One of the main goals of parents whose kids have asthma is avoiding trips to the emergency room (ER) for breathing problems. But it's also important to know when going to the ER is the right choice.
You'll be better prepared to make that decision if you discuss it with your child's doctor before your child has a severe flare-up. The doctor's instructions should be included in your child's asthma action plan, which also will list peak flow meter readings or specific symptoms that are your cue to go to the ER. If old enough, your child also should know what these signs are.
When to Seek Help
Some general signs that indicate you should seek help very quickly by getting to the doctor (or if the doctor isn't available, going to the ER or calling an ambulance) include:
- if there are changes in your child's color, like bluish or gray lips and fingernails
- if your child is having trouble talking
- if the areas below the ribs, between the ribs, and in the neck visibly pull in during inhalation (called retractions)
- if your child uses rescue medications repeatedly for severe flare-up symptoms that don't go away after 5 or 10 minutes or return again quickly
- if your child's peak flow reading falls below 50% and doesn't improve with medication
Making ER Trips Less Stressful
Advance planning can make trips to the ER less stressful for you and your child. Here are some ways to make it a little easier:
- Know the location of your closest emergency room. If there's a children's hospital ER nearby, go there and have the address and phone number readily accessible (it can be written on your child's action plan).
- If you have other kids, try to make arrangements with a relative or other caregiver who can take them in an emergency situation. But don't let the lack of a babysitter delay your trip to the ER. Someone can always come to the hospital later to pick up your other children.
- Take a copy of your child's asthma action plan or a note with the names and dosages of any medications your child takes to share with the medical staff at the ER.
Following Your Child's Asthma Action Plan
Well-managed asthma is rarely life threatening. People who have died from asthma usually haven't taken their medications as prescribed and have a history of repeated severe asthma flare-ups and emergency care. If you and your child take asthma seriously and work to manage it, you can reduce the chances that your child will need to go to the emergency room.
It's important to monitor your child's asthma using the written asthma action plan your doctor helps you create. This plan will outline your child's day-to-day treatment, list symptoms to watch for, and give detailed, step-by-step instructions to follow when your child has a flare-up.
Some key points of a plan are:
The doctor should be able to help you identify the triggers that can cause asthma flare-ups. These may include animals, dust mites, mold, tobacco smoke, cold air, exercise, and infections.
Taking the Controller Medications
Your child should take his or her controller medications as prescribed by the doctor, even when feeling fine. Skipping doses can cause the lungs to become more inflamed, which can lead to a decrease in lung function. (This can happen without your child even experiencing any symptoms.) It also puts your child at risk for more frequent and severe flare-ups.
Keeping Rescue Medications On Hand
Many kids go to the ER simply because they didn't have their rescue medications handy. Your child should have rescue medication accessible at all times.
Make Your Child a Partner in Asthma Management
As soon as your child is old enough, make sure he or she understands the asthma action plan and the importance of following it. Some kids with asthma, especially teens, resist taking controller medications and rely instead on their rescue medications to help them on an as-needed basis. This is never a good idea and will increase your child's chances of needing emergency care.
Know the Early Signs of a Flare-Up
Everyone's asthma is different. Some kids cough only at night, while others have flare-ups whenever they get a cold or exercise outside. As you manage your child's asthma, pay attention to what happens before a flare-up so that you know the early warning signs. These signs might not definitively mean that a flare-up will happen, but they can help you to plan ahead.
A peak flow meter is an essential tool in helping to predict a flare-up. Your doctor will give you specific number ranges to watch for.
Other early warning signs of a flare-up can include:
- coughing, even if your child doesn't have a cold
- tightness in the chest
- throat clearing
- rapid or irregular breathing
- inability to stand or sit still
- unusual fatigue
- restless sleep
Communicating With the Doctor
Be sure to call your doctor at the earliest sign of a flare-up or if you have any other concerns. Being prepared means you might prevent your child's symptoms from worsening and thus can make a trip to the doctor's office instead of to the emergency room.
Reviewed by: Nicole Green, MD
Date reviewed: November 2009