Asthma
Asthma should not stop your child from living a normal life.
Asthma is a very common long term lung condition. 1 in 11 children in the UK have asthma.
If your child has been diagnosed with asthma this means the small airways that carry air in and out of their lungs are affected. Children with asthma have sensitive airways which can become swollen.
How does Asthma affect the Lungs?
Watch the video below to learn how asthma affects the lungs.
What are the symptoms of Asthma?
Your child may have symptoms such as:
- cough
- wheeze
- feeling breathless
- tight chest
These symptoms are usually made worse when they come into contact with one of their triggers. If your child's asthma suddenly gets much worse (asthma attack) they will need urgent treatment. They should follow their asthma action plan.
If you're worried your child might have asthma, speak to your doctor.
In the video below an asthma nurse explains what symptoms to look for in children.
Asthma Triggers
Common triggers
Triggers can be different for every child. Some common triggers are:
- pets
- dust mites
- pollen
- mould
- air pollution
- second hand smoke
Pets
- It is a common myth that children are allergic to a pet’s fur. They are in fact allergic to the animal protein in saliva (spit) and wee, and their dander (dandruff)
- If your child's symptoms improve when they are not around pets you may decide to rehome your pets
- Do not allow pets in the area where your child sleeps
- If you think animals are triggering your child's asthma speak to your GP or asthma nurse
House dust mites
- Declutter your home as much as possible so there are less areas for dust to gather
- Dust with a damp cloth regularly
- Vacuum all soft furnishings
- Avoid the use of fans
- Open the windows daily
- Wash your child’s bedding at least once a week at 60 degrees
- Avoid bunk beds if possible. If this is unavoidable and your child has asthma they should sleep on the top bunk (they need to be over 6 to sleep on the top bunk)
- Get allergy covers for bedding if possible
- Reduce the number of soft toys
- Put soft toys in the freezer once a month for 6 hours to kill dust mites
- If you are planning to redecorate hard floors are better than carpets
For more information on house dust mites visit Allergy UK.
Exercise and weather
- Regular exercise improves asthma
- Make sure they drink enough during exercise and have regular breaks
- If cold weather is a trigger ensure they wrap up warm. Cover their mouth and nose with a scarf
- Most importantly make sure they have their yearly flu vaccine
- If warm weather is a trigger it may be due to the pollen or pollution level. Make sure you check the weather forecast and take precautions such as closing your windows
- Avoid hanging your washing out when the pollen count is high
- Avoid letting your child play out in the midday sun
Indoor air triggers and asthma
There are things in the air inside our homes and inside other buildings that can affect your child's asthma.
Activities that can affect the air in our homes and trigger asthma symptoms include:
- smoking or vaping indoors
- using cookers, especially gas cookers
- using open solid-fuel fires
- using candles and incense sticks
- using free-standing gas heaters
- using cleaning products, household sprays or aerosols and paints
- having a bath or shower
- air-drying clothes in the home
Asthma and Lung UK have put together 6 top tips to help families have cleaner air within their homes.
6 top tips
- Open windows if you can (be careful on high pollen or pollution days) or use extractor fans, especially in kitchens and bathrooms. It will help clear any indoor pollutants and prevent damp and mould. Opening windows on cold days can make your home harder to heat. See our page on housing and keeping your home warm if you are struggling.
- Reduce dust mites as much as possible by regularly washing bedding or using anti-allergy covers. Asthma and Lung UK have more information on dealing with dust mites.
- Avoid aerosols and sprays. Instead go for non-spray cleaning and personal products.
- Avoid strong smells and chemicals.
- Don’t smoke indoors. Cigarette smoke is a dangerous asthma trigger and it can also make you and your child more sensitive to other indoor triggers. Your local stop smoking service is free and able to offer support to help you stop smoking.
- Make sure any heaters, cookers and boilers are serviced regularly. Also make sure any new appliances are fitted properly with good ventilation.
Cookers and other home fuels affect the air we breathe
- Cookers give out fumes when you're cooking. Use an extractor fan or open a window. Let the fan run for 10 minutes after you finish cooking.
