Childhood Asthma

Childhood asthma is a chronic lung disease that causes the airways to become inflamed and narrowed, making it hard for children to breathe. Nearly 8 percent of children in the United States live with this condition, which can disrupt sleep, school, sports, and daily activities—but with proper treatment and management, most children with asthma can lead healthy, active lives.

Table of contents

• What is childhood asthma?
• How common is childhood asthma?
• Signs and symptoms
• What causes childhood asthma?
• Risk factors
• Common triggers
• How is asthma diagnosed in children?
• Treatment and management
• Living with asthma
• When to seek emergency help

What is childhood asthma?

Childhood asthma is a long-term lung disease that affects the airways—the tubes that carry air in and out of the lungs. When a child has asthma, these airways become swollen and inflamed, making them narrower than normal. Like a pinched straw, this makes it very hard to breathe.^[1][2]

During an asthma attack (also called an asthma flare-up or exacerbation), the airways react strongly to certain triggers. The muscles around the airways tighten, the lining swells even more, and extra mucus is produced. All of this blocks the flow of air, causing wheezing, coughing, chest tightness, and difficulty breathing.^[4]

Childhood asthma is not a different disease from asthma in adults. However, children face unique challenges because their lungs and immune systems are still developing. Most children who develop asthma show their first symptom by age 5.^[1][2]

While asthma cannot be cured, it can be controlled with proper treatment. With the right care plan, children with asthma can play, exercise, sleep well, and participate fully in school and other activities.^[1]

How common is childhood asthma?

Asthma is the most common chronic illness in children. It affects approximately 6 to 7.5 million children in the United States—about one in every 12 children.^[2][11] In some areas, including parts of Texas and urban regions, rates can be even higher, affecting 9 to 10 percent of children.^[19]

The rate of asthma in children has been steadily increasing. Between 1980 and 1994, the prevalence of asthma in children four years or younger increased by 160 percent. From 1980 to 1993, the death rate from asthma nearly doubled among young people aged 5 to 24.^[14]

Asthma is a leading cause of emergency department visits, hospitalizations, and missed school days. In the United States, it accounts for 3 million doctor visits, 570,000 emergency room visits, 164,000 hospital stays, and 10 million missed school days each year among children.^[14]

Certain groups of children are affected more severely. Black children in the United States are three times as likely to have asthma compared to white children, and they experience more severe disability, more frequent hospitalizations, and are four to six times more likely to die from asthma. Native American and Puerto Rican children also face increased risk.^[14]

Signs and symptoms

Not all children with asthma have the same symptoms, and symptoms can vary from one episode to another in the same child. Some children may have few day-to-day symptoms but experience serious asthma attacks occasionally. Others may have mild symptoms that get worse at certain times.^[10]

Common signs of childhood asthma include:^[1][2][3]

• Coughing, especially at night or early in the morning. In some children, cough may be the only symptom
• Wheezing—a whistling or high-pitched sound when breathing out
• Shortness of breath or rapid breathing
• Chest tightness or complaints that the chest “hurts” or “feels funny”
• Trouble sleeping due to breathing problems or coughing
• Less energy during play or physical activity
• Feeling weak or tired
• Retractions—when the skin between the ribs or at the neck sinks in when the child tries to breathe, showing they are working hard to breathe
• Irritability
• In infants, trouble feeding or grunting during feeding

Symptoms often get worse with certain triggers. You may notice your child’s asthma symptoms worsen at night or early morning, during physical activity, when they have a cold, when exposed to smoke or allergens, or during strong emotional reactions like crying or laughing.^[1][10]

It’s important to note that wheezing is not present in all children with asthma, and not all wheezing is caused by asthma. Some children may have a chronic cough as their only symptom. Young children may avoid sports or social activities, or they may slow down or stop playing due to fatigue.^[9]

What causes childhood asthma?

The exact cause of asthma is not fully understood. Researchers believe that childhood asthma develops from a complex interaction between genetic factors and environmental influences.^[2][3]

At the core of asthma is chronic inflammation—ongoing swelling and irritation of the airways. This inflammation makes the airways hyperresponsive, meaning they react strongly to things that wouldn’t normally cause problems. When airways are inflamed, they produce too much mucus, and the muscles around them can tighten suddenly, leading to asthma symptoms.^[4][14]

Asthma often develops during childhood when a child’s immune system is still maturing. Nearly half of all infants wheeze in their first year, but most will have their symptoms resolve. However, some children—particularly those with allergies, a family history of asthma, and persistent symptoms at a young age—may develop persistent asthma.^[4]

Risk factors

Several factors increase the likelihood that a child will develop asthma:^[3][8][9]

