Asthma in children
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Symptoms of asthma in children
If your child shows any of the symptoms mentioned, book an appointment with your GP as soon as possible. If you're concerned about their symptoms, you can also call NHS 111 for advice.
Changes in behaviour
- Feeling tired and not behaving as normal
- Not running around as normal
- Wanting to be carried around more
Tight chest
- Your child might describe this as a tummy ache or a sore tummy
- A tight feeling in their chest
- They might rub their chest or tummy
Wheezing
A high-pitched whistling sound can happen when your child is breathing out. It can be hard to hear so a GP might need to listen for this
Breathlessness
Feeling breathless and finding it hard to breathe may indicate asthma in children. To check your child’s breathing:
- Observe how quickly they breathe and listen to the sounds
- Watch for signs of effort, such as moving their shoulders up and down
- Look out for breathlessness, like getting out of breath during play, staying breathless for longer than usual, or avoiding activity due to breathlessness
Coughing
- Having a cough that won’t go away or keeps coming back
- Having a cough at night or in the early morning
- Having a cough after exercising
- Having a cough when they’re excited or laughing
Ask for an urgent GP appointment or call NHS 111 if your child:
- Has had a cough for 3 weeks or more
- Is coughing up blood
- Has chest pain that comes and goes, or happens when they’re breathing or coughing
- Is feeling breathless or short of breath
Call 999 if your child:
- Is struggling to breathe
- Has pale, blue or blotchy skin lips or tongue (this might be harder to tell in brown or black skin)
- Suddenly feels confused
- Can’t be woken up and they feel floppy
Causes of asthma in children
Asthma is caused by inflammation in the breathing tubes, which carry air to and from the lungs. This makes the tubes sensitive and causes them to narrow temporarily. Both genetic and environmental factors can increase the likelihood of developing asthma.
Your child is more likely to develop asthma if someone in your immediate family, such as a parent, brother, or sister, also has it. This increased risk is linked to genetics and the shared environment in which you live and grow up. Asthma is slightly more likely to be inherited from the mother than from the father.
However, having a close family member with asthma doesn't necessarily mean a child will develop the condition. Likewise, asthma can occur even if there is no family history of it.
Allergies like allergic rhinitis (an itchy or runny nose due to allergens), and a family history of allergies can increase a child’s risk of developing asthma. Having food allergies makes children 4 times as likely to have asthma compared to children without a food allergy.
Children are at greater risk of asthma if they were born prematurely (before 37 weeks), especially if they needed a ventilator to help them breathe after birth. Being born with a low birth weight can also be a risk factor.
Bronchiolitis can increase your child’s risk of developing asthma, especially if they’ve had it multiple times. Bronchiolitis is caused by a virus and it can lead to swelling in the lungs and airways, coughing and wheezing.
Croup, a childhood condition that affects the windpipe, the airways to the lungs and the voice box can increase your child’s risk of developing asthma. Like asthma, croup can cause coughing and feelings of breathlessness.
Smoking during pregnancy and smoking around your baby or child can significantly increase the risk of the child developing asthma or other breathing problems.
Air pollution can play a part in causing asthma. Studies have shown that children who live near very busy roads can be more likely to develop asthma. This is because their lungs are still developing and they breathe faster which means when they breathe, they’re taking in more polluted air.
Triggers of asthma in children
An asthma trigger is anything that can set off or make your asthma symptoms worse. Triggers can make the airways more swollen (inflamed) and can cause asthma attacks.
When your child comes into contact with a trigger, a few things can happen, including:
- Tightening of the muscles around the airways
- Swelling and inflammation of the airways
- Build-up of sticky mucus in the airways
Your child might have 1 or more triggers. Knowing and avoiding triggers can help keep their symptoms under control. Your child’s triggers can be obvious, but sometimes it can be harder to know what’s causing any symptoms, especially if they aren’t visible like pollen or indoor air pollution. It can help to keep a diary of activities and symptoms to help identify patterns and pinpoint triggers.
