Live Interactive Chat

Answers to Questions (Transcript)

April 7, 2003

Caring for Children with Asthma

Janette Hoffman
Child Care Nurse Consultant
Child Care Resource Service
University of Illinois at Urbana-Champaign and Macon County Health Department

See also: Biography and Related Resources

IELmoderator
Greetings, IEL Chat participants. Welcome to our IEL Chat on "Caring for Children with Asthma." To get started, let me introduce our guest speaker, Janette Hoffman, who is a Child Care Nurse Consultant with the Child Care Resource Service of the University of Illinois at Urbana-Champaign and the Macon County Health Department.

Janette Hoffman
This Chat session will focus on caring for children with asthma in the child care setting. Areas for discussion will include an explanation of this chronic breathing disorder, possible asthma triggers, asthma and emergency action plans, use of medications and treatment equipment, and communication between the parent, caregiver, and health care provider.

IELmoderator
The procedure for the live Chat session is as follows. Participants can send questions to the Chat guest at any time. When you send your question, please note that it will not be visible to all Chat participants. The IEL Moderator receives the question first and will post it to the whole Chat group. If there's a long queue of questions, the Moderator will notify the questioner that the question was received. Then, at the next break in the discussion, the question will be posted for all to see and for our guest to answer.

Note that there will be a pause after a question is posted while the Chat guest speaker composes a response to the question. So please be patient! During these pauses, the Moderator will post occasional information about the IEL Web site. Because some Chat participants enter the Chat in the middle of the session, some of these messages may be posted more than once.

Questions will be posted in the order they're received, unless there's some obvious reason to group similar questions together. Participants may send follow-up questions. If you do send a follow-up question, please remind the Guest and other participants of the earlier question (something like "In my earlier question about the third-grader's reading difficulty") because it's easy to forget earlier questions in the long list of questions that occur during the Chat session.

If your question is not answered by the time the Chat session ends at 8 p.m., the question and its answer will be included in the Chat transcript that will be made available online approximately 3 weeks from today.

Now let's begin our Chat. Ms. Hoffman, we have a question that we received in advance of the session.

Do you think that asthma in children is increasing, and, if so, why?

Janette Hoffman
According to the Centers for Disease Control and Prevention, asthma affects nearly 5 million children under 18 years of age in the United States. From 1980 to 1998, the incidence of asthma nearly doubled. The reasons for this increase are not fully understood. Most medical professionals believe it is a combination of several of the following theories: earlier and more accurate diagnosis; effects of indoor environmental pollution in energy-conserving homes with less ventilation; the increasing amount of time children spend indoors, which results in an increased exposure to indoor asthma triggers that may affect the immune system; and increased rates of childhood obesity, which increases asthma risk.

SandyShine
Is summer the worst time of year for asthma? It seems like my child really gets sick during this time. Is there a reason for that?

Janette Hoffman
SandyShine, really every asthma sufferer is different. Summer may very well be the worst time if one of the triggers is pollen and molds due to humidity. This would be an area to explore with your physician or allergy specialist.

IELmoderator
The transcripts of the IEL Chat sessions from 2002 and earlier in 2003 are archived on the IEL Web site. Go to the IEL Chat page at http://illinoisearlylearning.org/Chat.htm, then scroll down the page to the section called "Past Chat Sessions." For each Chat in that section, you'll see a link for "Chat transcript." Click on that link to view the transcript for that particular Chat Editor's note: This url has changed: http://illinoisearlylearning.org/askanexpert.htm#pastchat.

Tonight's Chat session is the fourth of 2003. The first Chat session was on the topic of "Handling Challenging Behaviors in Child Care and at Home: Autism," with Alyson Beytien. The transcript of this Chat session is available on the Chat page at http://illinoisearlylearning.org/Chat/beytien/trans.htm.

The second Chat of 2003 was on the topic of "Handling Challenging Behaviors in Child Care: Aggression and Anger in Young Children," with Mary Louise Hemmeter. The transcript of this Chat session is available on the Chat page at http://illinoisearlylearning.org/Chat/hemmeter/trans.htm.

