The majority of children with asthma have a tendency to be allergic too and their asthma is often associated with common allergens such as grass pollen, house dust mite and animal dander. Section XX will help you with trigger avoidance strategies.

 

The medication section (XX) describes common asthma medicines many of which are prescribed for children. There are some parents that are fearful to putting their children on inhaled corticosteriods because they have heard that it will affect their child’s growth. There is evidence that growth slows with the initial use of inhaled corticosteroids, but within one year, the former growth rate is regained and full predicted adult height is attained. There is no evidence of permanent growth impairment with inhaled corticosteroids.

 

Nebulizers with a facemask can be used from a very young age. Having loaded up and switched on the device, the parent can sit with the child on his/her lap and attempt to keep the child reasonably still for 5-10 minutes by playing, reading, or watching a video, and this can be built into the child’s daily routine as a moment of quiet and close parental attention. Of course, it can be difficult to get a three year old to sit still 2-4 times a day to use a nebulizer. Infants and young children receiving nebulized mediactions once a day may have their treatment while sleeping, if this is preferred. Be sure the mask fits properly so the mist does not blow all over the face.

 

An old technique called “blow by” should be avoided. In this technique, the nebulizer tubing is held near the patient’s face and hopefully some of the medication is inhaled. This practice really has nothing to recommend it: it wastes medicine and mist can get into the eyes more easily than into the lungs. Another myth is that a crying child will get just as much medicine from the nebulizer as a quiet child.

 

A metered dose inhaler plus spacer is designed for lower doses of medication than the nebulizer. This system has the advantage of being less time consuming than the nebulizer and the delivery of medicine into the airways is equally good. There are facemasks that can be fixed to some spacers for use with young children. In this situation, the child breathes normally and, after every 4-5 breaths, the parent shakes and then pushes the canister.

Many parents of children with asthma worry about their children becoming over-dependent on their asthma medication. There is a idea that “doing without” will somehow “strengthen their resistance,” and that using medication is a “sign of weakness.” Such views play havoc with compliance with regular therapy. Uncontrolled asthma is far more harmful and dangerous than any prescribed asthma medication, and that children do not become in any way dependent on or resistant to asthma medications with long term use.

 

Taking asthma medication at school presents several potential problems for the child.

Many schools insist that all medicines be kept in the school nurse’s office. From the school’s point of view, this avoids the possibility of inhalers being shared by other children, but from the child’s point of view it can be an extra obstacle to compliance. In addition, many children of school age hate to be seen to be “different” by their peers, and children can be extremely cruel in spotting “different” behavior and using it to bully or tease. Schools do require an authorization for treatment and this may serve as a useful way to promote communication between the child, the parent and the school.

 

Management of asthma in teenagers is often a special challenge. During these years, teens are establishing themselves as independent of their parents, although they still want to avoid being different from peers. They are fully capable of the denial of symptoms we see in other age groups, and although they may know intellectually that death exists, they often behave as if they were immortal.

 

Some strategies for successful asthma management with teens are: