Asthma in Children

When to Call a Doctor

If your child has been diagnosed with asthma and has an asthma action plan (which tells you what medications to take during an asthma attack), do the following.

Call911or other emergency services immediately if your child has severe asthma symptoms (in the red zone of the asthma action plan) and you have followed the plan, but:

• Your child is still having severe difficulty breathing.
• 20 to 30 minutes after taking the extra quick-relief medication, your child does not feel better and/or his or her peak expiratory flow (PEF) is still less than 50% of the personal best measurement.

Call your health professional immediately if your child:

• Has asthma symptoms that get worse and you feel there is nothing else you can do at home.
• Has had an asthma attack in the red zone, and 6 hours after taking the extra medication the following are true:
  • The child still requires inhaler medication every 1 to 3 hours.
  • The peak expiratory flow is below 70% of the personal best measurement.
• Is in the yellow zone of the asthma action plan and continues to have a peak expiratory flow below 70% of the personal best measurement in spite of home treatment using the asthma action plan.
• Is having a first attack of asthma symptoms, and they include wheezing, chest tightness, and moderate difficulty breathing.
• Is coughing up yellow, dark brown, or bloody mucus.

Call your health professional if your child:

• Has asthma symptoms, you do not have an action plan, and the symptoms are mild (chest tightness, cough, and slight shortness of breath or tiring easily during exercise).
• Is having symptoms in the yellow zone almost every day, but inhaler medication is providing quick relief.
• Has asthma and his or her PEF has been getting worse for 2 to 3 days.

If your child has not been diagnosed with asthma but has asthma symptoms, call your health professional and make an appointment for an evaluation. Many children and teens with frequent wheezing have asthma but are not diagnosed with the disease. Children and teens who are less likely to be diagnosed with asthma include:¹⁸

• Girls, especially teenage girls.
• Smokers or those exposed to household cigarette smoke.
• Those with low socioeconomic status.
• Those who have allergies.
• African Americans, Native Americans, or Mexican Americans.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your child's symptoms or condition without using medical treatment.

If you think your child has asthma, watchful waiting is not appropriate. See your health professional.

If your child has been getting treatment for 1 to 3 months and is not improving, ask your health professional whether the child needs to see a specialist (allergist or pulmonologist).

Watchful waiting may be appropriate if your child follows his or her daily asthma treatment and action plans and stays within the green zone. Monitor your child's symptoms, and continue to avoid asthma triggers.

Who to See

Health professionals who can diagnose and treat asthma include:

• Pediatricians.
• Family medicine physicians.
• Nurse practitioners.
• Physician assistants.
• Internists.

Your child may need to see a specialist (an allergist or pulmonologist) if he or she has:

• Unusual symptoms, or it is unclear whether the child has asthma.
• Other medical conditions that make it hard to treat asthma.
• Need for additional education or difficulty following the daily asthma treatment and action plans.
• Not made progress toward achieving the goals of treatment after 4 to 6 weeks of therapy.
• Not met the goals of treatment in 3 to 6 months.
• Had a life-threatening asthma attack.

Your child also needs to see a specialist if he or she:¹⁹

• Has moderate persistent to severe persistent asthma.
• Needs to take continuous oral corticosteroid medications or high-dose inhaled corticosteroids, or has had more than two treatments with corticosteroid medications by mouth in 1 year.
• Needs skin testing for allergy.
• Is thinking about starting treatment with allergy shots (immunotherapy).

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Author:	Maria G. Essig, MS, ELS	Last Updated: March 22, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Harold S. Nelson, MD - Allergy and Immunology
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