The most recent Chat was on the topic of "Encouraging Literacy Development in Infants and Toddlers," with Marsha Glick. The transcript of this Chat session was just uploaded to the Web site this afternoon. It is available on the Chat page at http://illinoisearlylearning.org/Chat/glick/trans.htm.

liz
I heard allergies have a lot to do with asthma.

Janette Hoffman
liz, about 80% of children with asthma have allergies. Having allergies increases the number of triggers causing asthma episodes. However, not everyone with asthma has allergies, certainly, nor does everyone with allergies develop asthma.

IELmoderator
Note that IEL Chat transcripts are also available in Spanish. The English transcripts listed above are currently being translated. To find IEL Spanish Chat transcripts (Trasuntos de Chateo), go to the Spanish Chat page at http://illinoisearlylearning.org/askanexpert-sp.htm#pastchat.

liz
If you smoke when you are pregnant, does it mean your child will have asthma?

Janette Hoffman
liz, good question! Research has shown that the risk of the child developing asthma is definitely increased with women who smoke during pregnancy.

liz
Yes, because I have a little girl in my class who just went to the doctor, and they said that is what is triggering it.

YMCA Infant/Todd
How soon should parents be looking for signs that their child might suffer from asthma? Would RSV be a sign?

Janette Hoffman
YMCA Infant/Todd, no, RSV is a viral infection, not a sign of asthma. It is very difficult for physicians to diagnose asthma in infants and toddlers.

IELmoderator
You can find additional resources on "Caring for Children with Asthma" in the supplement to this Chat session. This supplement is available on the IEL Web site at this URL: http://illinoisearlylearning.org/Chat/hoffman/sup.htm.

ronoboy
What about exercise-induced asthma that seems to only occur seasonally, primarily in the fall? Should my 5-year-old be receiving year-round treatment? When he has problems, we use the albuterol mistreatment, but we don't do anything the rest of the year.

Janette Hoffman
ronoboy, I cannot give diagnosis and treatment suggestions since that is up to your physcian to evaluate.

SandyShine
My friend claims that her child had asthma but grew out of it. Can you "grow" out of asthma?

Janette Hoffman
SandyShine, excellent question! NO. Asthma is a chronic condition in which the lungs always have some level of inflammation. For the most part, as boys get older, their symptoms decrease. As girls get older, their symptoms increase. Also, asthma sufferers gain better control of their asthma symptoms but it never goes away.

IELmoderator
As mentioned earlier, Janette Hoffman, RN, BSN, is a Child Care Nurse Consultant. She services Champaign, Macon, Douglas, and Piatt counties in Illinois. She is employed through the Macon County Health Department and housed at the Child Care Resource Service in Urbana, Illinois, under funding from the Healthy Child Care Illinois (HCCI) campaign and the Healthy Child Care America program.

The main goal of the Child Care Nurse Consultant program is to build strong connections between child care providers, parents, and child health experts to increase the health, safety, and quality of care received by children in Illinois. Janette has 25 years of pediatric experience and has been in her current position for one-and-a-half years.

Nettie
Is it true that a child with asthma who gets chicken pox can get very ill?

Janette Hoffman
Nettie, any child with a chronic illness who then gets a viral illness on top of it will have more difficulty with symptoms and the disease. Receiving a chicken pox vaccine will keep this risk to a minimum.

Cindy Lou
What is the largest trigger of an asthma attack?

Janette Hoffman
Cindy Lou, first it is preferred that you call it an "asthma episode" instead of an "attack." There are several, but the most common are smoke, animal dander, dust mites, mold, and, believe it not, cockroaches!
(IEL Editor: Return to lillsis question.)

Lisa
I was surprised to find that infantile eczema is usually a precursor to asthma. This happened with an infant in my care.

Janette Hoffman
Lisa, yes, there is a correlation between any type of allergy or immune system condition and asthma.

IELmoderator
Remember that the IEL Web site is available not only in English but also in Spanish. The Spanish home page is at http://illinoisearlylearning.org/index-sp.html.

QiQi
Can asthma only be treated with medication, and can kids outgrow it?

