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Asthma Management in Child Care
By Will Evans

Asthma is a remarkably common and chronic breathing disorder that affects at least one out of every 10 children. According to the National Jewish Medical and Research Center, the disease affects 14.6 million Americans. Of that number, 4.8 million are under the age of 18. Asthma can also be fatal. Each year, more than 5,400 people die from asthma in the United States.


Children with asthma suffer from attacks of coughing, wheezing, and shortness of breath. Many asthma attacks occur in children with respiratory infections, including infections triggered by common cold viruses. Children may also suffer from asthma attacks induced by:


·        Exposure to cigarette smoke

·        Stress

·        Strenuous exercise

·        Weather conditions (especially cold, windy, or rainy days)

·        Allergies to animals, cockroaches, dust, pollen, and mold

·        Indoor air pollutants, such as paint, pesticides, cleaning materials, chemicals, and perfumes

·        Outdoor air pollutants like ozone


Young children usually have the most difficulty with the disease. Statistics show that asthma patients under five years of age receive medical treatment about three times as often as children aged five to 15. There are several reasons for this:


·        The airways of younger children are smaller, so swelling or mucus blocks their airways more easily.

·        Upper respiratory tract infections, a major asthma trigger, attack young children more frequently.

·        Most children under five cannot use a peak flow meter to monitor an asthma attack.

·        Some parents of asthmatic children may not have learned an effective method of tracking the course of an asthma episode.


What actions can early childhood professionals take to reduce the potential for asthma attacks? They fall into two major categories: facility modifications and management strategies.


Facility Modifications

Facility modifications include:


·        Changing filters in the heating/air conditioning system every two to three months. (Use a high-efficiency particulate filter.)

·        Prohibiting smoking inside the center.

·        Wiping surfaces daily with a damp rag to reduce dust and dust mites.

·        Avoiding strong odors and chemical fumes from cleaning fluids and arts and crafts supplies.

·        Restricting “bug bombs” and pesticides to weekends and non-use hours at the center.

·        Installing electrostatic air purifiers.

·        Installing dehumidifiers (or other means) to reduce water entry in damp basements.

·        Removing furry and feathered animals that can trigger attacks (dogs, cats, birds, hamsters, etc.). Try fish instead!

·        Eliminating cockroaches. Some children are especially susceptible to cockroach-borne triggers. Cockroaches also pose an obvious threat to food safety.

·        Inspecting playground impact protection materials (particularly wood chips). Check these materials frequently for mold, and replace them if necessary. (Mold is one of the most frequent triggers for fatal asthma attacks.)

·        Restricting asthmatic children from freshly mown areas, and leaf and pine needle piles.

·        Laundering bed linens and stuffed toys.


Management Strategies

Management strategies focus on staff training and the development of a working partnership with parents of asthmatic children. Staff training is essential for both the recognition of the symptoms and the treatment of the disease. And depending on the response time of your local rescue squad, your staff may need training in various asthma-related emergency management techniques. Do you, for example, know how to use an inhaler, epi-pen, peak-flow meter, or nebulizer? Can you recognize the signs and symptoms of an asthma attack? Do you know how to respond? As with all emergencies, knowing what to do and how to react is critical.


You and your staff can take a number of steps to reduce asthma flares and the related discomfort the child may experience. Schedule rest times before and during outdoor activities. Some children may need a break after exercise; others may have to take medicine before exercise to prevent asthma flares. If a child does have an asthma attack, it’s critical to calm the child as much as possible. Place the child in a sitting position and rub his or her back. While assisting a child with asthma, ensure that the other children have supervision. A child in distress may cause other children to become distressed or act out in fear.



Managing children’s asthma can be a challenge in child care facilities. But with a well-conceived action plan in place and a bit of preparation, you and your staff can handle the stresses arising from most situations. Your efforts will not only demonstrate your professionalism, they will enhance your relationship with the parents of the children in your care.


Will Evans is the Director of Safety Education for Markel Insurance Company. He serves as an Emergency Medical Technician and a National Playground Safety Inspector, and conducts staff training and conference presentations across the nation. For more information, please call 800-431-1270, ext. 7563, or send e-mail to wevans@ markelcorp.com.