Asthma attack (asthma suddenly gets worse)

If your child’s asthma suddenly get much worse (asthma attack), they will require urgent treatment. Signs of an asthma attack include:

  • Sounding very wheezy
  • Having a tight chest
  • Finding it hard to breath
  • Being too breathless to speak is a sign of a severe asthma attack and needs emergency treatment

Sometimes there is no obvious cause for your child’s asthma attack, but the most common triggers are viral infections (coughs, colds and chest infections), sudden changes in the weather and exposure to cigarette smoke.

If you are concerned about your child’s symptoms please see when should you worry below.

Related topics: bronchiolitis, cough and colds, Covid-19, difficulty breathing

For more information on how to beat asthma please visit the Beat Asthma website qrcode_www.beatasthma.co.uk (2).png 

   

 

 

When should you worry?

If your child has any of the following:

  • Too breathless to talk / eat or drink
  • Has blue lips
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite 10 puffs blue (salbutamol) inhaler every 4 hours
  • Breathing very fast or breathing that stops or pauses
  • Working hard to breathe, drawing in of the muscles below the rib, unable to talk or noisy breathing (grunting)
  • Becomes pale, blue, mottled and/or unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched, continuous cry or extremely agitated
  • Has a fit (seizure)
  • A temperature less than 36oC or temperature 38oC or more if baby is less than 3 months
  • Develops a rash that does not disappear with pressure and seems unwell (see the 'Glass Test')
Ring 999 immediately for help. Give 10 puffs of blue (salbutamol) reliever inhaler every 10 minutes until ambulance arrives

Keep child in upright position and reassure them

 If your child has any of the following:

  • Blue (salbutamol) inhaler 2-5 puffs via a spacer is not lasting 4 hours
  • Cough or wheeze/tight chest during the day and night
  • Too breathless to run/play/do normal activities
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips, tongue or looking pale
  • Not had a wee or wet nappy in last 12 hours
  • Sleepy or not responding normally
  • Crying and unsettled
  • Not drinking
  • A temperature 39oC or above in babies 3-6 months
  • Temperature of 38oC or above for more than 5 days or shivering with fever(rigors)
  • Getting worse or you are worried about them

 

Immediately contact your GP and make an appointment for your child to be seen that day face to face

Increase blue (salbutamol) reliever inhaler 6-10 puffs every 4 hours

We recognise that during the current COVID-19 crisis, at peak times, access to a health care professional may be delayed. If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, then consider taking them to your nearest Emergency Department

If your child has none of the above:

Watch them closely for any change and look out for any red or amber symptoms

Additional advice is also available for families for help cope with crying in otherwise well babies

Self Care

Give 2-5 puffs blue (salbutamol) reliever inhaler every 4 hours until symptoms improve

Carry on looking after your baby or child at home. If you are still worried about your child , ring NHS 111 or visit 111.nhs.uk

 

This guidance has been reviewed and adapted by healthcare professionals across North East and North Cumbria with consent from the Hampshire development groups.

Children with poorly controlled asthma are much more likely to have an asthma attack compared to children's whose is well controlled.

Signs of poorly controlled asthma include

  • your child having a regular cough at night (nocturnal cough),
  • being wheezy or more breathless than other children when they run around or
  • using their reliever inhaler more often than expected. 

Arrange to see your GP or asthma nurse if they are experiencing such symptoms.

 

 

My child is having an asthma attack - Beat Asthma

See the next block further information. For more details and videos encouraging children to use their inhalers effectively visit Beat Asthma website.

 

It's really important to help your child use their inhalers properly as their asthma will not be controlled if their medicines are not getting into their lungs.


 

Choose appropriate sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath).

  1. Shake the inhaler well and remove cap
  2. Fit the inhaler into the opening at the end of the spacer
  3. Place mask over the child's face or mouthpiece in their mouth ensuring a good seal
  4. Press the inhaler once and allow the child to take 5 slow breaths or slow count to 10 between ease dose
  5. Remove the inhaler and shake between every puff. Wait 1 minute between puffs

Repeat steps 1-5 for subsequent doses.

Plastic spacers should be washed before 1st use and every month as per manufacturer's guidelines.

For videos on using your child's inhaler and spacer correctly vist Beat Asthma and select video from the top menu. 

Futher guidance:

Managing my child's asthma - Beat Asthma (see how to use my child’s inhalers)

Asthma medicines information - Beat Asthma

See your practice nurse or doctor if you are not sure whether your child is using their inhaler properly.

 

Avoid triggers where possible:

Although it is extremely difficult to avoid your child getting a viral infection or experiencing changes in the weather, you can reduce exposure to common irritants such as cigarette smoke. Even where adults smoke away from their children, smoke on their clothes and hair is likely to make their child’s asthma worse

Your child should have an influenza immunisation every autumn (the flu jab)

Not only can flu trigger an asthma attack in your child, your child is more likely to experience severe influenza if they have asthma. Protect them by having them vaccinated every year

Managing my child's asthma - Beat Asthma (see smoking and air pollution)

What should you do?

If your child has asthma symptoms or at the start of cold symptoms, you should seek medical advice according to our red/amber/green table above. At the start of cold symptoms (such as runny nose), begin your child on blue (salbutamol) reliever inhaler 2 puffs 4 hourly (including through the night). This can be increased to up to 10 puffs at a time if your child’s symptoms are still significant. If your child is requiring increasing amounts of blue inhaler you should seek medical advice according to the table below.

Treatment over the next few days

Over the next few days, your child will need to be regularly given a blue (salbutamol) reliever inhaler. This can be increased to up to 10 puffs at a time if your child’s symptoms are still significant. if your child is needing increasing amounts of their blue inhaler more often, seek medical advice. Have a look at our red/amber/green chart above  to see who would be the best person to contact and where would be best to take place to take your child to be seen

Where can I get more information on my child’s asthma?

The Beat Asthma website has a wide range of useful resources on asthma for children and families. 

Where should you seek help?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Click below to find information on your local health visiting team: 

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

The school nursing service delivered may vary depending on your local area offer. Click the link below to find information on your local school nursing team: 

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:-

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand – watch this video with them about going to A&E or riding in an ambulance
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