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Asthma Flare-Ups in Children

When your child has asthma, the airways in his or her lungs are inflamed (swollen). This narrows the airways, making it hard to breathe. During an asthma flare-up (also called an asthma attack) the lining of the airways swells even more and makes extra mucus. This makes the airways even narrower. The muscles around the airways also tighten, making it even harder for air to get in and out of the lungs.

Outline of child with head turned to side. Trachea and lungs are visible. Closeup of cross section of normal airway showing relaxed muscle and smooth lining inside open airway. Closeup of cross section of airway with asthma showing tightened muscle, inflamed lining, and mucus building up inside airway.

What Causes Flare-Ups?

Flare-ups occur when the airways in a child with asthma react to a trigger. These are things that make asthma worse. Triggers can include smoke, scents and chemicals, pollen, pet allergies, mold, cockroaches, and dust mites. A flare-up can also be triggered by exercise, having a cold or the flu, and changes in the weather.

What Are the Symptoms of a Flare-Up?

Your child is having a flare-up if he or she has any of the following:

  • Trouble breathing

  • Breathing faster than usual

  • Wheezing (a whistling noise when breathing out)

  • Feeling tightness or pain in the chest

  • Coughing, especially at night

  • Trouble sleeping

  • Getting tired or out of breath easily

  • Has to take a breath between words when talking

What to Do During a Flare-Up

When your child is starting to have symptoms, don’t delay! If your child’s health care provider gave you an asthma action plan, it should tell you exactly what symptoms signal a flare-up in your child. It should also tell you what to do. This may include having your child do the following:

  • Use quick-relief (rescue) medication. This eases your child’s breathing right away by relaxing the muscles that have tightened around the airways.

  • Use a peak flow meter to check how severe the flare-up is. If peak flow is less than 50 percent, your child’s flare-up is severe. You need to call your child’s health care provider right away. You should also call 911 if your child is having any of the symptoms listed in the box below.

When to Call 911

Call 911 right away if you see any of the following in your child during a flare-up:

  • Very fast or hard breathing

  • Sucking in between the ribs and above and below the breastbone (this is known as retractions)

  • Being unable to walk or talk

  • Lips or fingers turning blue

  • Peak flow reading less than 50 percent of normal best

Preventing Flare-Ups

The key to preventing flare-ups in your child is to make sure his or her asthma is well controlled.  Follow the steps below:

  • Work together with your child’s health care provider. Controlling asthma takes teamwork. Keep any appointments your child has with the health care provider who is managing your child’s asthma. Don’t just make an appointment when your child has a flare-up. Stick to the asthma action plan you and the health care provider developed for managing your child’s asthma.

  • Keep your child’s airways open. Long-term controller medications, such as corticosteroids and other anti-inflammatory medications, help with this. They reduce airway inflammation. A child with asthma can have inflamed airways any time, not just when he or she has symptoms. So controller medications must be taken daily, even when your child feels well.

  • Spot and manage flare-ups right away. Learn to recognize your child’s symptoms and to act quickly. Teach your older child to recognize and treat his or her own symptoms as well. Follow the tips under “What to Do During a Flare-Up” as well as your child’s asthma action plan.

  • Control triggers. Helping your child avoid triggers is another key to asthma control. Spend some time to figure out what your child’s triggers are. Your older child can help with this by telling you about triggers you may not know about. Then take steps to control the triggers. For example, if you or someone else in the household smokes, it’s time to quit. Or go outside to smoke. To control dust mites, wash all bedding and stuffed animals once a week in hot water. And vacuum every week using a vacuum with a filter that can trap the smallest particulates possible. 


Online Medical Reviewer: Berry, Judith, PhD, APRN
Online Medical Reviewer: Hanrahan, Maura, MD
Last Review Date: 11/15/2012
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