Janette Hoffman
QiQi, yes, medication is imperative to the treatment of asthma. Maintenance medicine is used to decrease the inflammation in the airways and make them less reactive to triggers. Rescue medicine opens the airways in acute asthma episodes. I feel I have already answered your second question.

lillsis
Are there any main things that can trigger a young child with asthma to have an attack?

Janette Hoffman
lillsis, I feel this has been answered in my previous response.
(IEL Editor: Go to previous question and answer.)

liz
Why can't they test children before the age of 5 for asthma?

Janette Hoffman
liz, children younger than the age of 5 can be diagnosed, but it is difficult because some of the respiratory tests cannot be conducted with children this young.

Nancy
The doctor said my son has diminished lung capacity. Will he outgrow this?

Janette Hoffman
Nancy, you need to investigate this with your physcian and get a better definition of exactly what this means.

liz
Are there different types of asthma -- such as physical, and so on?

Janette Hoffman
liz, yes, there is a certain type of asthma called "exercise-induced asthma" in which increased physical activity is the only trigger for an asthma episode.

lillsis
When at school, what would be a trigger of an episode? As a teacher, what should I be aware of?

Janette Hoffman
lillsis, there are many different triggers. As a teacher, you should talk with the parents about what the specific triggers are for that child in that class. Signs to look for in an asthma episode include the following: chronic coughing, stopping an activity to catch breath, complaints of shortness of breath, wheezing or difficulty speaking, and complaints of chest pain.

IELmoderator
IEL has additional Chat sessions scheduled for May and June. You can view the Chat schedule on the Chat page: http://illinoisearlylearning.org/chat.htm Editor's note: This url has changed:http://illinoisearlylearning.org/askanexpert.htm#pastchat. The next scheduled Chat is Tuesday, May 6, 2003, from 7 to 8 p.m. Central Time. The Chat topic is "Encouraging Literacy Development in Preschoolers." The guest speaker will be Jodi Scott, Early Childhood Consultant with the Regional Offices of Education #27, #28, and #49.

In June, IEL will host a Chat on "Best Practices for Infant and Toddler Care" with Debbie Trouth, Associate Director of the Child Development Laboratory at the University of Illinois at Urbana-Champaign. This Chat is scheduled for Thursday, June 19, 2003, from 7 to 8 p.m. Central Time.

helper
Why is asthma increasing so much?

Janette Hoffman
helper, good question; however, the answer is truly unknown. There are a couple of theories: better diagnosis, higher rates of childhood obesity, effects of higher indoor pollution (because homes are so "tight" with less ventilation), and more time indoors with possible exposure to indoor asthma triggers which may affect the immune system.

IELmoderator
You can find additional resources on "Caring for Children with Asthma" in the supplement to this Chat session. This supplement is available on the IEL Web site at this URL: http://illinoisearlylearning.org/Chat/hoffman/sup.htm.

Ms. Hoffman, here's a question we received via email from Mark.

What is the role of the school/day care environment in helping a child with asthma? What can one do if you suspect that your child's asthma is being exacerbated by a poor indoor environment? What is the responsibility of the school or day care provider?

Janette Hoffman
Mark, it is an excellent question with a lengthy answer that will be posted within the next several weeks to the Chat transcript. A Web site you may want to check out is http://www.schoolhealth.org/bulletin.html.Editor's note: This url has changed:http://www.schoolhealth.org/article.cfm?contentID=23

QiQi
Do you think that asthma poses greater problems for early childhood education professionals?

Janette Hoffman
QiQi, in what way?

QiQi
Having to watch children more carefully, or having to administer meds during the day.

Janette Hoffman
QiQi, children whose asthma is appropriately managed should not require a great deal of management as opposed to children who do not have asthma. It is important to have an "asthma action plan" in place for any child in your care. This plan will be fully explained in the transcript for this Chat.
(IEL Editor: See action plan below.)

liz
My doctor told me they can't. That is what I heard from other parents in my center, too.

Janette Hoffman
liz, can you please clarify your question?

liz
What can we do as parents and care givers to help these children with their asthma? I don't want to leave these children out of activities.

