Asthma in Children

Around 4.9 million children in the United States have asthma.¹ Asthma is one of the most common chronic (long-term) diseases in children. It is also one of the main causes for missed school days.² It cannot be cured, but it can be managed.

Childhood asthma tends to affect more male children than female children.¹ But during adulthood, females have higher rates of asthma than males. Some studies suggest that the increase in testosterone hormone in males decreases swelling in the airways.³

Some children have a higher risk of asthma. Asthma rates are highest in children who are:

• Living in households with lower incomes
• Puerto Rican
• Black
• Indigenous, Native American, Alaska Native
• Living in inner cities
• Living near high amounts of air pollution

What Are Symptoms of Asthma in Children?

People can develop asthma at any age. But asthma often starts in childhood. Asthma signs and symptoms in infants and toddlers may also be different from older children and teens.

The signs and symptoms of asthma in a baby or toddler include:

• Coughing (persistent, repeated, and/or at night)
• Fast or rapid breathing
• Working harder to breathe
  • Nostrils flaring
  • Skin is sucking in around and between ribs or above the sternum
  • Exaggerated belly movement
• Panting with normal activities such as playing
• Wheezing (a whistling sound)
• Trouble sucking or eating
• Tiredness, not interested in normal or favorite activities
• Cyanosis, a tissue color change on mucus membranes (tongue, lips, and around the eyes) and fingertips or nail beds – cyanosis appears grayish or whitish on darker skin tones and bluish on lighter skin tones

Signs and symptoms of asthma in school-age children and teens may include some of the symptoms above as well as:

• Shortness of breath
• Cough
• Chest tightness or pain
• Wheeze (a whistling sound when you breathe)
• Waking at night due to asthma symptoms)
• A drop in their peak flow meter reading (if your child uses one)
• Exercise intolerance (not able to do physical activity that’s normal for their age)

What Causes Asthma in Children?​

Experts don’t know exactly what causes asthma in children. But the following risk factors may make a child more likely to have asthma:

• Family history of asthma
• Respiratory illnesses, such as flu, RSV, and colds
• Allergies and eczema (atopic dermatitis)
• A mother who smoked during pregnancy
• Exposure to secondhand and thirdhand tobacco smoke or e-cigarette aerosol after birth
• Living in an area with high air pollution

Upper respiratory infections caused by viruses are the most common trigger for children with asthma.

How Do Doctors Diagnose and Treat Asthma in Children?

To diagnose asthma in a child, a doctor will ask about medical and family history, do a physical exam, and do lung function tests, if possible. This testing can usually be performed in people ages 5 years and older. They may also do allergy testing. If your child is too young or unable to do a lung function test, the doctor may prescribe a trial of asthma medicine to see if their symptoms get better.

It is important to get proper treatment for your child’s asthma. This will help them feel better, participate in all activities including sports, and miss fewer school days. It can also prevent permanent lung damage.

Treatment for asthma in children involves:

1. Avoiding or reducing asthma triggers. To do this, you need to know what triggers your child’s asthma and then take steps to manage those triggers. Once you know your child’s triggers, you can control or manage them. (Use AAFA’s Healthier Home Checklist to help you.) Triggers can include:
   • Respiratory infections caused by viruses
   • Exercise and physical activity
   • Cold and dry air
   • Big temperature and weather changes
   • Allergens (like pet dander, dust mites, pollen)
   • Strong odors, irritants, chemicals
   • Smoke (wildfire, cooking, cigarette, vaping)
   • Non-steroidal anti-inflammatory medicines (such as ibuprofen)
   • Indoor and outdoor air pollution
   • Strong emotions

2. Giving your child their asthma medicines as prescribed. They may need to take medicines daily, as needed, or both. This will depend on how severe your child’s asthma is and the type of medicine they take. Some asthma medicines work to control (or prevent) inflammation (swelling) in their airways. Other asthma medicines relieve the muscles that tighten and squeeze your airways and aim to stop symptoms after they begin. (Learn more about the different types of asthma medicines and how they work.)

3. Following an Asthma Action Plan. It’s important to know the signs and symptoms of asthma and when to give your child their medicines. An Asthma Action Plan can help you manage your child’s asthma. It can also help school nurses, teachers, and babysitters manage asthma in the children they are caring for and know what to do in an asthma emergency. Ask your child’s doctor or health care provider to provide you with an Asthma Action Plan in written form. This plan should be reviewed with your child’s health care provider to make sure it is effective and up to date.

4. Taking care of your child’s overall health. One of the top causes of asthma symptoms in children is respiratory infections caused by viruses. All kids get sick from time to time, and it lets their immune system learn to fight off certain illnesses. But some infections can worsen asthma. Help your child stay healthy by reducing your family’s exposure to illnesses such as RSV, croup, the flu, COVID-19, and bronchitis. You can do this by getting recommended vaccines, good hand washing, and wearing an appropriate face mask when these contagious illnesses are spreading in your family and community.

   You can also keep your child healthier by protecting them from exposure to tobacco smoke and e-cigarette aerosol. If you or a loved one smokes tobacco cigarettes or vapes, there are programs to help you quit. Resources to support your journey to a smoke-free life include:

• • Smokefree.gov
  • 1-800-QUIT-NOW
  • quitSTART app

You can also call your insurance company or your employer to see if they offer tobacco cessation programs and benefits.

Most children with asthma also have allergies. By treating their allergies, it will help their asthma stay under control, too.

When your child’s asthma is under control, you can expect:

• • Few or no symptoms
  • No interruptions to their daily activities (school, play, exercise) or sleep
  • The ability to take part in sports and physical activity
  • Fewer missed school days
  • Prevention of acute (sudden) asthma attacks
  • Fewer trips to urgent care, emergency room visits, and hospital stays
  • Less need for quick-relief medicines
  • Improved overall quality of life

Can My Child Outgrow Asthma?​

Asthma is a life-long disease with no cure. As your child gets older, their asthma symptoms may get better and appear to “go away.” But airway inflammation may never truly go away. It often returns later in life. They may also develop new asthma triggers over time that could cause symptoms to reappear and get worse.