Last reviewed 6 March 2020

With asthma now affecting one in eleven children in the UK, it is essential that early years providers can support any young sufferers in their care. Asthma affects each individual differently and practitioners need to work closely with families to ensure continuity of care while children are away from home. Elizabeth Walker discusses the importance of developing an asthma policy which sets out the provision’s commitment to meeting the needs of children with asthma.

Understanding asthma

The UK has among the highest prevalence rates of asthma symptoms in children worldwide and it is the most common long-term medical condition. On average, there are three children with asthma in every classroom in the UK and a child is admitted to hospital every 20 minutes due to an asthma attack. Asthma affects tiny tubes in the lungs called airways which carry air in and out of the body. If a child has asthma then their airways are almost always red and swollen. When they come into contact with an asthma trigger, such as pet hair, cigarette smoke or pollen, their airways become narrower making it harder to breathe. The condition varies in severity and while some children will experience an occasional cough or wheeze, for others the symptoms will be much more severe. Children can usually control their asthma effectively by avoiding known triggers where possible and taking the correct medicines.

Asthma triggers

Everyone’s asthma is different so it is important that all early years staff are aware of the triggers for each individual child at the provision. Providers must ensure that they obtain all relevant information from parents regarding their child’s asthma triggers so that they can take steps to avoid them wherever possible. Common asthma triggers in children include:

  • viral infections (colds or flu)

  • exercise

  • sudden changes in temperature and weather

  • emotions

  • allergies (eg to pollen, animals, house dust mites, moulds)

  • irritants (eg cold air, tobacco smoke, chemical fumes).

Asthma treatment

There are two main kinds of asthma treatment — relievers and preventers. Reliever inhalers are usually blue and are taken by the child when asthma symptoms appear. They quickly relax the muscles surrounding the narrowed airways, making it easier to breathe again. It is crucial that all prescribed inhalers are labelled and kept safely but are easily accessible so that they can be used as soon as symptoms occur. There should be a signed agreement in place with parents which states that trained staff can help children to administer their prescribed inhalers. (See also Administration of Medication Policy)

Preventer inhalers are usually brown and need to be taken every day, even if the child is feeling well, as they reduce the redness and swelling in their airways. This means that the child is less likely to react badly when they come into contact with an asthma trigger. These inhalers are usually taken at home. Preventer treatments will not relieve sudden attacks of wheezing or breathlessness.

Most children under five need to use a spacer to help them take their inhaler more effectively. Spacers are large plastic devices, shaped a bit like a plastic bottle. At one end there is a mouthpiece and at the other a hole for the inhaler to fit in. Spacers make inhalers easier to use and ensure that the child gets the correct amount of medicine into the lungs. If the child is under three, they will probably use a face mask.

Schools and early years providers can also keep an inhaler for use in emergencies when a child with asthma cannot access their own prescribed inhaler. Further information can be found in Guidance on the Use of Emergency Salbutamol Inhalers in Schools, published by the Department of Health in 2015.

Individual healthcare plans can be used for children with asthma who attend school or nursery. The plan sets out a child’s medical needs and how they should be managed. It includes any health issues, the care or treatment required and any action that needs to be taken in an emergency. This should be drawn up with input from the child’s parents, early years staff and any relevant healthcare professionals, such as a GP or asthma nurse.

Asthma attacks

It is vital that early years staff know how to recognise when a child is suffering an asthma attack as young children can deteriorate very quickly. The following signs may indicate that a child is in difficulty.

  • Coughing, wheezing or shortness of breath.

  • The child might go quiet — if a young sufferer is quieter than normal it is worth checking to see if everything is fine.

  • The child may complain that their tummy hurts because they are unable to explain that their chest feels tight.

  • The child may be breathing faster than normal, so much so that they are unable to speak in complete sentences or eat or drink anything.

  • The child is using their neck or tummy muscles to breathe, or appear to be going slightly blue around their lips.

Each child’s asthma will present itself in different ways, so it is vital that practitioners ask parents to tell them how they recognise an attack and that this is noted down so that it can be referred to in an emergency.

In the event of an asthma attack, staff should:

  • keep calm

  • encourage the child to sit up and slightly forwards; do not hug them or lay them down

  • make sure they take slow, steady breaths and take two puffs of their reliever inhaler immediately, one at a time, preferably through a spacer device

  • ensure tight clothing is loosened

  • reassure the child

  • if there is no immediate improvement, continue to make sure they take two puffs of reliever inhaler, one at a time, every two minutes for up to 10 minutes or until their symptoms improve

  • call an ambulance.

Asthma policy

It is good practice to develop an asthma policy which sets out the provision’s commitment to meeting the needs of children with asthma. An asthma policy can be a stand-alone policy or incorporated into a health and safety policy, first-aid or general health policy. Key points to cover in an asthma policy include the following.

The early years provision:

  • welcomes all children with asthma

  • keeps a register of all children with asthma

  • recognises that asthma is a condition that can be serious and affects many children

  • encourages and helps children with asthma to participate fully in activities

  • ensures children have immediate access to reliever inhalers

  • ensures that the environment is favourable to children with asthma and that all staff are aware of potential triggers and warning signs

  • ensures that other children in the group understand that asthma can be serious

  • provides training for staff on how to administer reliever inhalers and what to do if a child has an asthma attack

  • ensures that all staff are trained on the procedures to follow in the event of an emergency

  • obtains written permission from parents to administer reliever inhalers

  • works closely with parents of children with asthma to ensure continuity of care

  • works with parents and healthcare professionals to develop an individual healthcare plan if appropriate

  • always informs parents if a child has an asthma attack or needs their inhaler while at the provision

  • informs parents of procedures that will be followed when there’s a trip or outing

  • reviews the asthma policy on a regular basis.

Further information

  • Asthma UK offers support and information for children with asthma at nursery or school

  • British Lung Foundation provides information on asthma in children

  • Education for Health is a charity that provides education, training courses and resources to support people with long-term medical conditions. Their asthma module is useful for anyone who works with children

  • Guidance on the Use of Emergency Salbutamol Inhalers in Schools, Department of Health, March 2015

  • Allergy UK is the leading national charity dedicated to supporting allergy sufferers in the UK