According to the American Academy of Allergy, Asthma, and Immunology, nearly 9 million American kids have asthma. Asthma is the most common chronic illness in children and is responsible for 3 million doctor visits each year. Toddlers have smaller airways than older children, so they are more susceptible to the effects of narrowing in the bronchial tree. Since toddlers do not have the verbal skills of older children, diagnosing and treating asthma can be a challenge for parents and pediatricians alike.
Diagnosis
It can be tricky to diagnose asthma in toddlers. Parents may think that their toddler just has frequent colds that tend to go "into the chest." The diagnostic test commonly used to diagnose asthma, the pulmonary function test, cannot be performed in children younger than five. For this reason, parents should be aware of symptoms that could mean that their toddler has asthma. Coughing, especially when it occurs at night, frequent bronchitis and wheezing are common signs of asthma.
Beta Agonists
Beta agonists are inhaled medications that open up tight airways. There are two types of beta agonists: short acting and long acting. Short-acting beta agonists are often used for immediate relief of asthma symptoms and are the main medication found in nebulizer treatments. Short-acting beta agonists are used for acute, intermittent asthma symptoms and for rescue treatment when symptoms worsen. Long-acting beta agonists are similar to short acting, except that are very dangerous when used alone, or as monotherapy. The long-acting beta agonists are used as "add-on" drugs combined with inhaled corticosteroids. The FDA now recommends that pediatric patients use long-acting beta agonists only when they are combined in the same container with a corticosteroid in order to prevent confusion and misuse.
Corticosteroids
Corticosteroids are strong anti-inflammatory drugs. The body's adrenal gland produces cortisol, a natural corticosteroid, but higher doses are required to treat many different types of inflammatory illnesses. Since asthma is primarily an inflammatory disease, corticosteroids are the mainstay of asthma treatment. Oral corticosteroids, such as prednisone, are used for acute exacerbations of asthma in the short term. Inhaled corticosteroids, such as fluticasone, are the primary therapy for persistent asthma.
Leukotriene Inhibitors
Leukotriene inhibitors reduce inflammation in the airways. Montelukast is approved for children aged 2 and older. This medicine is often added to inhaled corticosteroids and beta agonists when the former are not controlling symptoms. It is well tolerated, but is not effective enough to be the first choice for treatment. However, leukotriene inhibitors have been shown to reduce asthma attacks associated with upper respiratory viruses in children from 2 to 5 years of age with intermittent asthma, according to the American Family Physician.
Emergency Planning
Even if your toddler has not been diagnosed with asthma, it is important to know symptoms that could indicate difficulty breathing. A normal rate of breathing for children 1 to 2 year of age is 20 to 30 breaths per minute. According to the Asthma and Allergy Foundation of America, breathing at a rate 50 percent above normal can be a danger sign for serious asthma. Noisy breathing, trouble eating, lethargy, weak cry, looking ashen or bluish around the lips or fingertips, abnormal movements of chest or stomach and flaring of the nostrils are also red flags that should prompt an emergency evaluation. Teach your child to tell you when he is not feeling well and have an emergency plan in place. Identify the nearest emergency room, carry important phone numbers and insurance information and plan for backup childcare for other children in the home.
