12. Asthma in Children

Asthma, many a time, starts in childhood, but the picture of asthma then is different from that observed in adulthood. In children, generally speaking, asthma is present as recurrent attacks of cough and wheezing only; in some attacks, it is accompanied by fever and breathlessness also. Breathlessness in asthmatic children, usually, does not come in the form of paroxysmal attack.
This picture of asthma has to be recognized clearly, otherwise in the time lost in making a correct diagnosis there is always the danger of chest deformities developing in the pliable bony cage of the children.
Premonitory symptoms
Children who have allergic symptoms are more liable to get asthma. These symptoms are :

  • Unusual and persistent colic.
  • Need for frequent changes of feeding formulae.
  • Unexplained diarrhoea or constipation.
  • Extreme likes and dislikes for certain foods.
  • Excessive vomiting.
  • Unexplained skin rashes.
  • Discharge of pus from the ears (otitis media)
  • If one or both the parents have some allergic disorder, there is a likelihood that some of their children may also have it, may be in the form of asthma.

Usual bronchodilator drugs, as given in adults, are useful in children as well, only that they have to be given in reduced dosages, according to the age and weight of the child. For children, these drugs come in the form of liquids, or syrups and the easily accepted Tedral liquid, if necessary, with a liquid preparation of Salbutamol are usually adequate in mild cases.
Corticosteroids are only rarely needed if all other measures are taken adequately. But, in case an attack of asthma does not subside in spite of all the other measures already undertaken, there is a need for giving cortisone for a few days, in order to bring the child out of the attack; cortisone can then be tapered of in a few days time.
It is not advisable to give antibioties children unless there is clear evidence of infection. Unnecessary administration of antibiotics like tetracyclines are liable to colour fall out, permanently. Even though milk teeth fall out, the permanent ones that have still to come are already being formed and can become discoloured; this has particularly a damaging effect in the case of girls. Penicillin is more liable to cause reactions in allergic chidren than in other people, hence antibiotics in asthmatic children should only be given when there is clear evidence of a bacterial infection.
Finding out to what the child is allergic and subsequent hyposensitization, if the allergen cannot be eliminated from the diet, is sometimes resorted to. However, it is difficult to get cooperation from the children. Hence, if other measures give relief, skin testing and hyposensitization may be held in abeyance for the time being.
Preventive Measures
Parents who have some symptoms of allergy are more likely to have children with allergy. Hence they require to take special precautions in the case of their children.
It has been reported that a breast-fed infant has one-seventh the chance of getting allergic eczema than the bottle fed baby. An early introduction of solid foods in the diet of an infant also predisposes him to allergy.
Milk should be boiled before giving. Eggs should not be introduced in the diet before six months of age and after that boiled eggs should be given, unboiled egg should never be given. The introduction of foods that are most commonly allergenic i.e., egg, wheat, fish, cocoa, etc. should be delayed.
Dust-Free Environments : The environments of a child who is potentially allergic, are very important. The child’s bed-room should be best reserved as a place for sleeping, not for play. It should be kept as free as possible of inhaleable allergens. The furnitures should be of a type which does not promote the presence of dust or mould spores. The matteress may be enclosed completely in a tight dust-proof casing, or a foam rubber mattress may be used. Dust-collecting drapes, bedspreads and wool rugs should be avoided. Blankets should preferably be made of synthetic fibres and covered with a cotton case. The child’s bed should not be situated next to an open window since a chill caused by cold weather may give rise to symptoms.
Pets should not be allowed in the bedroom and are best kept out of the house, otherwise dog or cat dander may become part of the house dust. Stuffed toys should be kept out of the crib.
House cleaning should, preferably, be done when the child is away at school. White-washing and painting, etc., should be done when the child is out of the house.
Protection from Infection : A potentially allergic child should be immunized like any other child against whooping cough, diphtheria, tetanus, typhoid, cholera and polio. Because so many allergic children are sensitive or sensitizeable to eggs, vaccines containing egg protein are a special hazard to them and should be avoided. Where there is a doubt, a preliminary scratch test with the vaccine may be done, and only if no reaction is elicited, the vaccine should be given.
Every precaution must be taken to see that the child does not get a bacterial or viral infection, but if he does, he must be treated promptly and adequately. Many a time, symptoms of allergy are precipitated during such an infection.
Children predisposed to allergy are likely to do well in a dry climate, away from the seashore and, also, in a climate which is free of industrial air pollutants.
Special recommendations are some times offered for allergic pregnant mothers. Some doctors believe that strong allergenic foods such as eggs, milk, nuts and fish should be curtailed considerably during pregnancy; others take a modified position and allow the mother to have all foods but not in excessive amounts.
Does Wheezing Always Mean Asthma?
A case of wheezing and breathlessness may or may not be a case of bronchial asthma. There are other disease also in which wheezing and breathlessness are the main or subsidiary symptoms. These conditions need to be recognized properly.
It is necessary to differentiate asthma from acute bronchiolitis, presence of a foreign body in the bronchial tree, pressure on the main bronchi from a tuberculos gland, enlarged thymus pressing upon the trachea, bronchietasis, cystic fibrosis of the pancreas in which lung involvement is predominant, and congenital disease of the heart.
When it is a foreign body in the respiratory tract causing wheeze and difficuly in breathing, the onset is sudden and there is usually a history of having inhaled a foreign material.
Without proper and adequate investigation, a wheeze should not be invariably considered as asthma.
Post-Natal Care For Your New borns

  • Dust proof casing or a foam rubber mattress should be used. Dust free environment is very important for a child.
  • Keep the pets away from the baby’s bed-room.
  • Stuffed toys should be kept out of the crib.
  • Preferably breast-feed your child. Chances of getting allergies is more in bottle-fed babies.
  • Boil the milk properly before giving.
  • Introduction of common allergenic foods such as eggs, wheat, fish, cocoa etc. should be delayed.


  • Dust collecting drapes, bedspreads, wool rugs and carpets should be avoided.
  • Avoid early introduction of soild foods in the diet.
  • Unboiled eggs should be avoided in diet before nine months of age and after that boiled eggs should be given.
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