Is It Asthma?
Several studies have shown that 50 to 80 percent of children who have asthma developed symptoms before their fifth birthday. In addition, children four years old or younger have the highest rates of hospitalization (59 per 10,000) and emergency room use (162 per 10,000) due to asthma — the highest of any age group.
If your young child is coughing or wheezing, you may wonder if he may be a part of that group. Oftentimes, though, it will be somewhat difficult for you — and even your health care provider — to initially make that diagnosis.
For years, medical professionals were taught that a child should not be diagnosed with asthma before the age of two. But, times have changed.
Fact
Guidelines from the National Asthma Education and Prevention Program (NAEPP) of the National Institutes of Health no longer list exclusions for any age group. Instead, diagnoses are now based on a child's physical examination, symptoms, assessment of quality of life, medical history, and response to treatments.
For years, asthma during early childhood was often underdiagnosed. For instance, a child might be diagnosed instead with chronic bronchitis, wheezy bronchitis, gastroesophageal reflux disease, recurrent upper respiratory tract infections, or recurrent pneumonia. This meant those children did not get the correct therapy for asthma that they needed at the time.
On the other hand, symptoms such as coughing and wheezing do not necessarily mean that the diagnosis should be asthma. Nearly half of all infants actually may have a wheezing illness once in a while that is related to the small size of their airways or a particular type of virus. This usually disappears as they get older, and their airways get larger. Health care providers, therefore, should be wary of leaping ahead in this case and diagnosing asthma.
Sometimes, it could be other serious conditions such as cystic fibrosis, congenital heart disease, or maybe a parasitic disease. Health care providers should take time to rule out other conditions before starting asthma treatment.
So, you may ask, where is the best place to start? It helps to look for signs and indications that you can present to your health care provider. Even though you may feel you're on the sidelines when your young child has asthma, you still have a big job ahead in finding the right path for her to take in managing her symptoms. With a little guidance, you can make it.
The Warning Signs
Sometimes it may not be initially clear if your child has asthma, but several warning signs may point to asthma such as:
A continuing cough, especially at night, with activity, or coughing longer than anyone else in the family after colds.
Labored, rapid breathing — even when resting.
Difficulty breathing in cold weather, especially when active.
Greenish or yellow mucus found in his nose may indicate allergies or sinus infections, both of which can flare underlying asthma.
Dark circles under his eyes may indicate allergies.
Pale skin may indicate allergies.
Changes in his sleep patterns due to coughing or waking at night with shortness of breath or chest pain.
Changes in daytime behavior, such as misbehavior or irritability.
More drooling than usual.
Also, if you or your family members have asthma, the likelihood that your child has it is higher. And, if your child is exposed to environmental factors such a secondhand tobacco smoke or various forms of air pollution, the likelihood of asthma could be increased as well.
A checklist could be a valuable tool in sharing information with your health care provider. The American College of Allergy, Asthma, and Immunology, for instance, has developed a specific asthma checklist test for children ages newborn through seven years (
Guidelines for Young Children
The asthma guidelines released by the NAEPP in 2007 include an asthma severity scale specifically created for children from birth to age four who currently are not taking long term control medication but have asthma symptoms. The different levels can give a health care provider a base by which to begin treatment. These levels are:
Intermittent — Symptoms occur less than two days a week, no nighttime awakenings related to asthma are reported, quick-relief medications are used less than two days a week, and no interference is reported with normal, daily activities.
Mild Persistent — Symptoms occur two or more days a week, one to two nighttime awakenings related to asthma occur monthly, quick-relief medications are used more than two days a week, and minor limitations are reported with normal, daily activities.
Moderate Persistent — Symptoms occur daily, three to four nighttime awakenings related to asthma occur monthly, quick-relief medications are used daily, and some limitations are reported with normal, daily activities.
Severe Persistent — Symptoms occur several times per day, nighttime awakenings related to asthma occur once a week, quick-relief medications are used several times per day, and normal, daily activities are reported extremely limited.
At the current time, data is inadequate to link flare-ups with levels of severity. However, for treatment purposes, the guidelines recommend that patients who have had two asthma episodes in the past six months or four wheezing episodes in the past year — and have risk factors for persistent asthma — may be considered the same as patients with persistent asthma (even if they fail to show signs of impairment associated with the other levels). Once treatment has started, your health care provider can determine if symptoms are well controlled, not well controlled, or poorly controlled for a child using current guidelines. (See Appendix C.)