• Genetics and family history: Children are more likely to have asthma if one of their parents has it, especially if it’s the mother. Asthma tends to run in families
• Allergies: Children who have other allergy-related conditions such as eczema, hay fever, or food allergies are at increased risk. Having diagnosed allergies, including skin allergies or allergic rhinitis, is a strong predictor
• Exposure to tobacco smoke: Exposure to secondhand smoke when their mother is pregnant or when they are young children increases risk significantly. Smoke and vape exposure are the most common irritants for people with asthma
• Respiratory infections: Having frequent viral respiratory infections as young children, including frequent upper respiratory infections or colds
• Environmental factors: Living in areas with high air pollution, exposure to allergens such as dust mites, mold, or pet dander
• Obesity: Children who are obese are more likely to develop asthma, and their cases tend to be more severe
• Low birth weight
• Socioeconomic factors: Limited access to medical care, environmental irritants, and living conditions that negatively impact respiratory health

Researchers believe that several factors may be contributing to the increasing rates of asthma in children, including exposure to more allergens and air pollution, not enough exposure to childhood illnesses that help build immunity, and lower rates of breastfeeding, which provides important immune system support.^[2]

Common triggers

An asthma attack happens when a child is exposed to an asthma trigger—something that irritates the airways and sets off or worsens symptoms. Different children have different triggers, and the same child may react to multiple triggers. Identifying and avoiding your child’s specific triggers is an important part of asthma management.^[3][4]

Common asthma triggers include:

Allergens: Substances that cause allergic reactions are major triggers for many children with asthma. These can include:^[3][9]

• Pollen from grass, trees, and weeds
• Dust mites
• Mold
• Pet dander from cats, dogs, or other animals
• Waste from pests such as cockroaches and mice

Respiratory infections: Colds, flu, COVID-19, and other viral infections are common triggers. Upper respiratory tract infections can cause symptoms to worsen significantly.^[3][4]

Air irritants:^[3][19]

• Tobacco smoke and secondhand smoke
• E-cigarettes and vaping chemicals
• Outdoor air pollution
• Strong smells from cooking spices, cleaning products, or household chemicals

Weather and air conditions: Cold air, changes in temperature or humidity, and weather changes can trigger symptoms in some children.^[3][25]

Physical activity: Exercise or active play can trigger symptoms in some children. This is called exercise-induced asthma. Some children struggle with even mild exercise, while others only have trouble with vigorous activity.^[8][25]

Emotions and stress: Strong emotional reactions such as crying, laughing, or yelling can trigger symptoms. Stress can also make asthma worse.^[4][25]

Certain medications: Some medicines can worsen asthma symptoms in certain children.^[3]

How is asthma diagnosed in children?

Diagnosing asthma in children can be challenging, especially in young children. Many childhood conditions cause similar symptoms, and some children don’t have symptoms very often, so it may seem like they are just having frequent respiratory infections.^[3][12]

Before age 5, children often cannot complete standard breathing tests accurately. This makes diagnosis particularly challenging in infants, toddlers, and preschoolers, who also cannot describe how they feel. For these reasons, doctors must rely heavily on information from parents, caregivers, and observations.^[3][11]

To diagnose asthma, healthcare professionals use several approaches:^[3][12]

Medical history and symptom review: The doctor will ask detailed questions about your child’s symptoms—how often they occur, what they look like, what makes them better or worse, and what triggers them. They will also ask about family history of asthma or allergies, and about your child’s environment, including exposure to smoke or pets.

Physical examination: The doctor will examine your child, listening to their breathing and checking for signs of respiratory problems.

Lung function tests: These tests measure how well the lungs work. The most common is spirometry, which involves blowing forcefully into a tube to measure how much air flows through the lungs and how fast. Because asthma causes airways to be inflamed and narrow, children with asthma may have difficulty blowing out air forcefully. These tests are usually done in children age 5 and older, as younger children typically cannot perform them accurately.^[3][8]

Other lung function tests may include peak flow meters, exercise challenge tests, and FeNO testing (measuring nitric oxide in exhaled breath, which can indicate airway inflammation).^[4]

Allergy testing: If the doctor suspects allergies are triggering your child’s asthma, they may recommend allergy skin tests or blood tests. These can be done at any age and help identify specific allergens that may be making the asthma worse.^[3][11]

Chest X-rays or other imaging: These may be done to get a closer look at the lungs and rule out other conditions that could be causing symptoms.^[3]

Trial of asthma medicines: Sometimes doctors prescribe asthma medications to see how a child responds. Clinical improvement during treatment and worsening after stopping can help confirm the diagnosis.^[4]

For very young children, if symptoms recur frequently, a doctor may diagnose what is sometimes called reactive airway disease rather than asthma, as the final diagnosis may not be made until the child is older and more testing can be done.^[11]

Treatment and management

The main goals of asthma treatment are to control symptoms so children can breathe normally, sleep through the night, participate in all activities including sports, prevent asthma attacks, avoid emergency room visits and hospitalizations, and prevent permanent lung damage.^[10][16]

Asthma treatment involves several components working together:

Medications

There are two main types of asthma medications:^[13][25]

Quick-relief (rescue) medications: These are used when your child is experiencing symptoms or having an asthma attack. They work by quickly opening up the airways. The most common is albuterol, a short-acting bronchodilator that relaxes the muscles around the airways. These medications are usually given through an inhaler with a spacer device or through a nebulizer machine that turns liquid medicine into a mist.