- Gas cookers give out the most pollution so good ventilation in the kitchen is even more important if you cook with gas.
- Get cookers checked and maintained at least once a year to make sure they’re not giving out too many fumes.
- Make sure new cookers are well installed.
- Use cleaner fuels when heating your home. If you have an open fire or wood burning stove, try cleaner fuels such as wood with a ‘Ready to burn’ symbol.
Asthma Attack
Asthma Medication
Your child will be started on treatment based on their asthma symptoms.
Asthma treatments only work if they are taken as advised by your doctor or asthma nurse.
The aim of your child’s treatment is to prevent asthma attacks and day and night symptoms. It should stop them from needing to use their blue reliever inhaler frequently. Well controlled asthma means your child can play sport and keep active just like their friends.
Your doctor or asthma nurse will change your child's asthma medication depending on their symptoms. They may use a stepwise approach.
Your child should have an asthma review at least once a year with their doctor or nurse. They will be given an asthma action plan.
Preventer Treatment
This medication is not used to treat an asthma attack.
Your child may be started on a preventer treatment to help manage their asthma.
There are 3 types of preventer:
- Steroid only inhaler which reduces the inflammation (swelling) of the airways
- Combination inhalers which include a steroid and a long acting airway muscle relaxing drug
- Medications for example montelukast
There are different coloured preventer inhalers. The most common is brown. Preventer inhalers will never be blue.
Preventer treatments may take a few weeks to start working. Your child must keep taking them every day.
If taken everyday preventer medication should:
- Reduce sensitivity to asthma triggers
- Reduce the use of their blue reliever inhaler
- Improve sleep at night
- Improve activity through the day
Preventer treatments do not need to be taken to school. They are usually given in the morning and/or evening. We advise your child to brush their teeth after using their preventer inhaler. This is to prevent oral thrush. To help you remember, you can set reminders or keep the inhaler near your child’s toothbrush.
It is important to order your child's preventer medication on time every month so they don't run out.
With the right treatment your child can lead a normal life. There are some myths about the treatment of asthma. Please watch this video to find out more about these myths.
Read more information by Beat Asthma on asthma inhalers, treatments and medications
Relievers (salbutamol inhaler)
Your child's reliever inhaler will be blue. They come in different shapes and sizes. It contains a medication called salbutamol. This medication relaxes and widens the muscles of the airways. This opens up the airways making it easier to breathe. It works fast and can last up to 4 hours.
Your child should carry their blue reliever inhaler and spacer with them at all times in case of an emergency. School or nursery should also keep a spare blue inhaler and spacer. You can ask your GP to give you 2 inhalers and spacers for your child so you can keep one with your child and one at school or nursery.
Relievers can cause tremors (shakes) and make your child’s heart beat faster for a short period of time. These side effects are normal and harmless. If needed your child should still use their reliever.
If your child is using their blue inhaler more than 2 times a week you should speak to your doctor or asthma nurse for an urgent review.
Call the Asthma + Lung UK helpline on 0300 222 5800 to speak to someone about anything from managing your child’s asthma to what to do if you are planning a trip away.
Spacers
Your child must always use a spacer to get the right amount of medication into their lungs.
Spacers are empty plastic tubes. They attach to your child’s inhaler at one end. They have a mouthpiece or mask at the other end. If your child does not use their spacer they will not get the best from their prescribed medication.
There are lots of different sized and coloured spacers depending on your child’s age. It is very important they have the correct spacer.
Please see the video below to find out which spacer should be used and why.
Spacers are available on prescription or you can buy them from your local pharmacy. Please speak to your doctor or asthma nurse if your child needs a spacer or if you feel that they have the wrong one for their age.
It is vital that your child uses their inhalers and spacer correctly
Choose the right sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath).
1. Shake the inhaler well and remove cap
2. Fit the inhaler into the opening at the end of the spacer
3. Place mask over the child's face or mouthpiece in their mouth ensuring a good seal
4. Press the inhaler once and allow the child to take 5 slow breaths or slow count to 10 between each dose
5. Remove the inhaler and shake between every puff. Wait 30-60 seconds between puffs
Repeat steps 1 to 5 for each dose.