Janette Hoffman
liz, their activities should not have to be severely modified, except occasionally, when they may have an upper respiratory infection or during occasions when they are having difficulty with a particular trigger. I do want to say that if you have a child who seems to require constant activity modification, his or her asthma is not being appropriately controlled. Children with asthma should be able to participate in any activity that other children participate in.

liz
Are we supposed to leave children out of physical activities because we don't want the activities to trigger their asthma? How can we help them so their asthma doesn't trigger?

Janette Hoffman
liz, children with exercise-induced asthma need to pre-medicate before the physical activity and monitor themselves with a peak flow meter. More explanation of this device will be in the transcript for this Chat.

liz, also, about 10% of Olympic athletes have asthma.

IELmoderator
Besides the resources found at the URL listed above, you can find information about asthma in an ERIC Digest from the ERIC Clearinghouse on Urban Education: Supporting Students with Asthma at http://www.ericfacility.net/databases/ERIC_Digests/ed438339.html Editor's note: This url has changed:http://www.ericdigests.org/2000-4/asthma.htm.

Information on asthma intended for parents can be found in a recent issue of Parent News, the news magazine of the National Parent National Information Network (NPIN). See the article "Asthma and Children" from the Fall 2002 issue of Parent News at http://npin.org/pnews/2002/pnew902/int902a.html Editor's Note: this url is no longer active.The National Parent Information Network was discontinued on December 31, 2003. As a result, this resource is no longer available.

YMCA Infant/Todd
Any recommendations for staff working in summer camps or summer day care centers where they might not know if a child is having an "asthma episode"? Is it strictly a child breathing heavily (out of breath), and is there something a common joe can do to help? Like the breathing into a paper sack or head between the legs thing?

Janette Hoffman
YMCA Infant/Todd, this involves a long answer that will be included in the transcript, but PLEASE DO NOT have them breath into a paper sack or have them put their heads between their legs. Both of these could make an asthma episode worse.

Cindy Lou
What is it about cockroaches that can cause an asthma episode?

Janette Hoffman
Cindy Lou, actually breathing in the cockroach droppings that end up in dust seems to be a common trigger.

Nettie
I don't have asthma in my family, but there is so much of it at my son's school. Parents of children with asthma are saying we should try to keep our children home from school if they have a cold because it is so bad for the child with asthma. With a cold lasting sometimes a week, how can kids afford to miss that much school?

Janette Hoffman
Nettie, the best way to prevent viral respiratory infections is to teach your children good handwashing technique.

helper
I have 2 kids with asthma, 2 with ADHD, and one with diabetes in my class of 4-year-olds. The problem for me is that, even with an aide, I worry I'll miss something going on with one of these children, not to mention the "teachable moments" that I'm probably missing with these kids. Any advice for a harried teacher?

Janette Hoffman
helper, wow! What a busy group! As far as the children with asthma, watching for their activity level is most important because children that age will first stop playing when they are having difficulty breathing.

IELmoderator
Ms. Hoffman, here's a question we received prior to the Chat.

Does pollution in urban areas affect the incidence of asthma in children?

Janette Hoffman
Actually, the level of air pollution in the U.S. has decreased, and, in general, our environment is less toxic than it used to be. Even though pollution is known to trigger asthma episodes in those who already have the disease, some countries with dirtier air have lower rates of the disease. The incidence of asthma is higher in urban areas, but there has been no cause-and-effect relationship between pollution and asthma established.

IELmoderator
Ms. Hoffman, here's our next question.

What steps should a care provider take when a child has an asthma episode?

Janette Hoffman
Basic Asthma Management:

1. STOP all physical activity.
2. If possible, remove the child from exposure to the known asthma trigger.
3. Assist the child into an upright position and encourage the child to remain calm.
4. Ensure that prescribed medications are given according to the asthma action plan, and allow the medication time to take effect.
5. Look for improvement in symptoms. The medication used during the episode should be a rescue medication.