Treatment & management of asthma in children
There currently isn’t a cure for asthma, but asthma treatments can help to control the symptoms. In most cases, if your child’s treatment is working, they should:
- Not have asthma attacks
- Not wake up at night because of symptoms
- Not need their reliever inhaler
- Have no symptoms during the day
- Not miss school due to asthma symptoms
- Not miss out on playing or exercise
Most children with asthma are prescribed inhalers to help manage their condition. There are two main types of inhalers: preventers, which help reduce inflammation and prevent symptoms, and relievers, which quickly ease symptoms when they occur.
These inhalers can help control your child’s asthma. They contain corticosteroids which treat the swelling and narrowing (inflammation) of their airways. If your child is taking their preventer inhaler every day as prescribed, they’re less likely to be affected by their triggers.
If your child is still having asthma symptoms, even if they’re taking their preventer inhaler as prescribed, speak to your GP so their treatment plan can be reviewed. They may need to change the dose of their preventer inhaler. With suitable support, your child will be able to manage their asthma symptoms.
If your child stops taking their preventer inhaler or starts using it less, they’ll be more at risk of having symptoms and asthma attacks.
These inhalers (usually blue) are essential if your child is having any asthma symptoms or is having an asthma attack. It’s important to make sure that it’s close by so that any symptoms can be dealt with quickly.
A good inhaler technique can help with symptoms and prevent any side effects like having a sore mouth.
Some children may need extra treatment to help with their symptoms. These, if needed, will be prescribed by their GP or specialist. They may need to take any extra treatments with their usual preventer inhaler.
In some cases, your child might be given a combination inhaler called a MART inhaler (Maintenance and Reliever Therapy). A MART inhaler combines a reliever and a preventer inhaler. This can be used as their emergency reliever inhaler.
Not all combination inhalers can be used as reliever inhalers. If your child isn’t on MART treatment, they should also have a reliever inhaler. Their reliever inhaler will help to open their airways when they have symptoms or have an asthma attack.
Inhalers & spacers
A spacer is an empty tube that’s usually made of plastic. It’s attached to the mouthpiece of the inhaler on one end and at the other end, you can use a mouthpiece or a mask. If your child is using a metered dose inhaler, a spacer can help you get the most from it. Some inhalers don’t need spacers. If you aren’t sure if your child needs one, speak to your GP.
There are different types of spacers that fit different inhalers. They’re available on prescription. Your GP, asthma nurse or pharmacist can help you find the spacer that’s suitable for your child. They can also be bought from your pharmacy without a prescription.
Using a spacer can mean:
- Less medicine is wasted as it’s going straight to your child’s lungs
- Less side effects from preventer inhalers as less medicine is absorbed into the rest of their body
- It’s easier to take the medicine as they can breathe it in without needing to get the timing right
Your GP, asthma nurse or pharmacist should show you how to help your child use their inhaler and spacer correctly. You can also make sure they’re using the right technique in their annual asthma review.
To help your child use a spacer:
- Sit them on your lap, either sideways or facing away from you
- When you’ve finished, remove the inhaler from the spacer and replace the caps on both the spacer and the inhaler
- If your child’s inhaler has steroids in it, make sure they rinse their mouth out with water to help reduce the risk of any side effects
With babies and younger children, you might find it easier to use a face mask. Using a spacer and face mask means that more of the medicine can get into their lungs to help manage their symptoms.
