How to Know If Your Child Has Asthma

While 80% to 90% of asthmatics are diagnosed in early childhood, an asthma diagnosis can sometimes be tricky to make. "How do I know if my child has asthma" is a common question from parents in the winter when wheezing illnesses are more common.

Symptoms to Look For

Young children cannot tell you they feel bad, they are wheezing, and may have mild or infrequent symptoms. Any child with one or a combination of the following symptoms or risks is at increased risk of asthma:

  • Cough: Could be constant or infrequent. A cough is often worse at night.
  • Wheezing: the high pitched sound that you normally hear on expiration
  • Chest tightness: Children may complain of their chest hurting. They may also describe a squeezing or fullness that occurs with exercise or activity.
  • Tiredness: May not perform normal activities or keep up with siblings/other children. Consider if your child gets more tired than children of a similar age or if they seem to have problems at physical education or other activity.
  • Sleeping problems: Frequent awakenings due to breathing or coughing can be a sign of asthma. Be especially mindful of sleep problems. Some parents do not hear a nighttime cough, wheezing, or other symptoms. Poor sleep may be the only clue.
  • Shortness of breath and fast breathing: Depending on your child's age they may not be able to describe shortness of breath and you may just need to watch them for this or some sort of exercise intolerance.
  • Infants: May struggle to feed and you may hear grunting. Poor feeding is especially important to monitor.
  • Older children: May avoid activities due to difficulty breathing or fatigue. It is especially important to see how kids in this age group perform compared to their peers. They may tell you they do not have symptoms and may not say they are decreasing their activity level due to poorly controlled asthma.
  • Family history: In terms of the genetics of asthma, you are at an increased risk of asthma if the parents or siblings of a child have asthma. As many as 50% of asthma cases can be linked to a genetic predisposition. However, unlike other diseases where identification has lead to a possible treatment, there are not currently any gene-based therapies for asthma.
  • Allergic disease such as eczema or atopic dermatitis: Many cases of asthma have an allergic component. These skin diseases identify you as having allergic tendencies that could also be related to asthma.

If your child has any of these symptoms, you may want to discuss asthma with your healthcare provider. Asthma can sometimes be difficult to diagnose as the symptoms mentioned above can occur in diseases other than asthma. Your doctor will take a history, perform a physical exam, and them may order tests such as a chest x-ray, peak flow, or pulmonary function test. Alternatively, your doctor might just give you a therapeutic trial and see if your symptoms resolve with treatment.

Can You Do Anything to Prevent Asthma?

While controversial, breastfeeding may lower your baby's risk of developing allergy problems and subsequently asthma. Food avoidance during pregnancy does not appear to alter your child's risk of developing allergies.

Attendance at daycare, while often a subject of angst for new moms, may actually decrease the risk of development of asthma. The mechanism is likely early exposure proposed in the Hygiene Hypothesis where exposure to bacteria and viruses in early life may protect the immune system.

Diet interventions for the prevention of asthma are mixed. Increased intake of fruits and vegetables is a good dietary habit that may also help prevent allergic disease. However, eating omega-3 fatty acids found in fish are the only dietary intervention that has regularly demonstrated a benefit in preventing asthma.

Unfortunately, not all that wheezes is asthma. Your child could have a variety of conditions such as an upper respiratory tract infection or some other condition that may have wheezing associated with it. Patients with cystic fibrosis may wheeze but will usually have poor growth, cough, and shortness of breath in addition to wheezing as a symptom. Gastroesophageal reflux disease or GERD may also lead to symptoms, especially at night. Regurgitation, frequent heartburn, and water brash or a sour taste in the back of your mouth may indicate that you have GERD impacting your asthma.

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