Asthma in the Child Care Setting

Asthma is a chronic breathing disorder and is the most common chronic health problem among children. Children with asthma have attacks of coughing, wheezing, and shortness of breath, which may be very serious. These symptoms are caused by spasms of the air passages in the lungs. The air passages swell, become inflamed, and fill with mucus, making breathing difficult. Many asthma attacks occur when children get respiratory infections, including infections caused by common cold viruses. Attacks can also be caused by:

• exposure to cigarette smoke,
• stress,
• strenuous exercise,
• weather conditions, including cold, windy, or rainy days,
• allergies to animals, dust, pollen, or mold,
• indoor air pollutants, such as paint, cleaning materials, chemicals, or perfumes, or
• outdoor air pollutants, such as ozone.

As with any child with a chronic condition, the child care provider and parents should discuss specific needs of the child and whether they can be sufficiently met by the provider. Some people believe that smaller-sized child care centers or family child care home environments may be more beneficial to a child with asthma because exposure to common respiratory viruses may be reduced. However, this has not been proven to be true.

Children with asthma may be prescribed medications to relax the small air passages and/or to prevent passages from becoming inflamed. These medications may need to be administered every day or only during attacks. Asthma medication is available in several forms, including liquid, powder, and pill, or it can be breathed in from an inhaler or compressor. The child care provider should be given clear instructions on how and when to administer all medications and the name and telephone number of the child’s doctor.

The child care provider should be provided with and keep on file an asthma action plan for each child with asthma. An asthma action plan lists emergency information, activities or conditions likely to trigger an asthma attack, current medications being taken, medications to be administered by the child care provider, and steps to be followed if the child has an acute asthma attack. Additional support from the child’s health care providers should be available to the child care provider as needed.

Most children with asthma can lead a normal life, but may often have to restrict their activity. Some preventive measures for reducing asthma attacks include:

• Avoiding allergic agents such as dust, plush carpets, feather pillows, and dog and cat dander. Installing low-pile carpets, vacuuming daily, and dusting frequently can help to reduce allergic agents. A child who is allergic to dogs or cats may need to be placed in a facility without pets.
• Stopping exercise if the child begins to breathe with difficulty or starts to wheeze.
• Avoiding strenuous exercise.
• Avoiding cold, damp weather. A child with asthma may need to be kept inside on cold, damp days or taken inside immediately if cold air triggers an attack.

If a child with asthma has trouble breathing:

1. Stop the child’s activity and remove whatever is causing the allergic reaction, if you know what it is.
2. Calm the child; give medication prescribed, if any, for an attack.
3. Contact the parents.
4. If the child does not improve very quickly, and the parents are unavailable, call the child’s doctor.
5. If the child is unable to breathe, call 911.
6. Record the asthma attack in the child’s file. Describe the symptoms, how the child acted during the attack, what medicine was given, and what caused the attack, if known.