To use a spacer with a mask:
- If you have a baby or young toddler, sit them on your lap facing you
- With young babies, some people find it’s easier for them to tilt them back slightly
- If your child is older, you can sit them on your lap sideways or facing away from you. This can make it easier to handle the spacer and the inhaler
- If they prefer to sit or stand by themselves, face them
- Hold the inhaler upright and take the cap off
- Check the mouthpiece is empty
- Shake the inhaler well
- Put the inhaler into the hole at the back of the spacer with the indent for the nose on the mask facing upwards
- Ask them to sit or stand up straight and slightly tilt their chin up as it helps the medicine reach their lungs
- Put the mask on their face to make a seal over their nose and mouth
- Encourage your child to breathe in and out
- Press the canister on the inhaler once and get them to breathe in and out slowly and steadily 5 times
- Remove the mask from their face
- If your child is using a small volume spacer with a mask, some of them make a whistling sound if they are breathing in too fast
- If your baby is using a large-volume spacer with the mask, you need to tilt the end of the inhaler up to open the valve
- The device should make a clicking sound as the valve opens and closes
- If your child needs to take another dose, remove the mask from their face
- Wait 30 seconds to a minute and shake the inhaler again, then repeat the steps
- When you've finished, take the inhaler out of the spacer and replace the cap
- If your child has used an inhaler that has steroids in it, wipe your child's face with a damp cloth and rinse their mouth out with water or brush their teeth to help reduce the risk of side effects
If your child is using a spacer without a mask, there are 2 breathing techniques they can use, ‘tidal breathing’ and the ‘single breath and hold’ technique. Your GP or asthma nurse can advise you on what technique your child should use.
Tidal breathing:
- Hold the inhaler upright and take off the cap
- Check the mouthpiece is empty
- If the spacer has a valve, make sure the valve is facing upwards
- Shake the inhaler well
- Put the inhaler into the hole at the back of the spacer
- Take off the spacer cap (if it has one)
- Ask your child to sit or stand up straight
- Slightly tilt their chin up as it helps the medicine reach the lungs
- Ask them to put their lips around the mouthpiece of the spacer to make a tight seal
- Ask them to start breathing in and out
- Press the canister on the inhaler once
- Encourage them to breathe in and out slowly and steadily into the spacer five times
- With tidal breathing, the spacer should make a clicking sound as they breathe in and out
Single breath and hold:
- Encourage your child to breathe out gently and slowly away from the inhaler and spacer until their lungs feel empty and they feel ready to breathe in
- Ask them to put their lips around the mouthpiece of the spacer to make a tight seal
- Press the canister on the inhaler once and have them breathe in slowly and steadily until their lungs feel full
- Take the mouthpiece of the spacer out of their mouth and with their lips closed, ask them to hold their breath for up to 10 seconds or for as long as they comfortably can
- Then have them breathe out gently away from the spacer and inhaler
- Finally, if your child has been prescribed a second puff, with the inhaler and spacer away from their mouth, wait 30 seconds to a minute, shake the inhaler again and repeat the steps
- When you've finished, take the inhaler out of the spacer and replace the caps on the inhaler and the spacer
- If your child is using a small volume spacer, some of them make a whistling sound if they are breathing in too fast
- If they are using a large-volume spacer, the breathing techniques are the same
- If your child has used an inhaler that contains steroids, make sure they rinse their mouth out with water or brush their teeth to avoid side effects
Make sure that as a parent or carer, you aren’t:
- Smoking around them
- Overdressing or underdressing them to help with their temperature if they have a fever
It’s important to make sure that your child is still taking their asthma medication as prescribed to help keep it under control. Speak to your GP if you’re concerned about any of their symptoms or their condition getting worse.
Severe asthma in children
If your child’s asthma isn’t under control even though they’re taking their medicines as prescribed, they might get diagnosed with severe asthma.
This diagnosis can take some time as:
- They’ll need to see a specialist team
- They’ll need to have tests like chest X-rays
- They might need to be observed in hospital
Severe asthma might impact their daily life more. Your child will be at a higher risk of an asthma attack, be more likely to need emergency care for their asthma and may have to go to hospital.
