asthma in children

Overview

Asthma is a long-term condition that affects the small breathing tubes in the lungs. These tubes can become swollen, narrow, and filled with sticky mucus, making it harder for air to get in and out. In children, asthma can come and go, with times when symptoms flare up and times when they feel well.

Yes. Asthma affects millions of children around the world. In the UK, it is one of the most common long-term conditions in children, affecting roughly 1 in 11 children.

Asthma can start at any age, but it often begins in early childhood. It is more common in boys before puberty, and in girls during and after puberty. It also affects children with a family history of asthma, eczema, or allergies more often.

Symptoms

Common symptoms

• A dry cough, especially at night, early in the morning, or during exercise
• A whistling sound when breathing out, called wheeze
• Feeling short of breath or breathing faster than usual
• Tightness or discomfort in the chest

Symptoms in children

• A persistent cough that may be the only symptom
• Coughing or wheezing when playing, laughing, or exercising
• Breathing faster than normal or noisy breathing
• Tiredness and less interest in play or activities
• Trouble feeding in babies and younger children
• The skin pulling in around the ribs or neck when breathing

Symptoms in older adults

• For older adults with asthma, symptoms are not always typical. They may feel unusually tired, breathless during everyday activities, or have a persistent cough without wheeze.

Causes

Main causes

• The exact cause of asthma is not fully understood, but it involves inflammation and narrowing of the small airways in the lungs.
• The airways become oversensitive to certain triggers, causing coughing, wheezing, and breathlessness.
• Triggers include colds and viral infections, allergens like pollen or dust mites, smoke, cold air, exercise, and strong emotions.

Risk factors

• A family history of asthma, eczema, food allergy, or hay fever
• Having a childhood allergy such as eczema or a food allergy
• Being born prematurely or having breathing problems as a baby
• Exposure to tobacco smoke, especially during pregnancy or early childhood
• Living in areas with high air pollution, though this can affect anyone

When to see a doctor

See a doctor urgently if:

• If you have just been given a new symptom to watch out for and your child has any breathing difficulty that is getting worse
• If your child needs their reliever inhaler more often than usual or symptoms are not settling after a few hours
• If they are too breathless to finish a sentence or are pulling in their chest, seek urgent medical advice right away

Book a routine appointment if:

• If your child has a cough, wheeze, or shortness of breath that keeps coming back
• If symptoms happen more than twice a week or wake your child at night
• If your child is coughing or getting breathless with exercise or active play
• If you are worried about your child’s breathing at all, it is always okay to ask a healthcare professional

Diagnosis

There is no single test for asthma in children. A doctor or asthma nurse will ask about symptoms, listen to the chest, and ask about family history and triggers. They will also consider whether symptoms improve with a trial of an inhaler. For some children, especially younger ones, a clear diagnosis may take several visits.

Tests that may be done

• Spirometry: a breathing test where the child blows hard into a tube to measure how fast and how much air they can breathe out
• Peak flow monitoring: using a small handheld device to check how well air moves out of the lungs
• FeNO test: a simple breath test that measures inflammation in the airways
• Allergy tests: skin prick tests or blood tests to look for common allergic triggers

What to expect at your appointment

The healthcare team will explain the tests to you and your child in a child-friendly way. Tests are usually painless and safe. After assessing your child, they may create a written asthma action plan that describes how to manage symptoms, when to use medicines, and when to get urgent help.

Treatment

Treatment for childhood asthma focuses on controlling symptoms, preventing flare-ups, and helping your child take part in normal activities. This is done with a written asthma action plan, regular check-ups, trigger avoidance, and inhalers that are suited to your child’s age and symptoms.

Self-care at home

• Follow the child’s written asthma action plan from your healthcare team
• Learn what triggers your child’s symptoms and try to avoid them where possible
• Make sure your child uses the correct inhaler technique; this makes medicines work much better
• Keep regular asthma review appointments, even when your child feels well
• Do not smoke around your child or inside the home or car
• Let your child’s school or nursery know about their asthma and what to do in an emergency

Medical treatments

Most children with asthma are prescribed inhalers. There are two main types: a reliever inhaler to open the airways quickly when symptoms happen, and a preventer inhaler used every day to reduce inflammation and stop symptoms in the long term. Some children need additional medicines if asthma is harder to control, but these are always chosen by a doctor or asthma specialist and reviewed regularly.

Living with this condition

With a good care plan, most children with asthma can enjoy normal daily activities, including sports and play. The key is to keep symptoms well controlled, use preventer medicines as prescribed, and keep quick-relief medicines available when needed.

Lifestyle tips

• Encourage regular physical activity; exercise is good for lung health, and most children with asthma can play sports if their asthma is well controlled
• Keep the home as smoke-free as possible and reduce exposure to dust mites, pet fur, and mould where triggers are relevant
• Help your child understand their condition in a simple, calm way so they feel confident telling an adult if they feel breathless
• Make sure teachers, family members, and carers know what to do in an asthma flare-up

Diet and exercise

There is no special diet to cure asthma, but eating a balanced, healthy diet is good for overall health. Exercise is encouraged; a warm-up before physical activity and a reliever inhaler if prescribed for exercise can help prevent symptoms. Always ask the healthcare team for advice about exercise and asthma.

Mental health and emotional wellbeing

Growing up with asthma can sometimes cause worry, fear, or frustration for children and parents alike. It is normal to feel this way. Talking openly, staying calm during flare-ups, and giving children age-appropriate responsibility can help. If worry or low mood affects daily life, speak to a healthcare professional.

Prevention

Asthma itself cannot always be prevented, but many asthma attacks and symptom flare-ups can be prevented. Keeping asthma well controlled, following the action plan, and avoiding known triggers reduces the chance of sudden attacks.

Vaccines

There is no vaccine that prevents asthma. However, staying up to date with recommended childhood vaccines, including the flu vaccine, can help prevent infections that often trigger asthma attacks.

Screening programmes

There is no routine screening test for asthma in healthy children. For children already diagnosed with asthma, regular check-ups are a form of monitoring and help keep the condition under control.

Complications

If left untreated

• Frequent asthma attacks that disrupt sleep, school, and daily activities
• Emergency visits to the hospital
• Reduced lung function over time if the condition is not well managed
• Rarely, severe asthma attacks can be life-threatening

Long-term outlook

The outlook for children with asthma is very good. With the right care, most children with asthma lead full, active, and healthy lives. Asthma often changes over time, and symptoms may become milder as your child grows. The aim of treatment is always to help your child live without constant worry and to do all the things they love.

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