Watch the Asthma UK videos on how to use your child's inhaler and spacer correctly.
Speak to your asthma nurse or doctor if you are not sure if your child is using their inhaler and spacer properly.
Looking after your child's spacer
A spacer should be replaced every year. It may need to be replaced sooner depending on it's condition.
The spacer should be cleaned before use and once every month after that.
Make sure your spacer is stored correctly to keep it in good condition. It should be stored away from dust and liquids, in a plastic free sealed bag or purse. This is to avoid damage and stop a build-up of static that can affect delivery of the asthma medication.
You can make it fun and personalise the storage bag. This will make children more likely to carry and use it.
When should you worry?
12-18 months
12-18 MONTHS
Contact your health visitor or GP if your baby is 12-18 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Finds it hard to stand or walk, for example:
- Can’t pull to stand
- Fall over a lot when standing still
- Doesn’t cruise (walk while holding on to furniture)
- Walk on their tiptoes a lot
18-24 months
18-24 MONTHS
Contact your health visitor or GP if your baby is 18-24 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Find it hard to balance when standing still, or fall over a lot
- Can’t walk by themselves
- Walk on their tiptoes a lot
- Are suddenly unsteady when walking
2 years
2 YEARS
Contact your health visitor or GP if your baby is 2 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when crawling or walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Haven’t started to run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
3 years
3 YEARS
Contact your health visitor or GP if your baby is 3 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Have not started to jump or run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
4 years
4 YEARS
Contact your health visitor or GP if your baby is 4 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still
- Suddenly become unsteady when walking
- Find it hard going upstairs or uphill
- Trip or fall a lot
- Walk on tiptoes most of the time
- Feel pain in their arms or legs
- Move from laying down or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
5 years
5 YEARS
Contact your health visitor or GP if your baby is 5 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance, or trip or fall a lot
- Persistently walk on tiptoes
- Suddenly become unsteady when walking
- Feel pain in their arms or legs
- Move from laying or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
15 months
Your Child By Fifteen Months
Social/Emotional Milestones
- Copies other children while playing, like taking toys out of a container when another child does
- Shows you an object she likes
- Claps when excited
- Hugs stuffed doll or other toy
- Shows you affection (hugs, cuddles, or kisses you)
Language/Communication Milestones
- Tries to say one or two words besides “mama” or “dada,” like “ba” for ball or “da” for dog
- Looks at a familiar object when you name it
- Follows directions given with both a gesture and words. For example, he gives you a toy when you hold out your hand and say, “Give me the toy.”
- Points to ask for something or to get help
Cognitive Milestones (learning, thinking, problem-solving)
- Tries to use things the right way, like a phone, cup, or book
- Stacks at least two small objects, like blocks
Movement/Physical Development Milestones
- Takes a few steps on his own
- Uses fingers to feed herself some food
18 months
Your Child By Eighteen Months
Social/Emotional Milestones
- Moves away from you, but looks to make sure you are close by
- Points to show you something interesting
- Puts hands out for you to wash them
- Looks at a few pages in a book with you
- Helps you dress him by pushing arm through sleeve or lifting up foot
Language/Communication Milestones
- Tries to say three or more words besides “mama” or “dada”
- Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”
Cognitive Milestones (learning, thinking, problem-solving)
- Copies you doing chores, like sweeping with a broom
- Plays with toys in a simple way, like pushing a toy car
Movement/Physical Development Milestones
- Walks without holding on to anyone or anything
- Scribbles
- Drinks from a cup without a lid and may spill sometimes
- Feeds himself with his fingers
- Tries to use a spoon
- Climbs on and off a couch or chair without help
2 years
Your Child By Two Years
Social/Emotional Milestones
- Notices when others are hurt or upset, like pausing or looking sad when someone is crying
- Looks at your face to see how to react in a new situation
Language/Communication Milestones
- Points to things in a book when you ask, like “Where is the bear?”
- Says at least two words together, like “More milk.”
