Managing Your Baby/Child’s Asthma - Kids Clinic

Managing Your Baby/Child’s Asthma

a child with asthma inhaler

What is Childhood Asthma?

Asthma is the leading cause of chronic illness in children. It affects as many as 20% of children and can begin at any age, but most children have their first symptoms by age 5.

Why Are More Children Getting Asthma?

No one really knows why a growing number of children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke. Others suspect that children are not exposed to enough childhood infections and living in cleaner environments, thus causing their immune system to shift towards being more allergic-type. And still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.

What Happens During an Asthma Attack?

Asthma attacks are usually caused by exposure to triggers, which lead to increased inflammation of the air passages. The air passages narrow and produce more mucus, leading to obstruction and difficulty in breathing for the child. Although inflammation is worse during an asthma attack, it may also be present and ongoing even when a child with asthma appears to be well without much asthma symptoms. Thus, asthma is a chronic condition which requires proper treatment and monitoring, and not just a once-off problem.

What are the Symptoms or Signs of Childhood Asthma?

  • Frequent coughing spells, which may occur during play, at late night/early morning, or while laughing. It is important to know that cough may be the only symptom present in asthma (parents are often confused when doctors diagnose asthma in many children with chronic cough)
  • Less energy or more breathless during play
  • Rapid breathing
  • Complaint of chest tightness or chest “hurting”
  • Whistling sound (wheezing) when breathing in or out
  • See-saw motions (retractions) in the chest from labored breathing
  • Shortness of breath, loss of breath
  • Tightened neck and chest muscles
  • Feelings of weakness or tiredness

Keep in mind that not all children have the same asthma symptoms, and that these symptoms can vary from episode to episode in the same child. Also note that not all wheezing or coughing is caused by asthma, thus a careful evaluation by your child’s doctor is necessary to make a correct diagnosis.

What Causes/Triggers Asthma Attacks?

The triggers that result in asthma attacks may differ in each child. It is important to avoid triggers as much as possible. Some possible triggers include:

  • Viral infections, including the common cold and flu.
  • Environmental irritants, including cigarette smoke (both passive and active smoking) and smoke haze.
  • Environmental allergens, including house dust mites, animal dander, pollen and indoor mould.
  • Changes in temperature or humidity due to indoor and outdoor climate variation.
  • Psychological stress
  • Certain medications (e.g. beta-blockers, non-steroidal anti-inflammatory drugs)

Does My Baby/Child Have Asthma?

Asthma is often difficult to diagnose in infants (less than 1 year of age) and requires other diagnoses (e.g. congenital airway abnormalities, heart defects) to be excluded properly first. However, in older children, the disease can often be diagnosed based on your child’s medical history and physical examination.

Your child’s doctor will be interested in any history of breathing problems your child may have had, as well as a family history of asthma, allergies, allergic rhinitis, eczema, or other lung disease. It is important that you describe your child’s symptoms — cough, wheezing, shortness of breath, chest pain or tightness — in detail, including when and how often these symptoms have been occurring.

During the physical examination, the doctor will examine your child’s heart and lungs, and assess other aspects of his well-being such as growth, development and nutritional status.

  • Pulmonary function tests (also called lung function tests or spirometry) can help in the diagnosis of asthma and in assessing its severity. These tests measure the amount of air in the lungs and how fast it can be exhaled. Generally, children younger than 5 years are unable to perform pulmonary function tests reliably. Thus, doctors rely heavily on history and physical examination in making the diagnosis.
  • Exhaled nitric oxide measurements are used to determine severity of airway inflammation in asthma, and helps in supporting the diagnosis in cases which are less clear-cut. Again, children younger than 5 years generally unable to perform this test reliably.
  • Skin prick tests or blood tests may also be ordered to help identify particular allergens which may trigger asthma.
  • A chest X-ray or other scans may be required if the diagnosis of asthma is not certain, especially in infants less than 1 years of age.

How to Treat or Manage Asthma in Babies/Children?

