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Childhood Asthma

Know what to do

Priya Patel, MD
University of Pennsylvania

Asthma can interfere with so many parts of a child’s day — from playing to school to sleeping. And those irritating symptoms can sometimes turn into dangerous asthma attacks, leading to visits to the emergency room.

Although childhood asthma can’t be cured — symptoms may linger into adulthood — proper treatment can make asthma manageable and protect growing lungs. So, what do you need to know about childhood asthma?

What Is Asthma?

Asthma is the same condition in both children and adults — a chronic lung condition characterized by inflammation and tightening of the airways. The airways of those with asthma are more sensitive than the norm and can be triggered by a wide range of things. Triggers include such things as change in weather, cold air, hot weather, illnesses, strong smells, chemicals, pollen, animal dander, dust, mold, tobacco smoke and even activity.

When a person with asthma is triggered, their airways become inflamed and the muscles around the airways begin to squeeze. This leads to common symptoms such as difficulty breathing, chest tightness, wheezing and cough.

Testing and Diagnosis

It can be challenging to diagnose asthma in children younger than 6 because episodic wheezing and cough may be common and breathing tests can’t be performed at that age. But, some characteristic symptoms — recurrent cough that’s worse at night, reduced activity due to breathing symptoms, and personal or family history of other allergic conditions (eczema, hay fever, food allergies) — may suggest that asthma is an issue and should be investigated.

For children 6 and older, an asthma diagnosis is based on their clinical history and objective breathing tests, such as pulmonary function test, spirometry or peak expiratory flow (ask your healthcare provider about these). If the child responds favorably to chronic asthma therapies, that’s further support for the asthma diagnosis.

Treatments and Therapies

Asthma therapy at all ages typically consists of prescribing long-term medications to control the condition and using an inhaler to relieve symptoms.

Controller or maintenance medications are used to help control day-to-day chronic asthma symptoms and help reduce worsening symptoms. A reliever inhaler is used to help with acute symptoms, such as wheezing, chest tightness or cough.

Chronic controller medications include different types of inhalers. Your doctor may start with an inhaled corticosteroid, which helps reduce inflammation of the airways. If there’s no relief with this, typically a combination inhaler is used, which consists of an inhaled corticosteroid with a long-acting bronchodilator — the latter helps relax the muscle around the airways so the airways open up.

Other add-on maintenance medications to improve lung functions — such as long-acting muscarinic antagonists and leukotriene receptor antagonists — can be prescribed if first-line therapies alone are not effective.

New Guidelines and Therapies

Our latest national asthma guidelines now recommend a management approach for children 5 and older called SMART therapy — Single Maintenance And Reliever Therapy. This approach, which uses the same inhaler for both maintenance and reliever therapy, has been shown in studies to reduce asthma-related flareups and hospitalizations. Since only certain types of inhalers can be used for this approach, your child’s doctor can help decide which management plan is best.

There are also various injectable therapies that are now approved for moderate to severe or difficult-to-treat asthma in children 6 and older. An asthma care specialist can help prescribe these medications that target inflammatory proteins, which can then help reduce inflammation, asthma exacerbations and asthma-related emergency room visits and hospitalizations. Depending on the type of therapy, the injections are typically given every two to eight weeks. And many injectable therapies can be given at home by a caregiver after appropriate education.

In all cases it’s important to address other risk factors that can be modified when working to control asthma. For example, it’s essential to ensure inhalers are used appropriately. For younger children, using a spacer with mask can better ensure effective delivery of the inhaled medication to the child’s lungs.

If there are environmental triggers, it’s important to address those as well. It may be helpful to see an allergist to help pinpoint environmental triggers through allergy testing and discuss how to control the environment to help reduce triggers. Other chronic medical conditions such as sleep apnea, reflux, allergic rhinitis and eczema can also play a role in asthma management and should be addressed.

Visits to the Emergency Room

All patients with asthma and their caregivers should have a clear asthma action plan, which can help them recognize and respond to worsening asthma symptoms. The action plan may specify when and how often to use reliever therapy, when to reach out to the healthcare provider, and when go to the emergency room.