- Points to at least two body parts when you ask him to show you
- Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes
Cognitive Milestones (learning, thinking, problem-solving)
- Holds something in one hand while using the other hand; for example, holding a container and taking the lid off
- Tries to use switches, knobs, or buttons on a toy
- Plays with more than one toy at the same time, like putting toy food on a toy plate
Movement/Physical Development Milestones
- Kicks a ball
- Runs
- Walks (not climbs) up a few stairs with or without help
- Eats with a spoon
2.5 years
Your Child By Thirty Months
Social/Emotional Milestones
- Plays next to other children and sometimes plays with them
- Shows you what she can do by saying, “Look at me!”
- Follows simple routines when told, like helping to pick up toys when you say, “It’s clean-up time.”
Language/Communication Milestones
- Says about 50 words
- Says two or more words together, with one action word, like “Doggie run”
- Names things in a book when you point and ask, “What is this?”
- Says words like “I,” “me,” or “we”
Cognitive Milestones (learning, thinking, problem-solving)
- Uses things to pretend, like feeding a block to a doll as if it were food
- Shows simple problem-solving skills, like standing on a small stool to reach something
- Follows two-step instructions like “Put the toy down and close the door.”
- Shows he knows at least one color, like pointing to a red crayon when you ask, “Which one is red?”
Movement/Physical Development Milestones
- Uses hands to twist things, like turning doorknobs or unscrewing lids
- Takes some clothes off by himself, like loose pants or an open jacket
- Jumps off the ground with both feet
- Turns book pages, one at a time, when you read to her
3 years
Your Child By Three Years
Social/Emotional Milestones
- Calms down within 10 minutes after you leave her, like at a childcare drop off
- Notices other children and joins them to play
Language/Communication Milestones
- Talks with you in conversation using at least two back-and-forth exchanges
- Asks “who,” “what,” “where,” or “why” questions, like “Where is mommy/daddy?”
- Says what action is happening in a picture or book when asked, like “running,” “eating,” or “playing”
- Says first name, when asked
- Talks well enough for others to understand, most of the time
Cognitive Milestones (learning, thinking, problem-solving)
- Draws a circle, when you show him how
- Avoids touching hot objects, like a stove, when you warn her
Movement/Physical Development Milestones
- Strings items together, like large beads or macaroni
- Puts on some clothes by himself, like loose pants or a jacket
- Uses a fork
4 years
Your Child By Four Years
Social/Emotional Milestones
- Pretends to be something else during play (teacher, superhero, dog)
- Asks to go play with children if none are around, like “Can I play with Alex?”
- Comforts others who are hurt or sad, like hugging a crying friend
- Avoids danger, like not jumping from tall heights at the playground
- Likes to be a “helper”
- Changes behavior based on where she is (place of worship, library, playground)
Language/Communication Milestones
- Says sentences with four or more words
- Says some words from a song, story, or nursery rhyme
- Talks about at least one thing that happened during her day, like “I played soccer.”
- Answers simple questions like “What is a coat for?” or “What is a crayon for?”
Cognitive Milestones (learning, thinking, problem-solving)
- Names a few colors of items
- Tells what comes next in a well-known story
- Draws a person with three or more body parts
Movement/Physical Development Milestones
- Catches a large ball most of the time
- Serves herself food or pours water, with adult supervision
- Unbuttons some buttons
- Holds crayon or pencil between fingers and thumb (not a fist)
5 years
Your Child By Five Years
Social/Emotional Milestones
- Follows rules or takes turns when playing games with other children
- Sings, dances, or acts for you
- Does simple chores at home, like matching socks or clearing the table after eating
Language/Communication Milestones
- Tells a story she heard or made up with at least two events. For example, a cat was stuck in a tree and a firefighter saved it
- Answers simple questions about a book or story after you read or tell it to him
- Keeps a conversation going with more than three back-and-forth exchanges
- Uses or recognizes simple rhymes (bat-cat, ball-tall)
Cognitive Milestones (learning, thinking, problem-solving)
- Counts to 10
- Names some numbers between 1 and 5 when you point to them
- Uses words about time, like “yesterday,” “tomorrow,” “morning,” or “night”
- Pays attention for 5 to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)
- Writes some letters in her name
- Names some letters when you point to them
Movement/Physical Development Milestones
- Buttons some buttons
- Hops on one foot
Advice and Guidance
Inhaler Advice
Some inhalers have a dose counter – this tells you how many puffs or sucks are left in your inhaler before it runs out. If it reads zero it tells you there is no medicine left and you should get a new one. But some puffer inhalers (called metered dose inhalers) don’t have dose counters, so how can you tell if your inhaler is empty? A help document by www.beatasthma.co.uk
It’s a lot harder than you think!
