- Your child is having an asthma attack
- Use this guide only if a doctor has told you your child has asthma
First Aid for Anaphylaxis – Epinephrine
- Anaphylaxis is a life-threatening allergic reaction.
- If you have epinephrine (such as Epi-pen), give it now.
- Do this while calling 911.
- Over 66 pounds (30 kg): Give 0.3 mg. Epi-Pen.
- 33-66 pound (15-30 kg): Give 0.15 mg. Epi-Pen Jr.
- Less than 33 pounds (15 kg): Give dose advised by your doctor.
- Give the shot into the upper outer thigh in the leg straight down.
- Can be given through clothing if needed.
- Albuterol inhaler: After giving the Epi-pen, give 4 puffs from your asthma inhaler.
- Benadryl: After giving the Epi-pen, also give Benadryl by mouth. Do this if your child is able to swallow.
- Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
- Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when your child is breathing out.
Causes (Triggers) of Asthma Attacks
- Infections that affect breathing (like colds or the flu)
- Animals (like cats)
- Tobacco smoke
- Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
- Asthma attacks caused by food allergy can be life-threatening
- Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard. (GREEN Zone: Peak Flow Rate 80-100% of normal rate)
- Moderate: SOB at rest. Speaks in phrases. Wants to sit (can’t lay down flat). Wheezing can be heard. (YELLOW Zone: Peak Flow Rate 50-80% of normal rate)
- Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. (RED Zone: Peak Flow Rate less than 50% of normal rate)
When to Call Us for Asthma Attack
Call 911 Now (your child may need an ambulance) If:
- Wheezing and life-threatening allergic reaction to similar substance in the past
- Starts to wheeze suddenly after taking medicine, an allergic food or bee sting
- Severe trouble breathing (struggling for each breath, can barely speak or cry)
- Passed out
- Lips or face are bluish when not coughing
- You think your child has a life-threatening emergency
Call Us Now (night or day) If:
- Your child looks or acts very sick
- Looks like he did when hospitalized before with asthma
- Lips or face have turned bluish during coughing
- Trouble breathing not gone 20 minutes after neb or inhaler
- Peak flow rate less than 50% of normal rate (RED Zone)
- Peak flow rate 50-80% of normal rate after using neb or inhaler (YELLOW Zone)
- Wheezing (heard across the room) not gone 20 minutes after using neb or inhaler
- Nonstop coughing not improved after using neb or inhaler
- Severe chest pain
- Need to use asthma medicine (neb or inhaler) more often than every 4 hours
- Fever over 104° F (40° C)
- You think your child needs to be seen urgently
Call Us Within 24 Hours (between 9 am and 4 pm) If:
- You think your child needs to be seen, but not urgently
- Mild wheezing lasts over 24 hours on treatment
- Sinus pain (not just congestion)
- Fever for more than 3 days
- Fever returns after gone for more than 24 hours
Call Us During Weekday Office Hours If:
- You have other questions or concerns
- Don’t have written asthma action plan from your doctor
- Use an inhaler, but don’t have a spacer
- Miss more than 1 day of school per month for asthma
- Asthma limits exercise or sports
- Asthma attacks wake child up from sleep
- Use more than 1 inhaler per month
- No asthma check-up in over 1 year
Parent Care at Home If:
- Mild asthma attack
Care Advice for Asthma Attack
What you should know:
- Over 10% of children have asthma.
- Your child’s asthma can flare up at any time.
- When you are away from your home, always take your child’s medicines with you.
- The sooner you start treatment, the faster your child will feel better.
- Here is some care advice that should help.
Asthma Quick-Relief Medicine:
- Your child’s quick-relief (rescue) medicine is albuterol or xopenex.
- Start it at the first sign of any wheezing, shortness of breath or hard coughing.
- Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
- Repeat it every 4 hours if your child is having any asthma symptoms.
- Never give it more often than 4 hours without talking with your child’s doctor.
- Coughing. The best “cough med” for a child with asthma is always the asthma medicine. (Caution: don’t use cough suppressants. If over 6 years old, cough drops may help a tickly cough.)
- Caution: If the inhaler hasn’t been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
- Use the medicine until your child has not wheezed or coughed for 48 hours.
- Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.
Asthma Controller Medicine:
- Your child may have been told to use a controller drug. Examples are inhaled steroids or cromolyn.
- During asthma attacks, keep giving this medicine to your child as ordered.
- For signs of nasal allergies (hay fever), it’s okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.
- Try to get your child to drink lots of fluids.
- Goal: Keep your child well hydrated.
- Reason: It will loosen up any phlegm in the lungs. Then it’s easier to cough up.
- If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
Avoid or Remove Allergens:
- Shower to remove pollens or other allergens from the body and hair.
- Avoid known causes of asthma attacks (such as smoke or cats).
- Do not take part in sports during the attack.
What to Expect:
- If treatment is started early, most asthma attacks are quickly brought under control.
- All wheezing should be gone by 5 days.
Call Your Doctor If:
- Trouble breathing occurs
- Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
- Wheezing lasts over 24 hours
- Your child becomes worse