The goals of asthma treatment are to control all asthma symptoms, prevent asthma attacks and allow your child to lead a healthy and normal life. Based on your child’s history and the severity of asthma, your child’s doctor will develop a care plan, called an “asthma action plan.” The asthma action plan describes when and how your child should use asthma medications, what to do when asthma gets worse, and when to seek emergency care for your child. 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 to successfully controlling his or her asthma. Keep it handy to remind you of your child’s daily asthma management plan, as well as to guide you when your child develops asthma symptoms. In addition to following your child’s asthma action plan, you want to make sure exposure to asthma triggers is avoided as much as possible, especially passive/active smoking and house dust mites.

What Medicines are Used to Treat Asthma in Babies/Children?

There are two main groups of asthma medicine, relievers and controllers/preventers.

Medicines that work rapidly to open up the narrowed air passages during an asthma attack. They provide quick relief of asthma symptoms and enable your child to breathe better. They are used for short periods only when needed, such as during asthma attacks or when the asthma is uncontrolled and causing significant symptoms affecting sleep or play. It is incorrect and unsafe to rely completely on regular usage of these relievers, and patients often get confused about its role as a reliever (thinking that it is the cure for their asthma).

Medicines that work gradually to control the chronic inflammation in the air passages, making them less hyper-responsive (sensitive) to triggers, thus targeting the underlying disease process in asthma. These medicines MUST be used daily (regardless of whether the child is having symptoms/attacks or not) if prescribed by the doctor and should only be stopped/reduced when advised by the doctor. The period of treatment for each child prescribed with controllers/preventer medicines can range from many months to years, depending on the response and control of your child’s asthma. It is incorrect and unsafe to stop the controllers/preventers on your own because it may result worsening of the asthma control, causing more frequent and severe attacks/symptoms. Patients also often get confused about its role as a controller/preventer (thinking that they do not work, because they do not get immediate symptom relief from it).

All children with asthma will be prescribed with a reliever medicine for use during asthma attacks or when the asthma symptoms are not controlled. Many children whose asthma is not well controlled may need to use a controller/preventer medicine daily. The doctor will be able to assess and advise if your child needs to use a controller/preventer medicine daily. It is of paramount importance to be strictly compliant with the controller/preventer prescribed.


During acute asthma attacks, there are other medications that are commonly prescribed, including a short course (3-5 days) of oral steroids to help reduce the severe airway inflammation during attacks. These must be completed according to the prescription. A short course of oral steroids does not cause long-term side effects and does not need to be tailed down. Your child’s usual controllers/preventers does not help during acute asthma attacks – its role is more for achieving longer-term control.

How Do I Give My Baby/Child Asthma Medication?

give your children mask inhalerYou will probably give your child asthma medications using a spacer device (with or without a mask, depending on the child’s age and ability to cooperate) or a home nebulizer (also known as a breathing machine). The nebulizer delivers asthma medications by changing them from a liquid to a mist. Your child gets the medicine by breathing it in through a facemask. Your child may be able to use a metered dose inhaler (MDI) with a spacer. A spacer is a chamber that attaches to the MDI and holds the burst of medication. Talk with your child’s doctor to see if an MDI with spacer is right for your child.

How Do I Use the Space Chamber With A Mask to Administer the Inhaler Puffs to My Baby/Child?

Proper Metered-Dose Inhaler/Spacer Technique
Action Comment
  • Shake MDI (either attached or unattached to spacer)
  • Suspensions should be shaken, solutions do not require shaking
  • Breathe out
  • Place MDI/spacer (without face mas
    into mouth
  • Place MDl/spacer (with face mask) onto face
  • Face mask should form a tight seal
    around the nose and mouth
  • Actuate MDI
  • Only one actuation should be made per inhalation (or for four to six inhalations with face mask)
  • Without face mask: breathe in slowly and deeply (over 4.5 seconds)
  • With face mask: tidal breathing for
    4-6 breaths
  • Deep breathing is best, and when
    children are old enough, this should
    be encouraged
  • Without face mask: take spacer out of mouth, then hold breath for 10 seconds
  • Breath holding allows greater airway
    penetration by gravity
  • Remove MDI/spacer
  • Mouth rinsing should be done with
    inhaled corticosteroids, to avoid adverse effects (dysphonia, canadiasis)

Source: Edward A. Bell, PharmD, BCPS

How Do I Care For My Child's Spacer and Inhaler?