Long-term control (controller) medications: These are taken regularly, usually daily, to prevent symptoms and reduce inflammation in the airways over time. Children with persistent asthma should be on controller medications. The most important are:

• Inhaled corticosteroids: These are the most effective long-term medications for controlling asthma. They reduce inflammation in the airways. Despite concerns some parents have, when used as prescribed, they are safe and effective for children
• Long-acting bronchodilators: These help keep airways open for longer periods and are often combined with inhaled corticosteroids
• Leukotriene modifiers: Medications like montelukast that help reduce inflammation and are particularly useful when allergies trigger asthma
• Combination inhalers: These contain both an inhaled steroid and a long-acting bronchodilator

For children with severe asthma that doesn’t respond well to standard medications, doctors may recommend biologics—specialized medications given by injection—or other advanced treatments.^[13]

The Asthma Action Plan

Every child with asthma should have a written Asthma Action Plan created with their healthcare provider. This plan is a personalized guide that tells you and others caring for your child exactly what to do each day to manage the asthma, and what to do if symptoms get worse.^[5][21]

The plan typically includes:^[16]

• What medicines to take and when
• How to recognize early warning signs of a flare-up
• What steps to take if symptoms worsen
• When to call the doctor or seek emergency help
• Your child’s known triggers and how to avoid them

The Asthma Action Plan should be shared with everyone who cares for your child, including family members, school staff, coaches, and babysitters.^[5]

Avoiding triggers

A crucial part of asthma management is identifying your child’s triggers and avoiding them as much as possible. This might include:^[19][21]

• Keeping the home smoke-free and avoiding all exposure to tobacco smoke and vaping
• Using protective covers on mattresses and pillows to reduce dust mites
• Washing bedding in hot water weekly
• Removing or reducing carpeting and stuffed animals in the bedroom if dust is a trigger
• Keeping pets out of bedrooms if pet dander is a trigger
• Using air filters and controlling humidity to prevent mold growth
• Staying indoors when pollen counts are high
• Making sure your child receives flu and COVID-19 vaccines, as these infections can trigger severe attacks

Monitoring and adjusting treatment

Asthma treatment often follows a stepwise approach. This means starting with the level of treatment needed to control symptoms, then adjusting up or down based on how well controlled the asthma is. Regular follow-up with your child’s healthcare provider is important to assess control and adjust medications as needed.^[16]

Living with asthma

With proper management, children with asthma can live normal, active lives. The key is learning as much as you can about asthma, following the treatment plan consistently, and working closely with your child’s healthcare team.^[21]

Physical activity and sports

Exercise is important for all children, including those with asthma. While physical activity can trigger symptoms in many children with asthma, with proper management, most children can fully participate in sports and other activities. In fact, aerobic exercise can actually improve lung function by strengthening breathing muscles.^[22]

Tips for exercising with asthma include:^[22][25]

• Give your child their asthma medicine before exercising if recommended by the doctor
• Have them warm up properly before intense activity
• Teach them to breathe through the nose rather than the mouth
• In cold weather, have them wear a scarf over their mouth and nose
• Watch for warning signs and encourage them to rest if needed
• Keep rescue medication readily available

School and daily life

Asthma should not prevent children from attending school and participating in activities. Work with your child’s school to ensure they understand your child’s needs. Provide the school with a copy of the Asthma Action Plan and ensure teachers, nurses, and coaches know what to do if your child has symptoms.^[5]

Children may miss school due to asthma symptoms or doctor appointments, but with good control, these absences should be minimal. If your child is frequently missing school, talk to their healthcare provider about adjusting treatment.^[19]

Will children outgrow asthma?

How asthma affects a child throughout their lifetime varies. Many infants and toddlers who wheeze when sick with viral illnesses do not develop asthma later in life. Some children have fewer symptoms as they get older, and some may even appear to outgrow their asthma. However, others continue to have symptoms as teenagers or adults.^[22]

Even if symptoms improve, the underlying tendency toward airway inflammation often remains. It’s important to continue following up with healthcare providers and being prepared to restart treatment if symptoms return.^[22]

When to seek emergency help

Severe asthma attacks can be life-threatening and require immediate medical attention. Get emergency help right away if your child has any of these warning signs:^[2][3]

• Severe coughing
• Rapid worsening of shortness of breath or wheezing
• Serious breathing problems or very fast breathing
• Trouble speaking or inability to speak in sentences
• Turning pale or bluish in the face, lips, or fingernails
• Increased respiratory rate even at rest
• Loss of consciousness
• Symptoms that do not improve with rescue medication

If your child has any of these symptoms, call emergency services immediately or go to the nearest emergency room. Don’t wait to see if symptoms improve on their own.

With proper diagnosis, treatment, and management, most children with asthma can control their symptoms and live healthy, active lives. Working closely with your child’s healthcare team, following the Asthma Action Plan, avoiding triggers, and taking medications as prescribed are the keys to keeping asthma under control and preventing dangerous attacks.