Following is a checklist of the signs of an impending attack or the worsening of mild symptoms in asthmatic children:
•Sleep disturbance: does your child wake up in the night coughing and wheezing?
•Does your child have a persistent cough?
•Is your child tired in the morning?
•Does wheezing or shortness of breath limit your child’s normal activities?
•Does your child have to use a bronchodilator frequently? According to Dr R., even the most vigilant parents can miss important signs in their asthmatic children:
The most caring parents often overlook the development of worsening symptoms, but parents of asthmatic children must make an effort never to take any symptoms for granted.
I’ll ask Jimmy’s parents how he is and they’ll tell me he’s fine, his asthma is okay. Then I’ll ask them specific questions and I’ll find out he’s been waking three nights a week with asthma, he’s fatigued in the morning and he’s short of breath after any exertion. Because Jimmy has been doing this on and off for years, his parents have become used to it and assume it’s a normal asthma pattern. They often tell me there is nothing new to report, yet the child is displaying quite disturbing symptoms. My specific questions often reveal poor management.
A common worry for parents with asthmatic children is that the child may be on too many drugs and that lasting side effects may occur. Most of the asthma drugs used today have little or no side effects. However, long-term doses of oral steroids can have side effects, so doctors do not prescribe them unless they feel steroids are essential in stabilizing symptoms. In many situations, the long-term side effects of severe, untreated asthma are more detrimental to a child’s health than those of the prescribed medication. If you are worried about your child’s medication, your doctor should be able to reassure you or suggest possible alternative medication.
It is normal for children with asthma to express frustration and resentment when their illness restricts their activities. Children can suffer anxiety when they are having an asthma attack, and some develop psychological problems associated with their asthma. Some asthmatic children become introverted and withdrawn, while others react to the disease by becoming irritable and demanding. A child with any sort of illness can be quite difficult to handle and can cause stress to develop in the rest of the family. Sometimes both parents and children need support and encouragement from their doctor and other health professionals. Unfortunately, some parents feel that if they need professional help in coping with the problems of a sick child, they are somehow admitting failure. Nothing could be further from the truth. By seeking professional advice, parents take positive action toward resolving problems that would probably get worse if they were allowed to continue.
Patricia found that her non-asthmatic daughter needed just as much special attention as did her two asthmatic sons:
I have two asthmatic children, aged four and six. I also have an elder child, aged 11. We have just been through a period where the two asthmatic children have been particularly bad. We have had the dashes to hospital, the daily sessions with the nebulizer and the constant interrupted nights. Both my husband and myself have been exhausted and stressed. While I thought I had managed a very hard time fairly well, I was terribly upset when I found our eldest child sobbing in bed one night. When I asked her what was the matter, she said that I had not told her that I loved her for weeks, that her father had not read her a story for ages and that she wished she had asthma. She was feeling very neglected and, I think, jealous of the attention the two sick children were getting. Later on, her teacher told me she had not tuned in earlier to her feelings, and we have taken time to explain how worried we have been about the younger two. We have involved her to a degree in our discussions about asthma and she now helps us when we administer medication to her brothers. We also make sure we give her some solo time. This can be difficult when you are tired, but it is obviously worth it. I think we have avoided what could have become quite a serious family problem.
Another parent, Charlotte, found the easiest way to get her son to accept his asthma was to introduce him to other asthmatic children:
My child hates using his puffer in public and suffers deeply when he has to pull out of his sporting activities because of wheezing. He has even fudged his peak flow meter readings so that I will let him go to soccer practice. He has developed a way of making the reading go up by jerking his head forward when he blows. We have had some very upsetting scenes when I have curtailed his activities because of his wheezing or one of his regular chest infections. He desperately wants to be like all the other kids, not having to do things like taking medicine before sport, or going on school camps with his portable nebulizer. His attitude has improved since he has matured and since we organized with the specialist, whom he likes, to have a talk to him about his asthma. We also sent him on one of the asthma holiday camps run by the Asthma Foundation. I think it was actually that experience which was the turning point. He realized there are lots of kids who get asthma and that he could be a lot worse. We still have the occasional scene, but he is generally coping well and is more positive about life.
A recent development in the care of asthmatic children is that more schools are becoming aware of the potential severity of the disease and are including asthma medications, such as Ventolin, in their first aid kits. The various Asthma Foundations have been very active in instructing teachers and other staff about how to deal with asthmatic children and what to do in an asthma emergency. As a further aid for teachers, the Asthma Foundations have produced a concise and informative pamphlet, What Every Teacher Should Know About Childhood Asthma.
In the past, many schools as well as individual teachers have been reluctant to become involved in the administration of any medication stronger than aspirin because of the potential legal implications if anything goes wrong. But it is now accepted that allowing a teacher to administer measured doses of a bronchodilator is not dangerous, even if the diagnosis of asthma turns out to be incorrect. Not all teachers have the willingness or the knowledge to become involved in any aspect of first aid, and this position should be respected by both parents and school administration. However, it is in the interests of everyone involved to ensure there are enough people on the school staff prepared to take control in the event of an asthmatic child needing attention.
Parents of asthmatic children should keep teachers up to date about their child’s asthma. All relevant details, such as medication dosages or changes in daily peak flow meter readings, should be recorded on the child’s record card. When a child is known to have asthma, be it chronic, intermittent or mild, the record card should be kept in a place that is readily accessible to all school staff members.
If your child’s school is reluctant to become involved in monitoring and treating asthma symptoms, don’t be afraid to push for changes in the school’s attitude. As Susannah, the mother of a 12-year-old asthmatic girl, reports, school staff’s awareness of asthma is vital to the proper care of asthmatic children:
My daughter is at a private school that until very recently refused to have any asthma medication in its infirmary. This same school had actually experienced an asthma death of a student a few years ago. Even though my asthmatic daughter is old enough and capable enough to carry her own medication, I felt very strongly about the school’s attitude. So did a number of other parents with asthmatic daughters, and eventually we persuaded the principal to invite a respiratory specialist to talk to the teaching staff. As a result, a number of teachers expressed interest in learning more about coping with an asthma emergency and now there is a bronchodilator in the sick bay.
This was all very positive, but there are still problems. Even after the specialist explained aspects of asthma to the staff, one of the sports mistresses forced my daughter to play sport even though my daughter was asthmatic at the time. This particular teacher even refused her permission to get her Ventolin from the classroom. This sort of incident really worries me. I think that asthma education within the community must improve. You would think one asthma death at the school would be enough to make the staff more aware!
This report is just one of numerous such stories from parents of asthmatic schoolchildren. However, the support and understanding for asthmatic children from schools and other teaching institutions has improved dramatically overall. Asthma is much more of a community issue than it was in the past and most schools are willing to participate in the management plan of their asthmatic students.
Current treatment for childhood asthma is safe and usually effective. Only a very small percentage of young asthmatics are unable to lead a normal, active life.
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Asthma
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