  1. Clean your spacer once a week.
  2. Soak the spacer completely in mild soapy water made by adding two to three drops of dishwashing liquid into a container of water. Do not use a scrub to clean the spacer. Do not rinse the spacer again after removing it from the soapy water.
  3. Allow the spacer to drip dry. Do not use tissue paper or cloth to dry the spacer after washing it.
  4. Following the steps above help to reduce the static charge in the spacer and allow for better delivery of the medicine from the inhaler to the lungs.
  5. If you need to use the spacer urgently before it is dry after washing, prime the spacer by actuating ten puffs of reliever medication into the spacer after drying it.
  6. Wash the plastic holder of the inhaler once a week under warm running water and air dry the plastic holder thoroughly before putting the inhaler back into it for use.

What Do I Do When My Baby/Child Has An Asthma Attack?

If your child is showing symptoms of an asthma attack:

  • Give your child his/her reliever medicine according to the asthma action plan.
  • Wait 5 to 15 minutes. If the symptoms disappear, your child should be able to resume whatever activity he or she was doing. If symptoms persist, follow your child’s asthma action plan for further therapy. If your child fails to improve or you are not sure what action to take, consult your child’s doctor.
  • Danger signs are severe wheezing, severe coughing, trouble walking and/or talking, or blue lips and/or fingernails. If any of these are present, go to the emergency department or call 995.

Children with asthma often have symptoms at school, so it is very important to get the school involved in caring for your child’s asthma. This is true even if your child has only a mild case of asthma or if he or she does not need to take asthma medicines while at school. Most schools have several children with asthma, so teachers should be familiar with helping children with asthma. Still, it is important to take steps to ensure that your child gets adequate attention and that all relevant school personnel are familiar with what is needed to help your child. You can look at this in two ways: there are things you need to do to prevent your child from having an asthma attack at school, and there are things you need to do to make sure that your child gets the right treatment if an asthma attack occurs at school.

What Else Can I Do To Help Keep my Baby/Child’s Asthma Under Control?

  • Do not expose your child to second hand cigarette smoke and keep your child away from cigarette smoke-filled environments at all times.
  • Reduce the level of house dust mites. Wash bedsheets, pillow covers, and curtains in hot water (60 deg C) every 2 weeks. Avoid stuffed toys, thick curtains and carpets in the home.
  • Ensure that your child gets influenza vaccination annually. Do note that this only reduces the risk of influenza infection (i.e. the “flu”), but not the numerous other common cold viruses (which do not have specific vaccinations of their own).
  • If your child has allergic rhinitis (hay fever, sensitive nose), it must be treated accordingly because poorly controlled allergic rhinitis can worsen asthma control.
  • Avoid giving your child cold drinks and citrus fruits when unwell with asthma attack or flu symptoms.

Managing Your Child's Asthma in School:

The most important thing is to talk to your child and, depending on how old he or she is, explain as much about the disease that your child will understand. Ideally, your child should also:

  • Keep track of when it is time to take the medicine.
  • Know how to use the inhaler properly.

School officials should know about your child’s asthma, including:

  • How severe it is
  • What the triggers are
  • What medications to use and how to properly give them
  • What to do in case of an asthma attack

Write up and a list and distribute it to every school official who may be caring for your child. If possible, you should try to arrange a meeting with the school officials and explain the triggers, severity, symptoms, and treatment of your child’s asthma. You should look at your child’s classroom and other areas where he or she goes in school to see if there are any triggers. If you identify possible triggers for your child’s asthma (dust mites and dust are common triggers in a classroom), you should work with the teacher to reduce your child’s exposure to these triggers. It is very important to provide the teacher with all of your child’s asthma medicines and the proper instructions. Remember that for some medicines, like inhalers, there is often no way to tell whether or not the inhaler still has medicine. You need to keep track of this and replace the medicines at school on a regular basis. Some of the newer inhaler devices have dose counters, and you will be able to tell when the medication needs to be refilled. Be sure to check every few months that the school is taking care of your child’s asthma and that everyone involved understands your child’s condition.

