Everything You Need to Know About Childhood Asthma

We connected with a pediatrician and pediatric pulmonologist to answer your most pressing questions about children and asthma.

There is nothing more heartbreaking than a child who is struggling to breathe. If your child has recently been diagnosed with asthma, or you think they are showing signs of it, you likely have many questions. You probably also have some concerns. You may want to know what exactly asthma is, for example, and/or what causes it. You probably want to know the symptoms of asthma and the warning signs of an approaching attack. And, finally, you'll want to know how to get proper treatment so that your child can breathe easily again.

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We connected with a pediatrician and pediatric pulmonologist (lung doctor) to answer your most pressing questions about children and asthma. Read on for more.

What Is Childhood Asthma?

Childhood asthma refers to asthma symptoms among children under the age of 18. "Asthma is a chronic condition in which a child may experience coughing, wheezing, shortness of breath, and/or chest tightness from the inflammation and narrowing of small airways and obstruction of airflow," describes Kelsey Malloy, M.D., pediatric pulmonologist and medical director at Pediatrix Pulmonology of Nashville.

Christina Johns, M.D., pediatric emergency doctor and senior medical advisor for PM Pediatric Care explains that childhood asthma is generally categorized based on how frequently your child presents with asthma symptoms and how severe those symptoms are. "Asthma can be classified as mild, moderate, or severe," Dr. Johns says.

How Common Is It?

Asthma is more common than you might realize. According to the Centers for Disease Control and Prevention (CDC), about 6 million children under the age of 18 have asthma; that's one in every 12 kids. As the Asthma and Allergy Foundation of America (AAFA) notes, asthma is one of the most common chronic diseases diagnosed in children. About 44% of kids under 18 who have asthma will experience one or more asthma attacks in any given year. Among school-age kids, asthma is a frequent reason for missed school, according to AAFA.

That said, it's important to note that asthma doesn't impact all kids equally. Children assigned male at birth are more likely to experience asthma symptoms than children assigned female at birth. Black children are also more likely to experience asthma than white children. They are three times more likely to be diagnosed with asthma, as the AAFA reports.

Why Do Kids Get Asthma?

"The exact cause of asthma isn't known but is thought to be partially passed down through families," says Dr. Johns. That means that if you or your partner have asthma, your children have a higher likelihood of developing it. Still, the truth is, says Dr. Malloy, there are multiple factors that may cause a child to develop asthma. "Research is ongoing to further understand why some children are affected while others aren't," she says.

According to Dr. Malloy, there are certain risk factors that may make it more likely for children to develop asthma or that may trigger asthma symptoms in kids. These include:

• Exposure to indoor or outdoor pollution

• Allergens, such as pets, dust, pollen, and mold

• Exposure to smoke from cigarettes, vapes, and burning wood

• Viral infections, including RSV, which seem to increase asthma risk

Additionally, a recent study found that gas-burning stoves are responsible for roughly 12.7% of childhood asthma cases in America. Why? Because gas stoves can emit significant amounts of nitrogen dioxide, a pollutant that can trigger asthma and other respiratory conditions.

There are also some factors that occur during pregnancy or early childhood that may make a child more likely to develop asthma. "Some children may experience it because they have chronic lung disease or were born prematurely, both of which have a higher risk for the development of asthma," says Dr. Johns.

Finally, Dr. Malloy explains that having a family history of allergies, such as eczema, may increase your child's risk of asthma. Children who have a history of reflux or sleep apnea may have more difficulty controlling their asthma, she adds.

What Are the Signs of Asthma, Particularly In Kids?

The most common signs of asthma in kids are:

• Tight chest/tight breathing

• Ongoing cough, especially when lying down

• Labored, quick breathing

• Exhaustion from not getting enough oxygen and struggling to breathe

• Wheezing, which sounds like a whistling sound

• Trouble coordinating sucking and swallowing (in breast- and bottle-fed babies)

That being said, sometimes the signs of a child struggling to breathe can be more subtle, according to Dr. Malloy. "Parents may notice a dry cough that doesn't resolve for a few weeks after the child is feeling better from a cold virus. They may also observe a cough that keeps their child up at night," she says. Not only that, but small children can't always tell you what's going on. "Young children may not yet be able to vocalize how they are feeling or if it is difficult to breathe," Dr. Malloy describes.

How Is Childhood Asthma Diagnosed?

There is no single test to diagnose asthma, says Dr. Malloy. "Diagnosis of asthma involves a thorough review of a child's medical problems, family history, and environmental exposures," she explains. It can be particularly difficult to diagnose younger children with asthma. "Asthma symptoms can start early in life and are sometimes difficult to differentiate from recurrent viral symptoms, especially since infants and toddlers can have wheezing from viruses," she describes.

Besides taking a full medical history, asthma diagnosis may involve the following tests and diagnostic assessments:

• X-rays of the chest

• Tests that measure the functioning of the lungs, such as spirometry

• Allergy tests to ascertain if an allergy may be triggering your child's asthma

How Is It Treated?

Asthma treatment involves avoiding possible triggers, such as allergens or inhaling smoke. Additionally, asthma is usually treated with medication that can be taken via an inhaler, an inhaler with a spacer, or a nebulizer.

Medications for asthma focus on two main components, says Dr. Johns: treating the swelling and inflammation that happens in the airway as well as treating any wheezing, coughing or labored breathing. "Steroids such as dexamethasone or prednisone are used to decrease swelling while inhaled bronchodilator medicines like albuterol are used to open up the airways in the lungs," she explains. Children who have ongoing asthma issues may need a daily inhaler to help prevent asthma attacks, Dr. Johns adds.

The good news is that asthma treatments are very effective, and sticking to your child's asthma plan usually results in fewer asthma attacks, doctor's appointments, and ER visits. That being said, you should never ignore signs of an asthma attack in your child, even if they are being treated with medication.

"Parents should seek medical attention if their child is experiencing coughing, wheezing, or difficulty breathing that does not improve with asthma quick-relief medications, like albuterol," says Dr. Malloy. Rapid breathing and/or breathing so fast your child can't talk, eat, drink, or play is also cause for concern, she adds.