If your child has asthma, you always want to avoid a trip to the emergency room due to difficulty breathing, but deciding when to go to the ER can be a life-saving decision. In an emergency situation, it may be difficult to know which decision to make in the moment. That’s why having a plan to address your child’s asthma symptoms is so important. Along with a plan to address symptoms of an asthma attack, you will need to talk to your child and his or her pediatrician well before a flare-up occurs.

Spot signs of a flare-up

Pediatric asthma can vary from child to child. Kids may only cough at bedtime, get flare-ups at the onset of cold weather, get short of breath during exercise or experience asthma symptoms due to seasonal allergies. By paying attention to early warning signs, you can spot an asthma flare-up as soon as it starts and follow the appropriate course of action. Some early warning signs of an asthma flare-up may include:

  • Wheezing
  • Persistent coughing not attributed to a cold
  • Constant throat clearing
  • Irregular breathing or rapid breathing patterns
  • Shortness of breath during activities
  • Chest tightness
  • Unexplained fatigue
  • The inability to stand or sit still
  • Restless sleep 

As you manage your child’s asthma, don’t be afraid to call your pediatrician if you witness any of the early warning signs of an asthma flare-up, or if you have other concerns. By being prepared, you might be able to prevent a trip to the ER by keeping symptoms from getting worse.

Seek help when necessary

Not all asthma symptoms can be managed by a phone call or trip to the nearest pediatrics department. If your child has any of the following symptoms, seek help quickly by going to the ER or calling an ambulance:

  • Persistent breathlessness
  • Constant wheezing
  • Repeated use of a rescue inhaler or fast-acting inhaler for severe flare-ups that either don't go away after five or 10 minutes or return again quickly
  • Changes in color like blue or gray lips and fingernails
  • Difficulty speaking
  • Visible pulling in of the areas below the ribs, between the ribs and in the neck during inhalation (also known as retractions)
  • Peak flow readings below 50 percent, considered the peak flow red zone, that don’t improve after using an inhaler

Manage stressful trips to the ER

Another reason to plan ahead is to make any trips to the ER less stressful, and ultimately safer for your child. Try to always know the location of your closest ER and visit a children's hospital ER if possible. If you have other children, plan for a relative or caregiver to watch them in case of an emergency, but don’t wait for the babysitter to show up before going to the hospital. A quick phone call to a friend or relative and the kids will get where they need to go. Also, have your child's asthma action plan available to share with ER staff that contains the names and dosages of any medicines your child is currently taking, and note if your child has a medication allergy.

Follow your asthma action plan

Your pediatrician can help you create your asthma action plan by identifying the triggers that might cause asthma flare-ups, like certain animals, tobacco smoke, dust mites, pollen, mold, perfumes, aspirin, weather change, cold air, exercise, allergies and respiratory infections. Along with avoiding any potential triggers, your child may also be on a long-term control medicine called a controller or maintenance medicine. Even when your child doesn’t have any symptoms, skipping a dose prescribed by your doctor can cause lung inflammation and a decrease in lung function, which can increase the risk of more frequent and severe flare-ups. Additionally, keep quick-relief medicines available at all times to avoid unnecessary emergencies. Keep medicine with the school nurse, at sporting events and while traveling.

When asthma is managed well, it is less likely to be life threatening. By taking asthma seriously, you and your child can work to manage the symptoms and lessen the odds of a trip to the ER. Monitor your child's asthma and ask your pediatrician for help creating a written action plan that contains details on day-to-day treatment, symptoms to monitor closely and step-by-step instructions on what to do during a flare-up.

Partner with your child

When your child is old enough, involve them in the asthma action plan and make sure he or she knows how important it is. Some children, especially teens, may resist taking long-term control medicines and rely instead on their quick-relief medicines to help them on an as-needed basis, which can increase the odds of needing emergency care. When parents and kids work together to follow an appropriate asthma action plan, serious asthma flare-ups can be reduced.