If any of the following occur, start the Emergency Action Plan:

1. No improvement or relief from medication is noted after 15-20 minutes (or time period specified by the primary health care provider in the action plan).
2. Peak flow monitoring indicates less than 50% of personal best.
3. Retractions -- skin sucking in at the neck area or space between the ribs with each breath.
4. Posturing -- hunching over to breathe.
5. Child has difficulty walking or talking or is unable to speak.
6. Lips or fingernails turn blue or gray.

Emergency Action Plan:

1. Administer emergency medications specified in the action plan.
2. Notify emergency services or call 911.
3. Notify parent, guardian, or emergency contact.
4. Continue to keep the child in an upright position and to calm him or her.

(IEL Editor: Return to Qiqi's question.)

IELmoderator
Ms. Hoffman, here is our next question.

What is a peak flow meter? How can this be used to help prevent asthma episodes?

Janette Hoffman
It is a small meter that records the velocity at which the air exits the lungs. The speed at which the air leaves the lungs is called the peak expiratory flow (PEF) or peak flow. After moving the indicator to zero, the child takes in a deep breath, places the mouthpiece into his/her mouth and with lips kept tight around the mouthpiece blows the air out as rapidly as possible. The procedure should be repeated three times (if feasible) and the best effort recorded in the daily log.

Peak flow monitoring should be performed as recommended by the child's primary health care provider until the personal best baseline is determined and then daily as directed. Successful asthma management relies upon daily peak flow monitoring to accurately adjust medications and activities.

Children as young as age 4 can be taught to use a peak flow meter, and a meter should be available for monitoring at day care, preschool, and school. The peak flow meter will indicate narrowing of the airways in the lungs before any symptoms are felt or observed so that, if indicated, appropriate treatment can be started early to help prevent asthma episodes.

Treatment decisions and action plans are based upon zones derived form the child's personal best peak flow value. This personal best may change over time and should be reassessed periodically by the health care provider. A variety of peak flow monitoring devices are available with a physician's prescription at pharmacies or durable medical equipment stores.

liz
I have heard that if a child is having an asthma attack, you're supposed to take him or her outside in the cold during the winter.

Janette Hoffman
liz, each child has different triggers. Cold air actually can make an asthma episode worse in some children, so it is important to check with the parents (if you are a teacher) as to what, specifically, helps their child during an episode.

IELmoderator
What are the signs that an asthma episode is an emergency that requires immediate medical attention?

Janette Hoffman
All symptoms should be taken seriously and treated immediately with appropriate medication. All children with asthma should have an Asthma Action Plan developed with their primary health care provider. The plan details all necessary information, such as medications the child should take and when to take them, what to do in an emergency, and emergency contacts and phone numbers. Studies have shown that people with written action plans had reduced emergency room visits and hospitalizations and improved lung function.

Peak flow recording and understanding what to do when an asthmatic is in a specific zone is crucial to management. When a child is in the Red Zone on the action plan, immediate medical attention is required. This usually occurs when medication has been given several times, activity stopped, and there is little or no improvement in symptoms or peak flow level. The action zones are as follows:

Green Zone	GO
	Peak flow is 80-100% of personal best
	Proceed with normal activities and continue daily medications.
Yellow Zone	CAUTION
	Peak flow is 50-79% of personal best and coughing, wheezing, and shortness of breath may be present.
	Step up medications as prescribed and reduce activities as indicated.
Red Zone	STOP
	Peak flow less than 50% of personal best and posturing, retracting, difficulty speaking, or fingernail beds or lips turning blue/gray may be present.
	Restrict activities and call 911 or go to the emergency department.

Susan SL
Apart from albuterol, what are some other rescue medications?

Janette Hoffman
Susan SL, there are all types of albuterol. There is a medication called Pirbuterol which is in the same family of medications. These all dilate the airways.

You may want to visit http://www.lungusa.org/asthma/ Editor's note: This url has changed: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33276 for information on asthma.

Susan SL
Can frequent use cause these medications to work less effectively?

Janette Hoffman
Susan SL, this is a question you should pose to your physician.

