Asthma and children
Asthma in children can lead to severe complications if certain guidelines are not followed. A few steps and you can minimise the discomfort of this health condition that affects thousands
The mucous membranes in the small branches of the airways (bronchi) swell and the circular muscles contract ('spasm' or bronchospasm). More mucus is produced in the already restricted airways, which makes breathing a struggle. This usually produces a wheezing sound when breathing out.
What symptoms in children can be due to asthma?
Small children (up to three years):
* a wheezing sound when breathing out
* coughing, wheezing or breathlessness with exercise
* prolonged coughing, not because of a cold, often worse at night
* generally feeling unwell
* recurrent colds from which it takes a long time to recover.
Children from 3 to 15 years:
* a wheezing sound when breathing out
* prolonged coughing, especially at night
* waking up coughing during the night or in the morning
* inactivity or lethargy - no longer wishing to play physical games or take other exercise when they have enjoyed this before.
How common is asthma in children?
* Chronic asthma is the most frequent long-term children's disease.
* About 1 to 2 per cent of all children get chronic asthma during their childhood.
* Approximately 15 to 20 per cent of all children will have symptoms of wheeze without having chronic asthma.
What causes asthma in children?
An acute asthma attack usually occurs at the time of a cough and cold caused by a viral infection.
Wheezing in children is most often caused by colds rather than by asthma.
When they do develop asthma, it may be due to allergic reactions to irritants like those listed below:
* pollen, eg grass or birch
* animal hair or fur
* food, eg milk or eggs
* dust mites
* fungus.
What makes a child's asthma worse?
* Exposure to the things to which they are allergic.
* Cigarette or pipe smoke.
* Colds.
* Pollution and dust.
* Exertion or exercise, however exercise should be encouraged, with asthma symptoms relieved by medication.
When should a parent visit the doctor?
* If you suspect your child may have asthma.
* When the asthma medication normally used does not work.
When is it necessary to call the doctor urgently?
* If the child has trouble breathing.
* If the skin changes colour to white or blue, particularly on the lips or around the mouth.
* If the breathing difficulty deteriorates dramatically.
How does the doctor decide whether a child has asthma or not?
* By listening to the symptoms described by parent and child.
* By examining the child by listening to their chest using a stethoscope.
* By measuring the capacity of your child's lungs with a peak flow monitor - a simple device that measures the maximum speed at which the child can blow out. The reading is reduced if the airways are tight. This can be done at home or in the doctor's surgery.
* By checking whether the treatment recommended by the doctor works.
Why should a child take the medication?
It is often both necessary and helpful to give children medication because it can:
* remove their symptoms allowing them to play and exercise again, like other children.
* subdue the allergic reaction of their body and reduce the inflammation in the airways.
* remove or lessen damaging effects on your child's lungs so they develop naturally.
Which medication should my child use?
Medicines for asthma are generally thought of in two main groups:
* relievers (bronchodilators): these are quick-acting drugs that relax the muscles of the airways. They relieve the symptoms of wheeze, cough and breathlessness and are the first-line treatment of an acute asthmatic attack.
* preventers: these act over a longer time and work by reducing the inflammation within the airways.
* Relievers
There are three groups of these. All three types of reliever can be combined if necessary.
Beta 2 agonists
These drugs act on molecule-sized receptors on the muscle of the bronchioles. The drug fits the receptor like a key fits a lock and stimulates the muscle to relax. Examples of those that act for a short time (three or four hours following a single dose) are salbutamol and terbutaline.
These drugs (and the other inhaled drugs mentioned below) are inhaled from a variety of delivery devices, the most familiar being the pressurised metered-dose-inhaler (MDI). Special adaptors and types of inhaler are available to make it easier to administer inhaled medication to young children. A doctor or practice nurse can recommend which type will be the most suitable.
Longer-acting beta 2 agonists include salmeterol. Their action lasts over 12 hours, making them suitable for twice daily dosage. These medications are particularly good for exercise-induced problems and night-time symptoms. They are not suitable for very young children.
Anticholinergics
One of the ways in which the size of the airways is naturally controlled is through nerves that connect to the muscles. The nerve impulses cause the muscles to contract, thus narrowing the airway. Anticholinergic drugs block this effect, allowing the airway to open. The size of this effect is fairly small, so it is most noticeable if the airways have already been narrowed by other conditions, such as chronic bronchitis. These drugs are therefore not commonly used in children, but ipratropium is available for use in children if required.
