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Helping children to manage their asthma

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Helping children to manage their asthma

Written by Dr Jenny McWhirter, health educationalist

This factsheet is about children and how they can learn to manage their asthma. It is intended for:

parents with a child who has recently been diagnosed with asthma.

parents caring for children aged five years or more who need to use inhalers to manage their asthma.

health professionals working with parents and children to improve their day-to-day management of asthma.

Children and learning

To understand how children can learn to manage their asthma we need to know something about the process of learning, and something about children.

Learning is not just about increasing knowledge. While information is important, learning is also about:

increasing skills

exploring and challenging attitudes

reinforcing or changing beliefs.

All of these can affect how children (helped by their families) manage their asthma symptoms.

It is important to remember that children with asthma are just like other children. They learn in the same ways:

from experience

from what they see other people doing

from what they hear other people saying.

Because they are young, children often get things wrong, so along the way they need:

encouragement to try again

new ways to learn as they grow and change

confidence that there is someone able to step in when things go wrong.

Like most of us, children learn best when they are praised and less well when they are punished or blamed.

What is the aim of asthma management for school-aged children?

The primary aim is for the child to be able to live a normal life. This means living with as few symptoms as possible and with as little medication as possible. The most common medicines used by children of school age are inhalers. Typically, inhalers fall into two categories:

reliever inhalers that relieve symptoms rapidly and effectively.

preventer inhalers that reduce the inflammation in the lung and so provide a longer-term benefit by reducing the need for reliever medication.

Although most manufacturers in the UK have adopted a colour-coding system, it is not compulsory. So in general, reliever inhalers are blue and preventer inhalers are brown. However, some blues look green and some browns are cream or white.

If your child finds it difficult to know which inhaler to use when, you could colour code them yourself. You can buy coloured stickers from a stationery shop, or use plain ones, which the children can colour in or decorate themselves. Take care that the sticker does not affect the way the inhaler works.

What is the aim of asthma education for school-aged children?

The primary aim is for the child to be able to manage their symptoms by:

avoiding triggers

using their different inhalers in the way the doctor or nurse recommend.

This means taking the reliever inhaler when they have symptoms and getting into the habit of taking their preventer. If we think about it, this means two different kinds of things for children to learn.

Learning by experience

The first step is helping your child to recognise which inhaler is a reliever and which is a preventer.

Children learn by experience so they will soon recognise when their reliever works. If it does not provide the promised relief of symptoms then they may need help to improve their skills.

Learning to co-ordinate their breathing and operate an inhaler can be tricky for a child who is only just learning to manage a knife and fork, control a pencil or ride a bike. If your child is still at this stage, then do not assume that they can do two things at once.

A little practice may make perfect but if not, ask your doctor or practice nurse for advice. He or she may recommend that your child uses a spacer device to help them take their medicine.

It is not always practical to use a spacer, so if your child finds their inhaler difficult to use return to your doctor or practice nurse and ask if your child could try a different one. Some are easier to use than others.

Similar problems of co-ordination will affect how your child uses their preventer. Since these are more likely to be used at home you might continue to use the spacer for the preventer as well. As your child gets older, however, both of you will want more independence; so getting a device your child can use easily is an important step.

In the long term, experience will also help children to recognise that their preventer is working, but children find it difficult to link cause and effect over long periods. You could help your child to make those links by keeping a symptom diary.

There are several of these specifically designed for children, so your practice nurse may be able to provide one, but you could also make your own, concentrating on the child's main symptom. For example, if your child often wakes at night with a cough, then preventer therapy should reduce these symptoms after two or three weeks of regular use.

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