization shots (immunotherapy) may help if your child has allergic asthma that can't be easily controlled by avoiding asthma triggers. Your child will begin with skin tests to determine which allergy-causing substances (allergens) may trigger asthma symptoms. Once your child's asthma triggers are identified, he or she will get a series of injections containing small doses of those allergens. Your son or daughter will probably need injections once a week for a few months, then once a month for a period of three to five years. Your child's allergic reactions and asthma symptoms should gradually diminish.

Medication delivery devices
Most asthma medications are given with a device that allows a child to breathe medication directly into the lungs. Your child's medication may be delivered with one of these devices:

  • Metered dose inhaler. Small hand-held devices, metered dose inhalers are a common delivery method for asthma medication. Along with his or her inhaler, your child will probably also need a hollow tube (spacer) with a mouthpiece. If your child is younger than 4 years old, he or she may need a face mask. This device attaches to the spacer and delivers medication while your son or daughter breathes normally.
  • Dry powder inhaler. For certain asthma medications, your child may have a dry powder inhaler. This device is not generally used in children younger than 4 years old, as it requires a deep, rapid inhalation to get the full dose of medication.
  • Nebulizer. A nebulizer turns medications into a fine mist your child breathes in through a face mask. A nebulizer can deliver larger doses of medications into the lungs than an inhaler can. Young children often need to use a nebulizer because it's difficult or impossible for them to use other inhaler devices.

Asthma control: Steps for children under age 5

Managing your child's asthma can seem like an overwhelming responsibility. Following these steps makes it a lot easier.

Learn about asthma
A critical part of managing your child's asthma is learning exactly what steps to take on a daily, weekly, monthly and yearly basis. It's also important that you understand the purpose of each part of monitoring and treatment. You and your child, as well as caretakers (such as child care providers and preschool teachers) need to:

  • Understand the different types of medications for asthma and how they work
  • Learn to recognize and record signs and symptoms of worsening asthma
  • Know what to do when your child's asthma gets worse

Track symptoms with a written plan
A written asthma action plan is an important tool to let you know how well treatment is working, based on your child's symptoms. With your child's doctor, create a written asthma action plan that outlines the steps needed to manage your child's asthma. You and your child's caretakers (such as child care providers and preschool teachers) should have a copy of the plan. The plan can help you:

  • Track how often your child has asthma flare-ups (exacerbations)
  • Judge how well medications are controlling symptoms
  • Note any medication side effects
  • Check how well your child's lungs are working with a hand-held device called a peak flow meter (when your child is old enough to use it)
  • Measure how much your child's symptoms affect normal activities such as play and sleep
  • Adjust medications when symptoms get worse
  • Know when to see a doctor or seek emergency care

Many asthma plans use a "stoplight" system of green, yellow and red zones that correspond to worsening symptoms. This system can help you quickly determine asthma severity and identify signs of an asthma attack. Some asthma plans use a symptoms questionnaire called the Asthma Control Test (ACT) to measure asthma severity over the past month.

Make changes and see the doctor when necessary
Effective asthma treatment requires tracking how well medications are working on an ongoing basis — and knowing what to do when they're not working. You'll need to:

  • Work with the doctor to determine what types and doses of medications are most effective
  • Adjust your child's medications according to the asthma action plan you worked out with your child's doctor
  • Watch for side effects such as irritability, shaking, trouble sleeping or excitability, and report them to your child's doctor

Control asthma triggers
Taking steps to help your child avoid triggers is an important part of controlling asthma. Asthma triggers vary from child to child. Work with your child's doctor to identify triggers and steps you can take to help your child avoid them. Common asthma triggers include:

  • Colds or other respiratory infections
  • Allergens such as dust mites or pollen
  • Pet dander
  • Exercise
  • Cold weather
  • Cigarette smoke and other irritants in the air
  • Severe heartburn (gastroesophageal reflux or GERD)

The key to asthma control: Stick to the plan

Following and updating your child's asthma action plan is the key to keeping asthma under control. Carefully track your child's asthma symptoms, and make medication changes as soon as they're needed. If you act quickly, your child is less likely to have a severe attack, and he or she won't need as much medication to control symptoms. With careful asthma management, your child should be able to avoid flare-ups and minimize disruptions caused by asthma.

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