Theophylline
These medications are given by mouth and are less commonly used in Britain because they are more likely to give side effects than inhaled treatment. They are still in very wide use throughout the world.
* Preventers
There are three main groups of these.
Corticosteroids
Corticosteroids (or steroids) have made an enormous difference to the management of asthma. They work to reduce the amount of inflammation within the airways, reducing their tendency to contract and have allowed many people with previously troublesome asthma to lead almost symptom-free lives. They are usually given as inhaled treatment, although sometimes short courses of oral steroid tablets may be required for bad attacks. Although steroids are powerful drugs with many potential side effects, their safety in asthma has been well established. It is also important to balance the problems that arise from poorly treated asthma against the improvement in health that occurs when the condition is well treated.
Cromones
There are two drugs in this group: sodium cromoglicate and nedocromil. They also act to reduce airway inflammation. They tend to be best for mild asthma and are more effective in children than adults. The drugs are given by inhalation and usually very well tolerated. This is a good first-line preventative treatment in children, but may take up to six weeks to have an effect.
Leukotriene receptor antagonists
Leukotrienes are compounds released by inflammatory cells within the lung and which have a powerful constricting effect upon the airways. By blocking this effect with these antagonist drugs the constriction is reversed. One of these drugs, montelukast, is presently licensed for children over two years old. Zafirlukast can be used in children over 12 years old.
What are the long-term prospects?
* Most children outgrow the disease.
* The milder it is, the greater the chance of outgrowing it.
— Discovery Health
Sore throat
A sore throat (also known as pharyngitis or tonsillitis) is a disease primarily located in the area around the tonsils. It can be caused by both a virus and a bacteria. A sore throat is partly a disease in itself and partly an effect of other diseases such as flu and glandular fever.
The disease is normally seen in children and young people but it can occur at any age. The characteristics of the disease are throat pain and trouble swallowing. If the disease is due to bacteria it can be treated with antibiotics. Usually there are no complications.
How do you contract a sore throat?
By being infected by a virus or bacteria.
Infection by a virus may come from the same virus that causes colds and from an Epstein-Barr virus - the latter causes glandular fever. The infection originates from airborne droplets and hands that carry the infection from person to person.
Among the bacteria that cause sore throats, the streptococcus group A is the most common. The incubation period between picking up the infection until the disease breaks out, is two to four days or sometimes less.
What are the signs of a sore throat?
Pain in the throat and difficulty in
swallowing.
Pain may spread to the ears.
The throat is reddish, the tonsils are swollen and may be coated.
Possibly a high temperature.
Swollen lymph nodes under your jaw and in your neck may occur.
If the sore throat is due to a viral infection the symptoms are usually milder. Usually they are connected to the common cold.
If the sore throat is due to the Coxsackie virus, small blisters may develop on the tonsils and in the soft palate. The blisters erupt in a few days and are followed by a scab which may be very painful.
If the sore throat is due to a streptococcal infection, the tonsils often swell and become coated and the throat is sore. The patient runs a temperature, has sour breath and may feel quite ill.
Good advice
If signs of a sore throat persist for more than a few days or are severe with marked difficulty in swallowing, high fever or vomiting, then your GP should be consulted.
Warm drinks and soft food may ease swallowing problems.
Drink plenty of fluids.
How does the doctor make a diagnosis?
The doctor usually makes the diagnosis from the symptoms of the disease, but occasionally a swab of the secretions of the throat and maybe a blood sample are required to identify the cause.
What complications may arise?
Usually a sore throat causes no trouble and only lasts about a week, but the following complications may arise:
a secondary infection
may occur in the middle ear or sinuses.
if the sore throat is due to a streptococcus infection, there may be a rash (scarlet fever).
an uncommon complication is a throat abscess that usually occurs only on one side.
in very rare cases, diseases like rheumatic fever or a particular kidney disease (glomerulonephritis) may occur.
How is a sore throat treated and which medication may help?
In the vast majority of cases, a sore throat cased by a virus infection need only be treated with paracetamol to bring the temperature down.
In a small minority of patients, a sore throat caused by bacteria is treated with penicillin, or erythromycin in cases of penicillin allergy.
The symptoms of a sore throat can be relieved by using over-the-counter medicines, such as sprays containing antiseptics and anaesthetics to numb the sore area, or antiseptic gargles. These can be bought without a prescription and your doctor or pharmacist will be able to advise you about them.
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