  • Class teacher: This is the adult who is most likely to be around if your child has an asthma attack at school. The more the class teacher knows and the more vigilant he or she is, the better the chances that your child will be properly helped. Sometimes, kids who have difficulty breathing do not perform as well in school, even though they do not have asthma attacks. The class teacher should look out for this.
  • Physical education (PE) teacher: The PE teacher has a special responsibility. In addition to spending time with your child like other teachers, the PE teacher should keep an extra eye on your child when he or she is exercising, since exercise can trigger asthma. Also, you should make sure that your child is not being left out because he or she has asthma. The PE teacher should encourage your child to participate as long as the asthma is under control.
  • School principal

In addition to the above, the more teachers and other adults at school who know about your child’s asthma, the better. Your child could have an asthma attack while at lunch or in the hallway; these are places where the class teacher may not be present.

The school should have a clear set of instructions (your doctor can help with this) about what symptoms it should look out for, and what treatment it should give, where there is an asthma attack. The school should have a clear idea of what to do and when to call 995.

Should My Child with Asthma Avoid Exercise or Physical Activity?

The child should avoid exercise or physical activities during and soon after an asthma attack. Many children improve, in terms of asthma control, as they get older. Once asthma is properly controlled, your child should be encouraged to take part in all usual activities. There is no need to restrict activity. With the right medication and care, children with asthma should be able to participate in sports and lead normal active lives. Many outstanding athletes have won Olympics medals despite having asthma.

How Do I Know If My Child's Asthma is Well-Controlled?

You know your child’s asthma is well-controlled if, with medications, your child:

  • Lives an active, normal life.
  • Has few troublesome symptoms.
  • Attends school every day.
  • Performs daily activities without difficulty.
  • Has had no urgent visits to the doctor, emergency department, or hospital.
  • Has few or no medication side effects.

By learning about asthma and how it can be controlled, you take an important step toward managing your child’s disease. We encourage you to work closely with your child’s doctor to learn all you can about asthma, how to avoid triggers, what medications to use, and how to correctly give them. With proper care, your child can live free of asthma symptoms and maintain a normal, healthy lifestyle.

Will My Child Outgrow Asthma?

Will my child’s asthma go away or be cured?


Once a person’s airways become sensitive, they generally remain that way for life. However, about half of children experience a noticeable decrease in asthma symptoms by the time they become adolescents, therefore appearing to have “outgrown” their asthma. But, about half of these children will develop symptoms again in their 30s and/or 40s. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life. Nonetheless, it is very important to manage your child’s asthma properly and achieve good control as soon as possible, as this will help your child breath better and improve his/her quality of life, and it may potentially reduce the risk of asthma persisting into adulthood (as some studies have shown).


Asthma is a common chronic illness in children, affecting as many as 20% of children.


Frequent coughing spells, breathlessness or chest tightness are symptoms of asthma; however not all wheezing or coughing is caused solely by asthma.


Asthma attacks may be triggered by a variety of factors, including the environment, viruses, weather or allergens. It is important to identify and avoid your child’s asthma triggers as much as possible.


Asthma is usually difficult to diagnose in infants below 1 year. In older children, asthma can be diagnosed through a detailed medical history, physical examination or series of tests.


Based on your child’s history and condition, your paediatrician should develop an “asthma action plan” to outline when and how your child should use medication such as relievers and controllers/preventers.


Get your child’s school involved in caring for your child’s asthma – including identifying possible triggers and informing teachers of your child’s condition.

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About Kids Clinic

Because we believe that healthy children make happy parents. From newborns to toddlers, our experienced paediatricians are trained to meet a child’s health needs as they grow.

Our Kids Clinic branches are conveniently located in the heartlands for a fast and fuss-free visit.

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Incorporated in 2005, Singapore Medical Group (SMG) is a private specialist and primary healthcare provider with a network of more than 20 medical specialties. The Group is committed to its promise of providing patient centred medical care and experience to every individual. SMG has 35 clinics and a growing network of SMG Associates all across the island.

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For same-day consults/appointments, kindly walk in to our clinics directly.

For same-day consults/appointments, kindly walk in to our clinics directly.

For same-day consults/appointments, kindly walk in to our clinics directly.

For same-day consults/appointments, kindly walk in to our clinics directly.

For same-day consults/appointments, kindly walk in to our clinics directly.

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