Staying organised can help with managing severe asthma in children. The following can help:
- Having a written asthma action plan to remind you what medicines your child needs and when they need to take them
- Keeping a diary of your child’s symptoms so you can notice if any symptoms get worse
- Make sure your child’s medicines are easy to find by keeping them in the same place
- Make sure you always have a spare inhaler for your child
- Ordering new inhalers before they run out
- Make an asthma kit with their medicines, a copy of their action plan and any contact numbers so you have it to hand wherever you go
- Using a diary to keep track with any medical appointments
- Keeping important numbers like the GP or asthma specialist on the fridge and on your phone
Asthma attacks
An asthma attack is when your child’s symptoms get much worse. This can happen quickly or can build up over a couple of days.
Signs of an asthma attack may include your child:
- Finding it harder to breathe
- Breathing quicker
- Being unable to walk, eat or talk
- Wheezing and coughing a lot
- Complaining of a tummy ache or a tight chest
- Saying their reliever inhaler (usually blue) isn’t helping
- Needing their reliever inhaler more than every 4 hours
- Being unusually quiet
If your child has an asthma attack, take the following steps:
- Try to keep them calm
- Help them to sit up and don’t let them lie down
- Help them take 1 puff of their reliever inhaler (with their spacer if they have one) every 30 to 60 seconds, up to 10 puffs in total
- If they don’t have their reliever inhaler or their reliever inhaler isn’t helping call 999 for an ambulance
- If you’re worried at any time, call 999 for an ambulance
- If the ambulance hasn’t arrived after 10 minutes and their symptoms haven’t improved, repeat the third step
- If their symptoms aren’t better after repeating the third step and the ambulance hasn’t arrived, call 999 again immediately
It's important not to use a nebuliser to treat your child’s asthma attack unless their doctor has recommended it. This can mask any symptoms and delay you seeking help.
Asthma attacks are emergencies and can be life-threatening. Don’t hesitate to call 999 if you think your child is having an asthma attack and your child’s reliever inhaler isn’t helping, or if you’re worried at any time.
If their reliever inhaler has helped with their symptoms and they’ve improved, you should still speak to your GP. Book an urgent same-day appointment with them for an asthma review after the attack.
The above advice isn’t suitable for children on MART treatment. If your child is on MART treatment, speak to their GP or asthma nurse to find out what to do if they have an asthma attack.
Preventing asthma attacks
To reduce your child’s risk of having an asthma attack, you can try the following steps:
- Follow their personal asthma action plan and make sure they’re taking their medicines as prescribed
- Make sure to attend their regular asthma reviews with a GP or asthma nurse (these should be done at least once every year)
- Check with their GP or asthma nurse that their inhaler is being used correctly
- Help them avoid things that trigger their symptoms when possible
Don’t ignore if your child’s symptoms are getting worse or if they need to use their reliever inhalers more than usual. Make sure to follow their action plan and make an urgent appointment with their GP or asthma nurse if any symptoms get worse.
Related conditions
There are other health conditions that are more common when you have asthma. They can make asthma harder to manage. It’s important to speak to your GP if you think your child has any other health conditions alongside their asthma. The right diagnosis is needed to get the right support and treatment.
In some cases, if you have asthma, you can also have other allergic conditions. These include:
- Allergic rhinitis (the most common). Hayfever is a type of allergic rhinitis which is triggered by pollen usually in the summer, but allergic rhinitis can happen throughout the year. It can also be triggered by dust mites, pets or mould
- Eczema causes dry, itchy and cracked skin
- Food allergies
Allergies can make asthma symptoms like coughing, wheezing, chest tightness and breathlessness worse. This can increase the risk of your child having an asthma attack.
To lower your child’s risk of symptoms:
- Ask for allergy tests to rule out any allergies
- Use suitable antihistamines and nasal sprays to help relieve hay fever symptoms and allergies.
- Use their asthma action plan to keep a record of any allergies or triggers
- Carry an auto-injector pen if your child has been prescribed one because they are at risk of a severe allergic reaction
If allergies are making your child’s asthma worse, speak to their GP.
