Asthma attack
If your child’s asthma suddenly gets much worse (asthma attack), they will require urgent treatment. Signs of an asthma attack include:
- being 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.
Looking after your child during an asthma attack
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 the table below.
If your child has any of the following:
- Not improving despite using their inhaler according to their action plan
- Breathing very fast, too breathless to talk, eat or drink
- Working hard to breathe, drawing in of the muscles below the ribs (recession), or noisy breathing (grunting)
- Breathing that stops or pauses
- A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
- Is pale, blue, mottled or feels unusually cold to touch
- Difficult to wake up, very sleepy or confused
- Has a fit (seizure)
- Has a rash that does not go away with pressure (the ‘Glass Test’)
Ring 999 for immediate help.
Go to the nearest Hospital (A&E) Emergency Department or phone 999
Keep your child upright and reassure them
Get your child’s inhaler and follow your action plan
If your child has any of the following:
- They need increased doses of their inhaler for more than 2-3 days
- Breathing a bit faster than normal or working a bit harder to breathe
- A harsh noise as they breathe in (stridor) only when upset
- Dry skin, lips or tongue
- Not had a wee in last 8 hours
- Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
- Temperature less than 36°C in those over 3 months
- Getting worse and I am still worried
You need to contact a doctor or nurse today.
Please ring your GP surgery or NHS 111 - dial 111
Continue to follow your child’s action plan while seeking advice.
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, recheck that your child has not developed any red features
If none of the above features are present:
Watch them closely for any change and look out for any red or amber symptoms
Continue to follow your child’s action plan while seeking advice
If your child has other symptoms associated with their asthma attack, you might want to look at our information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache or our other pathways.
Give 2-4 puffs blue (salbutamol) reliever inhaler every 4 hours until symptoms improve. If needing this more than 24hrs contact your GP or 111 out of hours
If you require more puffs move to AMBER.
What can you do to reduce the risk of your child having another asthma attack?
1) Children with poorly controlled asthma are much more likely to have an asthma attack compared to children whose asthma 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 (exertional dyspnoea) or using their reliever inhaler more often than expected.
- Arrange to see you GP or asthma nurse if they are experiencing such symptoms.
To watch a video on encouraging children to use their inhalers effectively please click here.
2) Get an asthma action plan in place
A written asthma action plan drawn up between a healthcare professional and patient means you are four times less likely to have to go to hospital for your asthma.
3) It is vital that your child uses their inhalers correctly.
Your child’s 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).
- Shake the inhaler well and remove cap
- Fit the inhaler into the opening at the end of the spacer
- Place mask over the child's face or mouthpiece in their mouth ensuring a good seal
- Press the inhaler once and allow the child to take 5 slow breaths or slow count to 10 between ease dose
- 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 see goo.gl/235DQ 
See your practice nurse or doctor if you are not sure whether your child is using their inhaler properly.
4) 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.
5) 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
Where should you seek help?
- If it is non-urgent, speak to your local pharmacist or health visitor.
- If your child has any of the above amber features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111.
- You should only call 999 or go your nearest A&E department in critical or life threatening situations or red features above.
For wear and tear, minor trips and everything in between.
Self-care
Continue providing your child’s care at home. If you are still concerned about your child, call GP or out of hours NHS 111 – dial 111
Sound advice
Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.
For information on common childhood illnesses go to What is wrong with my child?
Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.
Sound advice
- Visit a pharmacy if your child is ill, but does not need to see a GP.
- Remember that if your child's condition gets worse, you should seek further medical advice immediately.
- Help your child to understand - watch this video with them about going to the pharmacy.
For information on common childhood illnesses go to What is wrong with my child?
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.
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.
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.
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.
GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.
Sound advice
You have a choice of service:
- Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
- Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre
For information on common childhood illnesses go to What is wrong with my child?
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
