Warning signs of an asthma attack in children

Asthma attacks are scary – especially for children and their parents. Asthma is the most common chronic disease in children. According to the Centers for Disease Control and Prevention (CDC), an estimated 1 in 12 children in the U.S. has asthma and 1 in 2 children with asthma have an asthma attack each year.

"During an asthma attack, you have trouble breathing," says Folashade Afolabi, M.D., Pediatric Pulmonologist at Children's Health℠ and Assistant Professor at UT Southwestern. "The main pipes that lead to the air sacs in your lungs start to twitch, contract and swell, making it difficult to get the air out and breathe. The body then starts to wheeze and cough – as a way to force air out of your lungs."

The good news is asthma can be well-controlled. Read on to learn the warning signs of asthma attacks in children, how to help and ways to prevent asthma flare-ups in the future.

What causes or triggers asthma attacks?

Anything that causes inflammation in the body can trigger an asthma attack. Common asthma triggers in children can include:

• Viral respiratory infections (colds, flu, RSV)
• Outdoor allergens (such as pollen, grass, weeds, bugs, rodents)
• Indoor allergens (dogs, cats, dust, dust mites, mold)
• Tobacco smoke
• Air pollution
• Exercise
• Stress and anxiety
• Rapid changes in weather – from cold to hot or hot to cold

"Rapid weather changes can cause inflammation. When your muscles get a little cold and seize up, the muscles in your airways tighten and cause bronchospasm," says Dr. Afolabi.

What does an asthma attack look like in a child?

Sometimes it's tricky to identify the early signs that your child is having an asthma attack. Your child may have itchy, watery eyes, a stuffy nose and not be as active as usual.

More obvious signs of an asthma attack in children include:

• Cough
• Shortness of breath
• Tightness in the chest or throat
• Wheezing

"We almost always say watch for a cough. But it might not be that hard, barking, wheezing cough," says Dr. Afolabi. "It might be a mild cough."

Can children have asthma attacks while sleeping?

It is possible for children to have asthma attacks at night. Overnight asthma flare-ups signal that your child's asthma is not well-controlled.

"When a child coughs, wheezes or displays other asthma symptoms while sleeping, the child is at higher risk of having problems with their asthma," says Dr. Afolabi.

Dr. Afolabi recommends following "the rules of two" for talking to your doctor about changing your child's asthma care plan or medications.

"If your child coughs and wheezes and needs albuterol 2x a month during the night, or 2x a week during the day, we need to change your child's asthma medicine or take additional steps to improve the asthma and prevent flare-ups," she says.

What should you do if your child is having an asthma attack?

If your child is having an asthma attack, first sit your child down, and make sure they look stable and their color is OK.

"When children are having trouble breathing, it's important they sit in a calm, quiet environment to relieve their anxiety," says Dr. Afolabi. "Asthma attacks are scary, and anxiety makes it worse."

If your child has already been diagnosed with asthma, their doctor has probably prescribed two types of asthma medications:

• Controller medicine, which is taken daily to control the asthma
• Reliever medicine, which opens the airways and gives your child quick relief of asthma symptoms (The most common reliever medicines are called albuterol or levalbuterol.)

When your child is having an asthma flare-up, give your child the reliever medicine. You should see asthma symptoms improve within a few minutes. For some children, it may take up to 30 minutes.

What should you do if a child has an asthma attack and does not have an inhaler?

If a child is having an asthma attack and does not have an inhaler, don't borrow someone else's inhaler medicine. You don't know what the medicine actually is or whether it's clean or expired. Remain calm and take the child to a medical facility as soon as possible. You can go to your pediatrician's office, urgent care or a hospital – wherever your child can be seen most expediently.

When should you take a child to the hospital for asthma?

If a child with asthma is unable to breathe or speak in complete sentences or if the child's skin changes color, call 911 or go to the hospital immediately.

Signs your child is having an emergency and needs to be assessed at the hospital include:

• Child's nose is flaring in and out
• Child's ribs are sucking in deeply

In cases like this, your pediatrician's office may not have all the medicines needed to help your child.

How to prevent asthma attacks

To prevent asthma flare-ups from happening in the first place, make sure your child takes the prescribed controller medicine as directed. This is the medicine that controls the inflammation and tightness of the airways.

"Most children with an asthma diagnosis, especially those with moderate to severe asthma, take their controller medicine every day, sometimes twice a day," says Dr. Afolabi.

If your child has allergies, take steps to help your child avoid exposure:

• Relocate dogs and cats
• Clean, dust and vacuum your house well
• Use a high efficiency filter in your vacuum
• Change air filters regularly
• Keep your child indoors when the air quality is poor, and the pollen count is high

If you teach children how to take their asthma medicine on a regular basis and avoid triggers, it's very possible for them to live a normal, active life.

Download the Asthma Buddy app

For around-the-clock management of asthma symptoms and medications, download the Asthma Buddy App. Text "ASTHMA" to 77-444 to download. Currently available to download on the Apple App Store or through Google Play.

Message frequency varies. Message and data rates may apply. See our Privacy Policy and Terms of Service.

Reply STOP to opt out of texts and reply HELP for help.

Learn more about caring for asthma

At Children’s Health, we offer expert care for the entire spectrum of asthma, from low risk to high risk. Learn more about our asthma program and services and see more resources for managing asthma in children.