When you become a parent, you quickly realize how important it is to be vigilant. As they say, "danger is all around you." But what to look out for, and why, isn't always clear, and when it comes to your child's health it can be difficult to distinguish the symptoms of a common cold from something more severe. That's why it's worthwhile for every parent to know the signs of childhood asthma, just in case a cough is a sign of something chronic.
Romper spoke with Dr. Luis E. Ortiz, MD, a pediatric pulmonologist and sleep medicine physician at Johns Hopkins All Children's Hospital, to learn more.
So what is asthma? Essentially, it's the constriction of the airways, either by inflammation (due to triggers, such as allergens, exercise, or respiratory infection), muscle constriction, and/or increased mucus production, according to the American Lung Association. In other words, it makes breathing harder. Asthma is the most common chronic condition among children, affecting approximately 6.1 million children under 18. While there is no set age as to when a child will develop asthma, it can happen as early as a few months old, but generally happens before kindergarten.
"About 80% of children with asthma will develop symptoms before age 5," Dr. Ortiz tells Romper. "But it is frequently misdiagnosed or not suspected. This is especially true for very young children such as infants and toddlers."
According to the Mayo Clinic, common asthma symptoms include frequent coughing, wheezing, and shortness of breath. But because these symptoms can vary in presentation, severity, and frequency — often getting better or worse on their own depending on a person's individual triggers — an asthma diagnosis may overlooked or misdiagnosed.
"A parent who reports that their child gets 'a cold' every month, with these symptoms, is suspicious for asthma," Dr. Ortiz says. In infants, he warns parents to be mindful of increased effort in breathing ("You might see the skin get tugged in-between the ribs or the muscles of their neck.") and a dry, hacking cough. In toddlers and preschoolers, in addition to frequent coughing, he also cites not being able to keep up with other children while playing, easily losing breath during physical activity, and coughing in their sleep as being potential symptoms.
Once a child reaches school age, asthma presentation becomes more identifiable and they are generally better able to describe their asthma symptoms. "Older children can better describe their experiences and may report chest pain or the sensation of not being able to take a full breath," Dr. Ortiz explains. "They may additionally report the sensation of panic or fear with these episodes."
Young children shouldn't have to modify their lifestyle because of asthma.
So why does anyone develop asthma? Dr. Ortiz says there are many risk factors that can contribute the a diagnosis, the majority of which cannot be avoided, like ethnicity, sex, family history, and co-existing conditions, such as allergies. "If I had to pick the big three factors, I would include exposure to tobacco smoke ... whether or not parents have asthma at any time in their life, and socio-economic status... children from poorer families are more likely to be diagnosed with asthma."
While the connection between poverty and asthma is the subject of continued study and debate, the Asthma and Allergy Foundation of America posits that poor rental housing and their location near highways (and therefore increased air pollution) may play a role.
While there is no surefire asthma prevention method (and may, in some cases, may be impossible to avoid) the Global Initiative for Asthma (GINA) recommends avoiding exposure to tobacco smoke (especially during pregnancy and the first year of life), acetaminophen and broad-spectrum antibiotics if possible in the first year of life, and encourages vaginal delivery and breastfeeding (both of which have been linked to decreased risk of asthma).
But if your child is diagnosed with asthma, Dr. Ortiz assures parents that their little ones can have happy, active childhoods just like anyone else.
"Young children shouldn't have to modify their lifestyle because of asthma," he says. "If they can't play and do things as well as other children because of their asthma, then that means that more needs to be done to treat their asthma." He added that the person whose life will be more affected by a diagnosis is a child's parents, at least until a kid becomes old enough to more independently manage their care.
Day-to-day asthma treatment may vary, but usually includes two medications, both delivered via inhaler: a bronchodilator (also referred to as a "rescue inhaler"), which relaxes the smooth muscles around the airways, opening them up, and a glucocorticoid (also referred to as "controller medication"), which reduces inflammation in the lungs. Regular "controller medication" use, ideally, decreases the need for "rescue" medication. Children with very mild asthma may only need to carry a rescue inhaler. Children with more severe asthma may also include an oral medication, such as montelukast, to control their symptoms. Others will need to treat co-existing conditions, such as sleep apnea or allergies to effectively treat their asthma.
Dr. Ortiz warns parents not to take good management of symptoms as a sign to cease medicating their child's condition. "Not treating asthma can result in worsening asthma," he says. "Frequent exposure to inflammation causes restructuring of the small airways of the lungs that results in increased sensitivity to irritants and inflammation that result in ore frequent and more severe asthma attacks. It can become a dangerous cycle that can only be broken by consistent adherence to medications."
But with treatment, Dr. Ortiz says, some patients can be treated with minimal medications in time. Indeed, some kids appear to "grow out" of asthma, though Dr. Ortiz warns this possibility should not be taken as a promise. "Some children get better as they get older, others get worse, and some will stay the same."
Being aware of your child's triggers, paying attention to when their symptoms worsen, and communicating with their care provider to find treatment that works for them can ensure that childhood asthma doesn't stand in the way of their childhood.