Health Concerns: Asthma

For young sufferers and their carers alike, asthma can be a frightening condition to deal with, so it is important to be prepared, says charity Asthma UK…

Asthma affects tiny tubes in the lungs called airways which carry air in and out of the body. If a child has asthma then their airways are almost always red and swollen. When they come into contact with an asthma trigger (things like furry pets, cigarette smoke or pollen) their airways become narrower, making it harder to breathe. The condition varies in severity. Some children will experience an occasional cough or wheeze, while for others the symptoms will be much more severe. Children can usually control their asthma effectively by avoiding known triggers where possible and taking the correct medicines.

Asthma triggers

Everyone’s asthma is different so it’s important that you’re aware of what triggers asthma for the children at your nursery. Make sure parents let you know what their children are sensitive to as it’s a completely individual thing – for example, furry pets, ladies’ perfume and residual smoke on clothes can all be triggers for a child with asthma, so being aware of these and taking steps to avoid them is key.

Spacers and inhalers

Children who have asthma often take inhalers and will use spacers: large, plastic or metal containers, with a mouthpiece at one end and a hole for the aerosol inhaler at the other. Spacers only work with an aerosol inhaler and they help to deliver asthma medicine to the lungs, making inhalers easier to use.

There are two kinds of inhaler: a reliever and a preventer. Reliever inhalers are usually blue and are taken when the child needs them; they open up the airways to make it easier to breathe. For this reason it’s crucial that they’re easily accessible. Preventer inhalers are usually brown and need to be taken every day, even if the child feels fine, as they reduce the redness and swelling in their airways; these inhalers are likely to be taken at home. Some children may take their asthma medicines as tablets instead of inhalers or as well as inhalers – so it’s best to speak to their parents to find out about each child’s medicines, and to make a note of this so that all staff are aware.

The best way to prevent an asthma attack is to make sure the child with asthma takes their preventer inhaler regularly at home and to ensure that at the setting they’re always able to access their medicine, and that they avoid anything that they know might trigger their asthma.

Asthma attacks

Sometimes, no matter how careful someone is, they may still have an asthma attack. It can be difficult to tell when a child is having an attack, but the following may indicate a child is having trouble:

● They’re coughing, wheezing or appear to be short of breath.

● They might go quiet – a sufferer may appear to be fine but if they are quieter than normal it is worth checking to see if they are okay.

● They may complain that their tummy hurts (because they are unable to explain that their chest feels tight).

There are two serious signs that a child is having an asthma attack and that they need help immediately:

● They may be breathing faster than normal, so much so that they’re unable to speak in complete sentences or eat or drink anything.

● They’re using their neck or tummy muscles to breathe, or if they appear to be going slightly blue around their lips.

Remember that different children’s asthma will present itself in different ways, so it’s crucial that you ask parents to tell you how they recognise an attack and that this is noted down so that it can be referred to in an emergency. Small children can deteriorate very quickly so you must act quickly if you suspect they’re unwell.

In the event of an asthma attack, you should do the following:

● Keep calm.

● Encourage the child to sit up and slightly forwards; do not hug them or lay them down.

● Make sure they take slow, steady breaths and take two puffs of their reliever inhaler immediately, one at a time, preferably through a spacer device.

● Ensure tight clothing is loosened.

● Reassure the child.

● If there is no immediate improvement, continue to make sure they take two puffs of reliever inhaler, one at a time, every two minutes for up to 10 minutes or until their symptoms improve.

● Call 999.

Challenges

Early years practitioners need to work with parents to ensure that the way they manage and speak about asthma in their setting is the same as at the sufferer’s home, to give them consistency. Although practitioners are under continued pressure to give priority to all aspects of a child’s mental and physical health needs, it’s important asthma is identified and treated in the right way so that it doesn’t become a significant problem.

If possible, ask for written health information from the parents, ideally working with their GP or asthma nurse, so that you can all work together in terms of providing care and support to the child. Ask parents to demonstrate how their child uses their inhaler; some may sing a particular nursery rhyme when they administer the medicine, and knowing tips like that can make it easier for you to assist the child at your setting.

Be prepared

Have an asthma policy
An asthma policy can be a standalone policy or be incorporated into a health and safety policy, first aid or general health policy. It sets out your commitment to meeting the needs of children with asthma.

Have an asthma register
Know which children have asthma and talk with them and their parents to find out which inhalers they have to take and when. If a child has an asthma attack or needs their inhaler while in your care, always inform the person collecting the child.

Provide access to medicines at all times
Taking a reliever inhaler could mean the difference between a child needing to go to hospital or not, so make sure they’re accessible.

Be aware of triggers and warning signs
Asthma is a variable condition so make sure that you’re aware of any triggers that could make a child’s asthma worse, and that you know of changes in their medicines. Speak with their parents to make sure you’re both aware if their condition is getting worse.

Be prepared for an asthma attack
Knowing what to do will give you the confidence to maintain the safety of children in your care.

For more information, contact Asthma UK’s Advice line on 0800 121 62 44 or visit asthma.org.uk