Some worsening asthma symptoms may safely be managed at the primary care provider’s office and may require only a prescription of an oral steroid. Other problems are best managed at an acute care facility.

At an acute care facility, such as the emergency room, the patient will be triaged and likely receive further reliever therapies using an inhaler or nebulizer, along with steroids. Other therapies or escalation of care may be needed depending on the severity of the symptoms. The decision to admit or discharge a patient is often based on their response to therapies, degree of respiratory distress and overall asthma risk factors.

It’s important to follow through with timely follow-up with the primary care physician or asthma care specialist after an emergency room visit to monitor symptoms, review the asthma plan and see if modifications are need.

Continuation Into Adulthood

Caregivers and clinicians should encourage adolescents and young adults with asthma to learn to manage their asthma, to help them transition from a pediatric to adult model of care. Preteens and teens should learn about their asthma, including their asthma medications, management and when to seek acute care. These steps will help them take ownership of their own health as they transition into adulthood.

Priya Patel, MD, is an assistant professor in pulmonary, allergy and critical care in the Perelman School of Medicine at the University of Pennsylvania. She serves as Associate Program Director for Penn Allergy/Immunology Fellowship and Codirector of the Asthma Program. Learn more at PennMedicine.org.

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Measles Is Back

How to keep your family safe

Lori Handy, MD, MSCE
Children’s Hospital of Philadelphia

You’re drinking your morning coffee and scanning the news. Your eyes catch a headline describing a case of measles confirmed in Pennsylvania. As you click into the article, you realize the article has listed the local urgent care clinic where you took your daughter over the weekend as a possible exposure location. You read more to learn about exposure risks and what to look out for in your child.

Families across the country have been having similar experiences all year, with over 150 cases of measles in the United States so far in 2024.

What Is Measles?

When many people hear about measles, they pause and think, “Which infection is that? I thought that wasn’t something to worry about anymore.” Even healthcare providers need a refresher as measles is relatively, and fortunately, uncommon now.

Measles is a highly contagious viral respiratory illness that can cause symptoms similar to a cold, such as runny nose, cough and fever. Additionally, people can develop red, watery eyes and small white spots in the mouth, known as Koplik spots. The hallmarks of the infection are fever and a distinct, blotchy red rash that appears three to five days after the other symptoms, starting at the hairline and moving down the body. Generally, this infection occurs in children, and they feel miserable.

So Why Worry?

Unfortunately, the complications from measles are quite serious, and the rate of hospitalization and death is much higher than a typical febrile illness. Of every 10 people who get infected, three are likely to have complications. People can get ear infections, pneumonia (where the virus infects cells of the lung and causes breathing problems), brain infections leading to seizures, blood clotting problems and, in extreme cases, death.

Before the introduction of the measles vaccine in 1963, almost 50,000 people were hospitalized annually, and 400 to 500 people would die. Most of these complications affected children.

Why is This Happening?

Scientists have been motivated to develop vaccines to reduce or eliminate infections from more worrisome diseases. Because of the severity of disease and the complications seen, measles was a top priority in the mid-1900s, when vaccine science was advancing rapidly.

The introduction of the measles vaccine in 1963 transformed measles from a common childhood illness to a relatively nonexistent problem in the U.S. in recent years. This is the result of widespread vaccination. Vaccination was so effective that by 2000, the U.S. was considered to have eliminated measles — meaning that we had a 12-month period without continuous spread of the virus.

Unfortunately, recent reduced vaccination rates have put that elimination status at risk. We need at least 95% of the population to be vaccinated to prevent spread in our communities.

While a rare, imported case brought into the country by an international traveler is to be expected, spread within the U.S. population should be preventable when we maintain the required level of protection.

In 2024, many of the measles cases that appear in the news were secondary cases in individuals not vaccinated for measles, although many of those affected were eligible for the vaccine.

Why Are Some Children Not Vaccinated?

There are a few reasons. Some members of the population can’t be vaccinated — infants under 1 year old or people with certain medical conditions like immune system problems. And rarely, the vaccine might not work.