IELmoderator
Remember, too, that if your question wasn't answered during the Chat, it will appear in the transcript along with a response. And you may send a question at any time to the IEL staff. Just email your question to iel@uiuc.edu or call us at (877) 275-3227 between 8 a.m. and 12 p.m. and between 1 p.m. and 5 p.m. on business days.

liz
Are these steroids or not? I know my son has been on steroids for asthma.

Janette Hoffman
liz, yes, most maintainence asthma medications are a type of steroid that decreases the inflammation in the lungs and makes them less reactive to triggers. There usually are few systemic side effects on the rest of the body because most of the medications are inhaled and the effects are only on the lungs.

liz
Are steroids better for asthma, or are the breathing machines?

Janette Hoffman
liz, this a complicated question because there are both steroids and bronchodilators that can be used in nebulizers (breathing machines).

IELmoderator
Now we'll bring our Chat session to a close. There are a few unanswered questions that will appear in the Chat transcript.

Thank you, Chat participants, for your interesting questions and also for your patience in waiting for responses. Please join us for IEL's next Chat.

Once again, this Chat is scheduled for Tuesday, May 6, 2003, from 7 to 8 p.m. Central Time. The Chat topic is "Encouraging Literacy Development in Preschoolers." The guest speaker will be Jodi Scott, Early Childhood Consultant with the Regional Offices of Education #27, #28, and #49.

Janette Hoffman
I enjoyed this Chat. Thank you for participating.

IELmoderator
Thank you, Janette Hoffman, for sharing your time and expertise with us tonight. Thanks again to all of tonight's Chat participants, and have a good evening.

Additional Questions

Question
How can a parent or a care provider recognize asthma in a child? Does the child always have wheezing?

Janette Hoffman
The primary symptoms of an acute asthma episode include intermittent coughing, wheezing, shortness of breath, and chest tightness. In some children, a cough may be the only symptom, and a persistent cough is the biggest red flag for asthma in kids. Some people with asthma never wheeze! All respiratory symptoms should be taken seriously and should be evaluated by a physician.

It is very important to recognize and have asthma diagnosed early to start appropriate treatment to help prevent permanent lung damage and emergency asthma episodes. Michael Welch, M.D., editor-in-chief of the American Academy of Pediatrics Guide to Your Child's Allergies and Asthma (Villard, 2000), states that four or more episodes of wheezing before a child's third birthday usually indicates the disease. Half of all children with asthma develop their first symptoms by age 4, but symptoms can start at any age.

Question
Should children with asthma play vigorously or take part in active games and sports?

Janette Hoffman
Children whose asthma is properly controlled should have no limits on activity levels. About 10% of Olympic athletes have asthma. Children who have been diagnosed with exercise-induced asthma (EIA) will need to pre-treat with medication before physical activity and need to closely monitor their peak flow measurements before, during, and after exercise. The key is monitoring peak flow is to assess if their asthma is well controlled. Many people who don't monitor peak flow measurements and have very mild or no symptoms can quickly get into trouble with an acute asthma episode while exercising because their lungs were compromised before the activity and they weren't aware of it.

Obviously, children with asthma may occasionally need to avoid participating in an activity if it will expose them to a known asthma trigger or if they are currently compromised with a respiratory infection. The American Lung Association and the Consortium on Children's Asthma Camps sponsor about 100 asthma summer camps throughout the U.S. with an emphasis on education to prevent limitations on activity levels. More information can be obtained at http://www.asthmacamps.org.Editor's note: This url has changed:http://www.asthmacamps.org/AsthmaCamps/index.asp?topic=consortiumhome

Question
What are the four categories of asthma, and how does this categorization affect care?

Janette Hoffman
The classification of asthma is based on the frequency and severity of asthma symptoms, and physicians prescribe medications accordingly. Physicians usually step up or step down therapy based on the child's response to medications. The peak flow level is the percent of predicted normal, which differs for each child and needs to be established at the start of treatment.

Category	Days with symptoms	Nights with symptoms	Peak Flow
Mild intermittent	twice weekly or less	twice monthly or less	80% or better
Mild persistent	twice weekly or more	3-4 times monthly	80% or better
Moderate persistent	daily	5 times monthly or more	50-80%
Severe persistent	continual	frequent	50% or less

Question
What steps can a child care provider take to make his/her program more "asthma friendly" for children?