Sinusitis, often referred to as a sinus infection, is the inflammation and swelling of the lining of the sinuses. Long-term sinusitis is more common in people with asthma. It can be a complication of allergic rhinitis. Sinusitis can make your child’s asthma worse and they may find it harder to breathe. They may also have post-nasal drip. This can make them cough more.
To lower your child’s risk of symptoms:
- Avoid any allergic triggers
- Make sure any rhinitis is treated
- Add sinusitis to their asthma action plan and make sure both are being treated
Having asthma can increase your child’s likelihood of getting nasal polyps. Nasal polyps are small growths in the nose which aren’t painful, but they can make the nose blocked or runny. It can sometimes feel like your child has a cold that isn't going away. Nasal polyps can be caused by sinusitis that keeps coming back.
If your child has asthma and nasal polyps, it can sometimes mean their asthma is more difficult to treat. If their nose is blocked or runny, it can impact the way they breathe and sleep, and it can also irritate their airways. This can make the airways more inflamed and sensitive to triggers. Speak to your GP if you think your child has a nasal polyp.
To lower your child’s risk of symptoms:
- Ask your GP about treatments for nasal polyps or if the polyps can be removed
- Book an asthma review for your child to make sure that their treatment plan is suitable
If your child has asthma, especially if it’s severe or difficult to control, they’re more likely to get acid reflux. They might get a burning feeling in their chest after eating, a bad taste in their mouth, or find it hard to swallow.
If they keep getting acid reflux or heartburn, it’s known as gastro-oesophageal reflux disease.
If your child has asthma and gastro-oesophageal reflux disease, you’ll need to keep an eye on their asthma symptoms, as they could get worse.
To lower your child’s risk of symptoms:
- Speak to your GP or pharmacist about their acid reflux
- Keep a food diary to see if anything makes it worse
Vocal cord dysfunction is when the voice box (vocal cords) doesn’t open properly, which can make it hard to breathe. Your child might feel breathless or may wheeze or feel like their chest is tight. Their throat might also feel tight. Vocal cord dysfunction can make their asthma worse. It can also be confused with asthma because the symptoms and triggers are similar.
To lower your child’s risk of symptoms:
- You can encourage them to try relaxation techniques and breathing exercises
- Talk about their vocal cord dysfunction during their asthma review
- Ask about speech therapy, which can help relax their throat muscles
Children who have had asthma for years, especially severe asthma, can sometimes develop bronchiectasis. This is when the airways become scarred, inflamed, and produce a lot of mucus.
This mucus can build up and become infected. If their airways get infected, it can make their asthma harder to manage, as the airways may become further inflamed.
Children with asthma and bronchiectasis are more likely to have asthma attacks and need hospital care than children with asthma alone.
To lower your child’s risk of symptoms:
- Speak to your GP about the annual flu vaccination
- Avoid smoking around them, and don’t let others smoke around them
- Speak to your GP about a referral to a physiotherapist for exercises to help clear mucus from the lungs
Difference between asthma & a chest infection
Chest infections affect the lungs or airways. The most common types are pneumonia and bronchitis. Asthma isn’t an infection, it’s a lung condition that causes breathing difficulties.
If your child has asthma, they are at greater risk of developing a serious chest infection. Chest infections can also trigger asthma, as they make the airways more inflamed.
The main symptoms of a chest infection can include:
- A chesty cough (producing yellow or green phlegm)
- A high temperature (38°C or above)
- Wheezing and breathlessness
- Chest pain or discomfort
- Aching muscles
- A headache
- Feeling tired
If your child gets a chest infection, there are steps you can take to manage their asthma, which include:
- Using a written asthma plan, so you know exactly what to do if they have any asthma symptoms
- Managing their asthma well, which includes remembering to give them their preventer medicines as prescribed, even if they feel well
- Always keeping their reliever inhaler on hand
To help reduce your child’s risk of getting a chest infection:
- Don’t smoke or let other people smoke around your child
- Speak to their GP about the annual flu vaccination
- Make sure they’ve had the pneumococcal vaccination. This is part of the routine childhood vaccinations given by the NHS. Speak to your GP if you’re unsure if your child has had their vaccination
- Feed them a healthy, balanced diet
Difference between asthma & pneumonia
Pneumonia is a type of chest infection that can affect your lungs. If your child has pneumonia, the air sacs in their lungs become swollen and fill with fluid which can make it harder for them to breathe. Asthma isn’t an infection, but a lung condition that can cause breathing difficulties.
