Asthma is a condition that affects the airways. Asthma symptoms include coughing, wheezing, a tight chest, and getting short of breath. However not every child will get all these symptoms.
Children with asthma have airways that are almost always red and sensitive (inflamed). These airways can react badly when someone with asthma has a cold or other viral infection or comes into contact with an asthma trigger. Common triggers include colds, viral infections, house dust mites, pollen, cigarette smoke, furry or feathery pets, exercise, air pollution, laughter and stress.
A child with asthma which is not controlled (a child who has recently been hospitalised, or frequently attends appointments with the asthma nurse) will have a bespoke asthma care plan written by a health professional that supports the child to manage their condition. This will be developed before the child attends the setting by the appropriate health professional.
A child with controlled asthma who has regular or 'as and when' prescribed medication will have a generic asthma management care plan.
It's the responsibility of the setting manager to make sure all children with asthma have an appropriate care plan in place.
The asthma flowchart provides information on the action to take when a child with asthma is attending your setting.
Asthma attacks / symptoms
Common signs of an asthma attack are:
- shortness of breath
- chest tightness
- recession on neck and ribs
- being unusually quiet
- being pale and lethargic
- difficulty in talking or walking
If a child has an asthma attack staff should follow the procedure in the child’s asthma management care plan.
Asthma medication and control
Asthma varies in severity. Avoiding known triggers and taking the correct medication can usually control asthma effectively.
There are several medications used to treat asthma. Some are for long term prevention, others relieve symptoms when they occur (although they may also prevent symptoms if they're used in anticipation of a trigger).
Asthma medication is usually given through the use of inhalers and the use of a spacer device for small children to administer a dose. For young children the inhaler will be administered by a staff member. As soon as the child is able they will be encouraged to administer their inhaler themselves, supervised by and with support from an adult. The individual needs of each child and the amount of assistance they need to receive their asthma medication will differ. Staff working with the children should offer assistance to each child which mirrors what the parent does in the home.
What parents should do
- Inform the setting if their child has asthma before the child begins attending the setting, or as soon as the child is diagnosed with asthma if they are already accessing a place.
- Understand that staff cannot administer asthma medication to their child if the condition has not been diagnosed by a doctor.
- Support the development of a care plan (in case of a bespoke plan for uncontrolled asthma this will be in conjunction with a health professional).
- Inform staff as soon as possible if their child’s condition changes, eg following an attack, if the child is hospitalised as a result of asthma symptoms, or if a new medication is prescribed.
- Provide a prescription labelled inhaler (and labelled spacer if required) to be kept on site. This will remove the risk of the child’s inhaler not being brought to the setting by mistake. GP’s will prescribe an extra inhaler for this purpose if parents request it.
What Early Years providers need to do
- Make sure all staff and children have a good understanding of asthma, the triggers, symptoms and treatments.
- Gather information and consent from parents/carers on the contract to support the type of care plan to be put in place.
- Train staff in first aid and administering of medication, which includes information on administering medications for asthma. Free training regarding asthma can be completed online in about 45 minutes. Complete asthma training on the Education for Health website.
- Develop and review a care plan appropriate to each child’s condition so staff, parents and carers are confident in the support the child will receive both day to day and in an emergency situation.
- Regularly check the child's inhaler at the setting to make sure it's within the use-by date and inform parents/carers well in advance of the date it needs replacing.
Administration of asthma medication
For a child who has regular prescribed medication, a medication form will need to be completed by staff in consultation with parents/carers and the settings medication policy and procedure will be followed.
For a child who requires ‘as and when’ medication the prescribed dose will be administered in accordance with the generic asthma management care plan. The dose will be recorded on the medication form as they're administered, and parents will be required to sign the form when the child is picked up, as per the asthma flowchart.
Staff completing medication forms must make sure all inhalers have their dispensing label (prescription label from the chemist) on the inhaler and are within their use-by date.
Storage of asthma medication
The child’s key person is required to make sure that both inhalers and spacers are clearly marked with the child’s name and date of birth. Children’s inhalers and spacers must be stored in a readily accessible safe place, eg in a safe place in the room that the child attends.
Out of date inhalers must be thrown away or returned to a chemist. When children stop attending the setting their inhalers should be given back to their parents/carers. There should never be inhalers on site that belong to children who no longer attend.
Generic asthma management care plan
The care plan should be reviewed by a member of staff responsible for the training around the child’s individual needs every six months, or sooner if the child’s condition changes. The care plan should be reviewed immediately if there are any incidents where parents/carers have to be contacted due to the child’s lack of response to medication, if an emergency situation occurs, or the child’s condition changes.
Any changes made to the care plan need to be decided jointly with the parents/carers. If the child’s asthma symptoms increase and becomes uncontrolled then a bespoke asthma care plan will need to be put in place, written by the health professional involved in supporting the child manage the condition.