You may think that you can tell by shaking it or seeing if a spray comes out, but this doesn’t work. Even an empty inhaler will still ‘puff’ when you spray it or sound like it has something in when you shake it. This is because inside these inhalers, as well as the medicine to help your asthma stay well, there is also something called a propellant. This is what the inhaler uses to make sure the medicine sprays out far enough to reach your lungs. After the medicine has run out, there will still be propellant left, so you will still feel like you are spraying medicine. But you’re not - all you are spraying is propellant. Lots of people use empty inhalers without realising it. This can mean they are not getting their medicine when they need it and not getting the help they need to look after their asthma.
So what should I do?
If your inhaler without a dose counter is a preventer (you use it every day to keep your asthma well) the best thing to do is to work out when the inhaler is likely to run out and make sure you order a new prescription to arrive before then. To do this follow these steps:
- Check how many puffs (or ‘actuations’) the inhaler has when it’s new. This should be printed on the box, or you can check with your pharmacist. It is usually 120 or 200.
- Add up how many puffs you take per day altogether. This is usually 2 or 4 puffs daily.
- Divide the number of puffs in the inhaler by the number of puffs you take per day. So if your inhaler has 200 puffs in it and you use 4 doses a day, your inhaler will last 50 days (200 ÷ 4 = 50). You might want to mark this on your calendar or set a reminder on your phone a week or two before your inhaler is due to run out.
You can also use this table to help you work out how long your regular inhaler will last:
120 dose inhaler
- 1 puff in the morning and 1 puff at night
- Your inhaler will last 8 weeks
- 2 puffs in the morning and 2 puffs at night
- Your inhaler will last 4 weeks
200 dose inhaler
- 1 puff in the morning and 1 puff at night
- Your inhaler will last 14 weeks
- 2 puffs in the morning and 2 puffs at night
- Your inhaler will last 7 weeks
If your inhaler without a dose counter is a reliever (blue) inhaler, you probably won’t take this regularly, which can make it hard to tell if it has run out. The best way to know is to keep a written tally of how many puffs you’ve taken. Some people find recording it on a mobile phone can be helpful.
Some people have more than 1 blue inhaler because they need them in different places, for example, one at home and one at school. Remember to keep different tallies for each inhaler. Try to avoid stockpiling lots of inhalers as this can make it even harder to track when they’re running out.
It is also possible to buy an electronic counter that attach onto some types of inhalers, but these are not widely available.
Will my inhaler go out of date?
If your asthma is well controlled, you will probably only need to use your blue inhaler once a week or less. This means it should last a few years, and it’s likely to pass its expiry date before it runs out so remember to check that too! If you need to use your inhaler more than twice a week then talk to your doctor or nurse about ways to get your asthma under better control.
Are there any other options?
There is another type of inhaler called a dry powder inhaler and this type always comes with a dose counter. Most people aged 12 or over can use these inhalers well. These inhalers don’t need a spacer and are also better for the environment than metered dose (puffer) inhalers. Talk to your doctor or nurse if you’d like to try one of these inhalers. If you do change inhalers, make sure you get them to check you are using it properly and that your asthma stays well controlled.
Disposal
When you’ve finished using your inhaler take it back to your pharmacist. Metered dose (spray) inhalers contain powerful greenhouse gases, even when they’re empty. Your pharmacist can make sure they are disposed of properly.
Asthma resources
Produced for #askaboutasthma by the Medicines & Healthcare products Regulatory Agency. Dr Rebecca Mann, a consultant paediatrician at the Taunton & Somerset NHS Foundation Trust explains the serious risks associated with using nebulisers for treating asthma attacks in children at home without being recommended to do so by an asthma specialist.
Self care and Prevention
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