But more often, people are not vaccinated by choice due to rising misinformation and vaccine hesitancy. Families should always keep in mind that children who do not receive vaccines are at increased risk of suffering from a vaccine-preventable disease. If your friends and family are not vaccinated, talk to them about measles and encourage them to reach out and talk with their doctor.

Keeping Your Family Safe: Vaccination

There is some reassuring news. The most important thing you can do to prevent your family from contracting measles is make sure all children and adults in your household are up to date on their recommended vaccinations — all of them.

One dose of the measles vaccine protects up to 93% of people; with a second dose, protection is around 97%. Parents can be reassured that studies have long confirmed the safety of the MMR vaccine (measles, mumps and rubella). Concerns about vaccines causing autism have been addressed by dozens of scientific studies, showing that children who receive vaccines are at no greater risk for developing autism than those who do not receive vaccines.

Because measles is highly contagious, it’s also important for parents to take precautions with children who are either too young to be vaccinated or who can’t get the vaccine for medical reasons, particularly when there is an outbreak in your region. During periods when outbreaks are not occurring, it’s safe to run normal errands with your baby. Just be sure to practice the usual precautions to keep your child from getting sick: Don’t allow strangers to hold or play with your baby; keep your child away from anyone with a fever, cough or other respiratory symptoms; and make sure you and your family wash your hands regularly.

If you think you’ve been exposed to or infected with measles, contact your healthcare provider. They can advise you on precautions to take to avoid potentially exposing others as you seek medical care.

Traveling Internationally

While we are seeing outbreaks in the U.S., measles is even more prevalent internationally. This means before your summer trip abroad, make sure everyone in the family is up to date on vaccines.

While it’s generally recommended for children to receive the MMR vaccine at 1 year of age, if you’re traveling internationally, the MMR vaccine is recommended for children 6 months and older at least two weeks before international travel to countries or regions with ongoing measles transmission.

Before your next trip, check your destination and the CDC’s global travel notices.

Lori Handy is the associate director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. She actively treats children with infectious diseases and works to educate healthcare providers and the public about vaccines and vaccine-preventable diseases. More at CHOP.edu.

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Protecting Kids from Whooping Cough

Cases have tripled recently

Jennifer Vodzak, MD
Nemours Children’s Health

As we break from the heat of summer, the rise in the spread of germs continues to increase the likelihood of colds and other illnesses. It’s likely that parents will hear the familiar percussion of coughs as they prepare to drop their children off at school or go about their daily routine.

Fortunately, many of these cough illnesses are mild and resolve quickly. But families should recognize that when an ordinary cough worsens, it could be a sign of whooping cough (pertussis), an infection of the respiratory system caused by Bordetella pertussis bacteria.

The Centers for Disease Control and Prevention (CDC) published data earlier this year reporting nearly three times as many cases of whooping cough in 2024 than in 2023. As we see more of this illness in our communities, parents can take steps to prevent whooping cough, recognize its symptoms and have a plan to find treatment if needed.

What Is Whooping Cough, and Why Is It Called That?

Whooping cough is a respiratory system infection that primarily affects infants under 6 months old who haven’t yet received full immunization and older children (11 to 18 years old) whose immunity to pertussis decreased naturally over time, as expected. Young infants are particularly at risk to get a more severe illness because they typically don’t receive their first dose of tetanus-diphtheria-acellular pertussis (DTaP) vaccine until they’re 2 months old. Fortunately they do gain additional protection with two more shots before their first birthday.

This illness is known as “whooping cough” because of the unsettling “whooping” sound that infected older children, teens and adults often make when they gasp for air at the end of a coughing fit. Infants and young kids also develop coughing fits, but may not have that distinctive “whoop” sound with their cough illness.

Signs and Symptoms

At first, the symptoms of whooping cough are like those of a common cold — a runny nose, mild cough, low-grade fever and sneezing. But after one to two weeks, the dry, irritating cough changes into coughing spells that can last for more than a minute.

