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Childhood Asthma
Childhood asthma is the same lung disease that adults get, but kids often have different symptoms. Doctors may also call this pediatric asthma.
You may need to use a spacer to help your child take their inhaler medicine. It can help them breathe the medicine in at their own pace. (Photo Credit: E+/Getty Images)
If your child has asthma, their lungs and airways may get easily inflamed when they have a cold or are around things such as pollen. The symptoms may make it hard for your child to do everyday activities or sleep. Sometimes, an asthma attack can result in a trip to the hospital. There's no cure for asthma in children, but you can work with your child's doctor to treat it and prevent damage to their growing lungs.
When your child has an asthma attack, the tubes that carry air to their lungs (bronchial tubes) become swollen and make extra mucus. This makes it harder for them to breathe, which leads to the following signs and symptoms:
Not all children have the same asthma symptoms . Your child might have only one or two of these symptoms or several of them. You may think it's just a cold or bronchitis, but if they have several episodes, it's time to see an asthma specialist, such as an immunologist or an allergist. A child may even have different symptoms from one asthma attack to another; their symptoms depend on what triggered their attack. With asthma, their symptoms often follow a pattern, such as being worse at night or in the morning, or they could come and go over time or within the same day.
Experts sometimes use the terms "reactive airway disease" and "bronchiolitis" when talking about wheezing with shortness of breath or coughing in infants and toddlers. Depending on their age, your child may have a hard time describing their symptoms. Tests may not be able to confirm asthma in children younger than 5.
When to get emergency care
A severe asthma attack needs medical care right away. Watch for these signs:
Common triggers include:
Asthma is the leading cause of long-term illness in children. It affects about 7 million kids in the U.S. Those numbers have been going up, and experts aren't sure why.
Most children have their first symptoms by age 5. But asthma can begin at any age.
Things that can make a child more likely to have asthma include:
Your child's asthma symptoms may be gone by the time you get to the doctor's office. You have an important role in helping your doctor understand what's going on. A diagnosis will include:
Questions about medical history and symptoms. Your doctor will ask about any breathing problems your child may have had, as well as any family history of asthma, allergies, eczema, or other lung disease. Describe your child's symptoms in detail, including when and how often they happen.
Physical exam. Your doctor will listen to your child's heart and lungs and look in their nose or eyes for signs of allergies.
Tests. Your child might get a chest X-ray. If they're 6 or older, they may have a simple lung test called spirometry. It measures the amount of air in your child's lungs and how fast they can blow it out. This helps the doctor find out how severe their asthma is. Other tests can help find asthma triggers. They may include allergy skin testing, blood tests such as immunoglobulin E (IgE) test or radioallergosorbent test (RAST), and X-rays. These tests can help your doctor check if sinus infections or gastroesophageal reflux disease (GERD) are making asthma worse. A test that measures the level of nitric oxide (eNO) in your child's breath can also point to inflamed airways.
Based on your child's history and how severe their asthma is, their doctor will develop a care plan, called an asthma action plan. This describes when and how your child should use asthma medications, what to do when asthma gets worse, and when to seek emergency care. Make sure you understand this plan and ask your child's doctor any questions you may have.
Your child's asthma action plan is important for controlling their asthma. Keep it handy to remind you of your child's daily management plan, as well as to guide you when your child has asthma symptoms. Give its copies to your child's caregivers, teachers, and even the bus driver so they'll know what to do if your child has an asthma attack away from home.
In addition to following your child's asthma action plan, you want to avoid or limit your child's exposure to their asthma triggers.
What asthma drugs can children take?
Most asthma medications that work for adults and older children can also be safely prescribed to toddlers and younger children. Drugs that are approved for younger children are given in doses adjusted for their age and weight. In the case of inhaled drugs, they may need a different delivery device based on their age and ability. For instance, many children can't coordinate their breathing well enough to use a standard inhaler.
There are two main types of asthma medications:
Quick-relief medications help with sudden symptoms. Your child will take them for fast help during an asthma attack. They need to keep this medicine with them all the time and use it when they have symptoms. Common reliever medicines include:
Long-acting medications prevent airway inflammation and keep asthma under control. Your child will probably take them every day. Common controller medicines include:
If an infant or older child has symptoms of asthma that require treatment with a bronchodilator medication more than twice a week during the day or more than twice a month at night, most doctors recommend daily anti-inflammatory drugs.
Many asthma medications contain steroids, which could have side effects. They can irritate your child's mouth and throat. Some research shows that over time, they might result in slow growth, bone problems, and cataracts. After your child takes them, their body might not be able to make as many natural steroids. But without treatment, asthma can lead to health problems and hospital visits. You and your doctor should talk about the pros and cons of medication when you make an asthma action plan.
Kids with asthma need to get a flu shot every fall because flu can make their asthma symptoms worse.
How do I give my child asthma medication?
Your child's doctor will tell you how often to give your child breathing treatments, based on how severe their asthma is.