There are several types of pneumonia:
- Bacterial
- Viral
- Aspiration
- Fungal
If your child has pneumonia, they’ll have symptoms which are similar to having the flu or having a chest infection. These symptoms can appear suddenly or more slowly.
Babies and very young children may be at higher risk of getting pneumonia as their immune systems haven’t fully developed.
Children may also be at higher risk if they:
- Are malnourished or underweight
- Have a weakened immune system
- Have been exposed to tobacco smoke
- Have been exposed to air pollution
Symptoms of pneumonia may include your child:
- Having a cough, which could be dry or wet, and may bring up yellow, green, brown, or blood-stained mucus.
- Feeling tired, ill and weak
- Feeling breathless or like they can’t catch their breath
- Having a lack of appetite
- Having a fast heartbeat
- Sweating and shivering
If your child has pneumonia, they might not have all the symptoms above. They may also have symptoms like:
- Wheezing
- Confusion
- Low blood pressure
- Coughing up blood
- Joint or muscle pain
- Feeling sick or being sick
If your child has bacterial pneumonia, they may be prescribed antibiotics. It’s important that they finish the whole course of antibiotics to make sure that it’s been treated fully.
If your child’s pneumonia is viral, antibiotics won’t be prescribed. Symptom management and rest can help treat it.
Most children with pneumonia can be looked after at home. Make sure that your child:
- Is getting enough rest
- Is staying hydrated
- Is going to the toilet as usual as this is a sign that they’re hydrated
- Is taking children’s pain relief if they’re in pain (cough syrup doesn’t help with pneumonia)
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Frequently Asked Questions
If you suspect your child has asthma but you aren’t sure, look out for symptoms like:
- Coughing: often at night, in the early morning, after exercise or when they’re excited or laughing
- Wheezing: a whistling sound in their chest usually when they breathe out
- Chest tightness
- Breathlessness
These symptoms combined can make asthma more likely. If you think your child has asthma, speak to their GP.
Cold weather can be a trigger for asthma and you might notice that a cold house is making your child’s asthma worse. This is because when it’s cold, the air is colder and drier. Breathing in cold, dry air can irritate their airways, which then makes their lungs tighter, making it harder to breathe. Well managed asthma is less likely to be triggered by cold weather.
An asthma cough is usually dry. If your child’s asthma isn’t well managed, they might have a productive cough which means they produce thick clear mucus.
An asthma action plan contains all the information you need in one place. It can help you keep your child’s asthma under control. A personal asthma action plan:
- Reminds you what to do to keep your child well
- Shows symptoms to look out for
- Shows you what to do if your asthma gets worse
- Tells you what to do if they have an asthma attack
An asthma action plan is made with your child’s GP or asthma nurse to make sure it’s personal to them. It’s important to take it to all their asthma appointments to make sure it’s kept up to date.
Yes. To prepare your child for school, make sure they are taking their preventer inhaler every day as prescribed to reduce the risk of them having an asthma attack.
Make sure you ask your GP for an extra reliever inhaler to give to your child’s school. The inhaler should be in its original packaging with the prescription label. If your child uses a spacer, send one in too.
Making sure that your child’s asthma action plan is up to date is key. Share this with your child’s school so they are aware of what to do if they have any symptoms.
2Access to treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
12Please note, free home postal delivery is only available to patients registered with a GP in England. However, the option to collect in-store is available for all customers registered with a participating GP anywhere in the UK. For patients registered with a participating GP surgery only. NHS Prescriptions charges may apply. Subject to availability.