In addition to making the characteristic whooping sound while breathing, a child may turn red or purple for a few seconds and feel the need to vomit due to the forceful feeling from coughing. Unlike many cough illnesses, the coughing spells with pertussis can last for one to three months. The coughing will become less intense and occur less frequently over time, and symptoms will slowly resolve.

If these symptoms are present or you suspect your child has whooping cough, call a doctor for advice and an evaluation. Consider emergency care if your child is seriously ill, such as having difficulty breathing or is less responsive. The doctor will ask about medical history and perform an exam, and may take nose and throat mucus samples to be checked in a lab. Blood tests and a chest x-ray may also be done.

Treating Whooping Cough

Doctors treat whooping cough with antibiotics. It’s thought antibiotics work best to shorten the length of the infection when taken early in the illness, before coughing spells begin. But even when they’re started later, antibiotics are important to stop the infection from spreading to others.

Whooping cough can be life threatening for infants younger than 6 months, who often need hospital treatment. Babies and younger children are more likely to be hospitalized because they’re at greater risk for problems like pneumonia. Other possible complications include trouble breathing, periods of breathlessness, needing oxygen (particularly during coughing spells) and dehydration. In the hospital, children may need suctioning to clear their airways. Medical professionals will monitor their breathing closely and provide oxygen if needed. A child who shows signs of dehydration or has trouble eating might get intravenous (IV) fluids.

Parents can play an active role in their child’s whooping cough treatment by following the schedule for giving antibiotics exactly as prescribed. Standard cold medicines, however, will not be effective. Many cough medicines can inhibit recovery as even the strongest products will not ease the coughing spells of whooping cough — in fact, the cough is the body’s way of trying to clear the airways. Also, cough medicines are not recommended for children under 6 due to potential side effects.

During recovery, children should rest in bed and use a cool-mist humidifier to help soothe irritated lungs and breathing passages. Homes should be kept free of irritants that can trigger coughing spells (aerosol sprays, smoke). Kids with whooping cough may vomit or not eat or drink much because of the coughing, but parents should offer smaller, more frequent meals and encourage drinking lots of fluids. Watch for signs of dehydration, such as thirst, irritability, restlessness, lack of energy, sunken eyes, a dry or sticky mouth and tongue, dry skin, crying without tears and fewer trips to the bathroom to pee (or fewer wet diapers for infants).

Preventing Whooping Cough

As cases of whooping cough increase, the pertussis vaccine — part of the DTaP immunization — can help prevent it. DTaP immunizations are routinely given in five doses before a child’s sixth birthday. Some immunity naturally fades as children get older, so for added protection, it’s recommended that kids ages 11 to 18 get a shot of the combination booster (called Tdap), ideally when they’re 11 or 12.

Getting the vaccine is especially important for people who have close contact with infants. An adult’s immunity to whooping cough lessens over time, so when adults get vaccinated, they’re also protecting infants and children from the infection. Families should consult their doctor to discuss recommended timelines and any special considerations for receiving the pertussis vaccine.

Whooping cough is contagious and is spread by droplets from coughing, sneezing and having a runny nose. People with pertussis are most likely to spread infection in the first one to three weeks of illness and are less contagious after completing a course of antibiotics. People who live with or have close contact with someone infected should also get antibiotics to prevent whooping cough’s spread, even if they’ve already been vaccinated against it.

Families can take action today to prevent whooping cough from affecting their family and their wider community. To learn more about whooping cough and other topics related to children’s health, behavior and development from before birth through the teen years, visit KidsHealth.org, which has doctor-reviewed advice on hundreds of topics, easy-to-follow articles, slideshows, videos and health tools designed to help families learn, grow and be their best.

Jennifer Vodzak, MD, is a pediatric infectious diseases physician in the Division of Infectious Diseases at Nemours Children’s Hospital, Delaware for clinical care. She also serves as Medical Director for the Antimicrobial Stewardship Program at the hospital’s campus. Dr. Vodzak has contributed to numerous publications, presentations, committees and projects in pediatric infectious diseases, informatics, patient safety and quality improvement. Nemours.org.