A history of recurrent symptomsany one or a combination of coughing, wheezing, chest tightness or shortness of breathis the most important indicator of asthma in children. The diagnostic test for asthma in children five and older is spirometry, a pulmonary function procedure (breathing test) that measures the speed and amount of air moving in and out of the lungs. A home peak-flow meter performs a similar function.
"But in younger kids, we have to rely on symptoms," says William Anderson, M.D., an allergy and immunology specialist in Bellingham, WA. "Rapid breathing can be a sign of airway narrowing. If the child is breathing around 30 to 40 or more times a minuteit should be around 20 or 25 times a minutethat can indicate airway narrowing.
Parents can also examine their child's rib cage. If the child is having to suck harder to get air into the lungs, the ribs become more prominent. There's a retraction between the ribs, and that's a subtle sign of airway narrowing," he says.
Who's at Risk?
Studies suggest that family history plays a role. About 40 percent of children who have asthmatic parents will also develop asthma. The disorder is nearly 40 percent higher in African-Americans than in Caucasians. And more boys than girls have asthma, although the opposite is true in adults.
Kids with nasal and respiratory allergies or the allergic skin disorder eczema are also at particular risk. Respiratory infections, such as those caused by the RS virus, as well as wheezing associated with colds due to rhinovirus, can also foreshadow a future with asthma. Parents need to know the signs of asthma so that their child can be evaluated early on, before severe asthma develops. Talk to your doctor if you have concerns.
When to See a Specialist
It's wise to see a doctor, according to the AAAAI, if your child experiences asthma's classic warning signs: struggling to take a breath, coughing or wheezing at night or after exercise, or breathlessness that interferes with everyday activities.
A doctor's care is also in order when over-the-counter medicines don’t control allergy symptoms or lead to unpleasant side effects. Although pediatricians and primary-care doctors can often manage a child's asthma, sometimes guidance from a specialist, such as an allergist/immunologist or a pulmonologist, is best. "If a child has frequent visits to the ER or gets admitted to the hospital for asthma, that raises the bar of the asthma's severity," says Wisconsin's Dr. Chiu.