You may give your child (usually for children under 4) asthma medications using a home nebulizer, also known as a breathing machine. A nebulizer delivers asthma drugs, usually bronchodilators, by changing them from a liquid to a mist. Your child gets the drug by breathing it in through a face mask. These breathing treatments usually take about 10-15 minutes and are given several times a day.
To use the nebulizer:
There are guidelines for managing asthma in children up to age 4. This includes the use of quick-relief medications (such as albuterol) for off-and-on symptoms. A low dose of an inhaled steroid or montelukast (Singulair) is the next step. After age 4, the focus shifts from symptom control to disease management. If your child's asthma is under control for at least 3 months, the doctor may lower their treatment.
Instead of a nebulizer, older kids may be able to use a hydrofluoroalkane (HFA) inhaler (formerly called a metered dose inhaler or MDI) with a spacer.
A spacer is a chamber that attaches to the inhaler and holds the burst of medication. This lets your child breathe the medication into their lungs at their own pace. To use an inhaler with a spacer:
To prevent asthma attacks or to keep them from getting worse, focus on known triggers with steps such as:
When it's not under control, asthma can cause problems such as:
There's no cure for asthma, but your child can learn to control it. They should be able to:
If they have trouble meeting all of these goals, ask their doctor for advice.
There's a lot that experts don't know about infant lung function and asthma. But they believe that a child is more likely to be diagnosed with asthma by age 7 if they've had multiple wheezing episodes, have a mother with asthma, or have allergies.
Once a child's airways become sensitive, they stay that way for life. But about 50% of children see a sharp drop in asthma symptoms once they reach their teens. It may seem they've outgrown their asthma, but some will have symptoms again as adults. There's no way to predict what may happen with your child.
By learning about asthma and how to control it, you take an important step toward managing your child's condition. Work closely with their care team to learn all you can about asthma, how to avoid triggers, what medications do, and how to give treatments.
No, kids don't outgrow asthma because asthma is a lifelong condition. Some kids may stop having symptoms (go into remission) when they become teens, but they generally still have asthma. Their symptoms may come back if they're exposed to a trigger.
Some kids who have wheezing when they get a cold may stop wheezing when they're sick, usually around age 6. These kids may get diagnosed with asthma, but if they never get symptoms again, they probably didn't have asthma to begin with. Some doctors will diagnose and treat kids for asthma out of caution because they feel it's safer to treat kids aggressively, as it could be dangerous or life-threatening if they don't.
Paul Alexander, Forced Into An Iron Lung By Polio In 1952, Dies At 78
Enlarge this image Paul Alexander, who held a Guinness World Record for living the longest with the help of an iron lung, has died. Here, medical staff stand among iron lung machines in an emergency polio ward at Haynes Memorial Hospital in Boston, Mass., on Aug. 16, 1955, when the city's polio epidemic hit a high of 480 cases. AP hide caption
toggle caption APPaul Alexander, who held a Guinness World Record for living the longest with the help of an iron lung, has died. Here, medical staff stand among iron lung machines in an emergency polio ward at Haynes Memorial Hospital in Boston, Mass., on Aug. 16, 1955, when the city's polio epidemic hit a high of 480 cases.
APPolio struck Paul Alexander in 1952, when he was just 6 years old. Within days, the disease robbed him of the use of his body. But he fought through the illness, using an iron lung for more than 70 years — and inspiring people with his determination to live a full life. He painted, wrote a book and worked for years as an attorney.
"Paul took a lot of pride in being a positive role model for others," his friend Christopher Ulmer, who organized a GoFundMe page for Alexander in 2022, said in a message to NPR. "More than anything I believe he would want others to know they are capable of great things."
Shots - Health News Wiping Out Polio: How The U.S. Snuffed Out A Killer Alexander died on Monday at age 78, according to a notice by the Grove Hill Funeral Home & Memorial Park in his hometown of Dallas, Texas.
Ulmer says he first met Alexander when he filmed an interview with him; the two stayed in touch afterward. Ulmer launched a donation campaign for Alexander after people betrayed his trust and left him in need of better living accommodations, he said. In response, people donated more than $140,000.
YouTube"It allowed him to live his last few years stress-free," Alexander's brother, Philip, said in a statement shared by Ulmer. "It will also pay for his funeral during this difficult time. It is absolutely incredible to read all the comments and know that so many people were inspired by Paul. I am just so grateful."
The man in the iron lung, living a large lifeAlexander contracted polio during the worst years of the U.S. Outbreak, a time when hospital wards held row after row of children lying in iron lungs — seven-foot-long cylinders that use negative pressure and bellows to draw air into their lungs.
The disease progressed quickly in Alexander, shutting his young body down in a matter of days. He survived thanks to a last-minute tracheotomy; from there, he set out to push beyond the limits of his condition. Holding a rod in his mouth, he was able to turn pages in books and create art. He went to high school, college and law school — and, later in life, he used a rod to type out words on a keyboard to write his autobiography.
"My parents taught me to use my intelligence and my energy to be productive," Alexander said in a 2017 video by Gizmodo. "I've never thought of myself as a cripple. That's the word I choose to use because I think it covers the ground in most people's perceptions."