Janette Hoffman
It is important to minimize any asthma triggers in the day care environment as much as possible. The setting should be free of tobacco smoke; cockroaches; mold; pets with fur or feathers; plants with high pollen levels; and strong odors from art supplies, perfumes, or cleaning products.

The provider should be aware of local pollen counts, ozone alerts, and weather with high humidity levels or very cold air. Dust mites should be minimized with the use of washable area rugs or uncarpeted floors, frequent vacuuming of carpet and upholstery with a HEPA air filter-equipped vacuum cleaner, frequent damp dusting, and frequent laundering of blankets and pillows. Maintaining good ventilation in the setting is important.

There should be a written asthma action plan with an emergency plan for each child with asthma. The plan should state clear actions to take and when and whom to call. Communication between the parents and child care provider is very important. The plan needs to be updated appropriately. A written medication administration policy is required with a medication administration form stating prescribed medications, dosage, and timing signed by the parent and physician.

All staff should receive education about asthma, observing for signs and symptoms, medication administration, and emergency actions. Medication must be available at all times, including during field trips and outdoor play. Children should be able to carry their own rescue asthma medicine when appropriate. Children should always be supervised when taking asthma medicines and monitored for correct inhaler and peak flow meter use.

All of the children in the program should receive education about asthma and how to help a classmate who has it. There should be alternative or modified activities available for children with asthma when medically warranted.

It is helpful to have a medical or nurse consultant available to help the staff write policies, develop guidelines, and educate about working with children who have asthma. The state of Illinois has 24 Child Care Nurse Consultants through the Healthy Child Care America program who are available as resources to child care providers throughout the state.

Question
What are some ways to explain an asthmatic episode to young children, both to the child who is having the episode and to those who witness it?

Janette Hoffman
It helps to teach children about breathing and that everyone breathes, even when they aren't thinking about it. Then, explain that children with asthma sometimes have trouble breathing and they cough and wheeze when this happens.

Having children breath through a pinched straw helps to give them some idea of what breathing during an asthma episode feels like. It is important to stress that children with asthma can run and play just like other kids if they take their medicine and see their doctor regularly.

Children can learn to help their friends with asthma when they have trouble breathing by telling them to sit down and stay calm and then going to get help. Stress that the medicine for the child with asthma is only for that child and should not be touched by others. It helps to show all the children the different devices used to give the medicine and how they work.

It is important to explain about allergies and things that may trigger asthma episodes and why the child with asthma may need to stay away from certain things. There are many books and videos available to help with this education and several have been listed in the resource section.

Question
What kinds of information should a provider solicit from a parent before enrolling a child with asthma and as the provider continues to care for a child with asthma?

Janette Hoffman
The most important information is to have a written asthma action plan that includes the child's name; parents' names, address, and phone number(s); physician's name, address, and phone number(s); and all emergency phone numbers. The plan should include the Green-Yellow-Red Zone plan of care, all medications, how much medication to take, when to take medication, peak flow values for each zone, and a list of triggers and allergies for the specific child.

The parent needs to provide all medication and equipment that the child may require during child care, along with instructions on correct usage. There should be daily communication between the parents and the provider, especially when activities need to be modified, and a plan to update the asthma action plan as needed.

Question
Can asthma in infants and toddlers be confused with other common illnesses or diseases?

Janette Hoffman
Diagnosis of asthma must be done by a physician and can be difficult to identify in infants and toddlers because the warning signs of asthma can mimic less serious ailments, such as respiratory infections. Wheezing and coughing are common in this age group because their airways are naturally narrow.

There is also a genetic risk for asthma. If either parent has asthma or allergies, the child is more likely to develop the disease.

Some things that parents can do to help decrease their child's chance of developing asthma are breastfeeding for at least 6 months or longer, decreasing their child's exposure to dust mites, preventing all exposure to cigarette smoke, limiting contact with pets if their child is allergic to them, and helping their child maintain a healthy weight.

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