Signs of asthma in children

Is your child’s cough or wheeze a sign of asthma? Symptoms to look out for

Coughing and wheezing are both common symptoms experienced in babies and young children, and are usually caused by a viral infection such as a cold. These symptoms are also common signs of asthma, but as children can have up to 8 colds a year, it can make it harder for parents to know when to speak to a doctor.  

Dr Jane Heraghty, consultant in respiratory and general paediatrics at Evelina London Children’s Hospital, shares the signs and symptoms of asthma to look out for, to ensure your child can get diagnosed and treated sooner.  

What is asthma in children?

Asthma is the most common long-term condition of childhood, with 1 million children in the UK affected. Symptoms include coughing, wheezing and shortness of breath, and often begin early in life, with many developing signs before the age of 5.

Although asthma is medically the same condition in adults and children, it can affect children differently. It can disrupt school attendance, disturb sleep, make it harder to play with friends and take part in sports and physical activities.

In some cases, the condition can lead to dangerous asthma attacks if symptoms are not well controlled – it’s one of the top 10 reasons why children attend A&E each year.

“There is no cure for asthma, but with the right treatment, your child’s symptoms can be kept under control, helping to protect their lungs as they grow and develop,” says Dr Heraghty.

Why coughing and wheezing doesn’t always mean asthma

Coughing and wheezing are both common in babies and young children and are usually due to a viral infection, such as a cold. Young children can have as many as 8 colds in a year, as their immune system is still developing.

When your child has a cold, mucus can run down their throat, triggering a cough to clear it. Chest infections can result in wheezing as young children have smaller airways that are prone to narrowing when inflamed or congested.

Children under 5 can also experience a ‘preschool wheeze’, which is very common with 30 to 40% of this age group affected. In addition to infections, a preschool wheeze can be triggered by air pollution, cigarette smoke and allergies.

In most cases, a preschool wheeze disappears as children grow – about 80% of children no longer have it by age 10. However, 1 in 3 children with preschool wheeze will get diagnosed with asthma by age 6.

What are the symptoms of asthma to look out for?

As coughing and wheezing are so common during childhood infections, it can be difficult for parents to know when these symptoms may be a sign of asthma rather than repeated colds.

Coughing or wheezing is more likely to be a sign that your child has asthma if:

• symptoms last longer than 3 weeks
• symptoms won’t go away or keep coming back
• wheezing occurs without other symptoms of a cold
• there is a regular dry cough
• symptoms are triggered by exercise (or after running around), breathing in cold air or laughing
• coughing or wheezing is worse at night or early in the morning
• your child also feels breathless
• symptoms are triggered by allergens like pollen, dust mites, pets or pollution

“If you’re worried that your child may have asthma, it’s important to speak to a doctor. An early diagnosis means we can put them on the right treatment plan sooner to help manage their symptoms. With their asthma under control, your child can take part in all the activities they enjoy again,” explains Dr Heraghty.

What can cause asthma in children?

The exact cause of asthma is unknown, but some risk factors can make it more likely for your child to develop the condition. These include:

• a family history of asthma (genetics)
• having allergies, such as hay fever
• being born underweight or prematurely (before 37 weeks)
• exposure to cigarette smoke

How asthma is diagnosed in children

It can be hard to diagnose asthma in children, particularly if they are young. Also, some children may not always experience symptoms of asthma very often, so the condition can be confused with lung infections instead.

Our paediatric lung specialists use a range of non-invasive tests to diagnose asthma. These include:

• spirometry – a type of lung function test which measures how much air your child breathes out in one forced breath
• FeNO test – this measures the amount of nitric oxide in your child’s breath, which shows how much inflammation is in their airways
• allergy tests – if we suspect your child’s asthma is due to an allergy, we may refer them for an allergy test

Some lung function tests like spirometry may not be suitable for children under 5 as they require specific breathing techniques they may not be able to do. Instead, our specialists may recommend starting asthma treatment, without testing, to see if their symptoms get any better.

How asthma is treated in children

“The goal of asthma treatment for children is to get their symptoms under control, so they can return to normal activities,” says Dr Heraghty.

All children with asthma need to take both a:

• steroid preventer inhaler – this helps prevent inflammation in their airways
• bronchodilator reliever inhaler – this helps open their airways quickly if they have symptoms or an asthma attack

These may be provided as 2 separate inhalers, or a combined inhaler. A combined inhaler is only suitable for children over 12, but our specialists may provide the treatment ‘off-license’ if they feel your child may benefit from it.

Depending on your child’s condition, they will receive one of the treatment plans below:

• AIR (anti-inflammatory reliever) therapy – where a combination of the inhalers are used as needed when your child gets asthma symptoms
• MART (maintenance and reliever) therapy – where they will need to use the combination of inhalers every day to help prevent symptoms, as well as when they get symptoms

If your child’s asthma is due to an allergy, we will also recommend a strategy to avoid triggers, if possible.