"I'm crippled in most people's minds, except mine," he said, adding later, "I'm Paul Alexander, human being."
He was eventually recognized by Guinness World Records as the longest-surviving iron lung patient.
Radio Diaries Decades after polio, Martha is among the last to still rely on an iron lung to breathe At least one other American was known to be relying on an iron lung in recent years: Martha Lillard, who contracted polio one year after Alexander. Both of them were able to learn to breathe outside of the massive respirator for hours at a time, using a technique that required them to intentionally swallow air. But each night, they would return to the iron lung.
"I've tried all the forms of ventilation, and the iron lung is the most efficient and the best and the most comfortable way," Lillard told the Radio Diaries project.
The polio vaccine emerged in the 1950sIn 1955, the polio vaccine developed by Jonas Salk and his colleagues became an essential tool to fight the feared disease — and one for which Salk never sought a patent. It ended years of panic and fear.
"The first known polio outbreak in the United States was in Vermont in 1894," according to the Smithsonian Museum of American History. By the time Lillard and Alexander got sick in the early 1950s, polio epidemics had been growing worse and worse, with tens of thousands of new cases reported each year, often in the summer. Different people experienced differing symptoms, from a flu-like condition to a spreading paralysis.
Goats and Soda The dream of wiping out polio might need a rethink "Communities reacted with dread because no one understood how or why people got it, and because children were the most frequently affected," the museum said, posting images showing closed playgrounds and signs barring children under age 16 from entering cities.
The U.S. Officially eliminated "wild" transmission of polio in 1979, but sporadic cases have popped up over the years, including a 2022 case involving an unvaccinated traveler in Rockland County, N.Y.
Iron Lung Survivor Paul Alexander Was My Childhood Friend In Dallas
As I entered the small home near my own childhood home the first sound I heard was a loud and slowly rising and falling bellows. My father, former Dallas council member Max Goldblatt, whispered to me, "Joe, this is an iron lung."
As a 4-year-old boy living in Pleasant Grove, I was both amazed and frightened at the size of this enormous metal contraption that filled every inch of the tiny living room. A woman drying her hands upon a dish towel quickly came from the kitchen to the front door to welcome us and ushered us to meet the young child who was four years older than myself and who would one day be recognized by Guinness World Records for spending the most time in an iron lung.
During the 1950s, polio ravaged the United States, and the very mention of this disease closed swimming pools overnight as parents were terrified that their children would be infected, severely paralyzed and even potentially killed. A vaccine was developed and, accompanied by our parents, we lined up with thousands of others in front of our schools to receive the magic sugar cube that would help bring an end to this terrible scourge.
My childhood friend Paul Alexander, because he was older than I, was not one of the lucky children who received the life-changing, life-saving, and life-affirming vaccine. Therefore, when Papa introduced us, although we were close in age, our life expectancy and quality of life could not have been more different.
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What I found so extraordinary about the contraption where Paul was to spend the next 70 years was how natural and normal it all seemed in this small home. I suppose it was because it was a house that was filled with love and affection for the small boy inside and whose parents worked day and night to make certain that Paul had every opportunity to seize every moment of life he possibly could.
When my mother and father celebrated their 50th wedding anniversary at the botanical center at Fair Park, Paul attended as a special guest. By then we were both in our mid-30s and Paul swiftly rolled in using his electric wheelchair. I had no idea how much courage it took for him to leave his iron lung for a few hours to help Mama and Papa celebrate.
By that time Paul had earned a law degree and had become a well-respected lawyer. Later he wrote about his lifetime inside an iron lung. The book was featured in an article in the The Guardian newspaper in the United Kingdom where I live. After reading about my old friend, I asked the author to please ask Paul if I could contact him, and we soon happily reunited over Facetime.
Recently, D Magazine featured an article written over four decades ago about my father's colorful political career, and, when asked by the reporter how he wished to be remembered, Papa is quoted as saying, "No one will remember me." The article was selected as one of the 50 most popular articles in the history of the magazine. I guess Papa was indeed remembered.
And my friend Paul shall also be remembered, not only for his achievement of longevity in an iron lung, not only for surviving one pandemic to eventually die of another, but most importantly for the millions of lives he informed and inspired through his intellect, creativity and, of course, personal courage.
The Goldblatt family was indeed lucky the Alexander family lived a few doors away from us, and today, as tears roll down my cheeks thousands of miles away from that home, I still hear those bellows, refusing to give up and helping ensure one of the most remarkable friends I have ever known will not be forgotten.
His life, which ended March 11, is one that will be treasured and cherished by me, my family, and millions of others because, despite being confined within a metal capsule, his iron-clad determination defeated his ever-present iron lung and brought hope and happiness to a troubled world that now, perhaps more than ever before, needs more individuals like my forever friend, Paul Alexander.
Professor Joe Goldblatt grew up in Pleasant Grove and has lived in Edinburgh, Scotland, for 16 years, where he is Emeritus Professor of Planned Events at Queen Margaret University.
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