Childhood Asthma

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Q & A with Judith Palfrey, M.D., American Academy of Pediatrics

Dr. Palfrey is a general pediatrician and child advocate. She is the T. Berry Brazelton Professor of Pediatrics at Harvard Medical School and directs the Children’s International Pediatric Center at Children’s Hospital in Boston. She received her M.D. from Columbia University College of Physicians and Surgeons, completed her residency training at the Albert Einstein College of Medicine and was a fellow in Community Child Health at Children’s Hospital.

Be Smart. Be Well. sat down with Dr. Judith Palfrey, past president of the American Academy of Pediatrics and a leading authority on children and asthma. Watch the video interview above or read the transcript below.

To learn more about childhood asthma, visit Be Smart. Be Well. Childhood Asthma.

Video Transcript

What are some signs a child might have asthma?

Dr. Palfrey: Parents should be concerned if they see their children having any difficulty taking in air. If the child is struggling in anyway, or the chest is, is raised up where they’re, sometimes you can actually hear the wheezing. Those things should alert parents to come right on in to be checked. Another thing is if a child has a lot of cough and just persistently is coughing, particularly if there is no fever or anything like that, that’s another reason to come right on in to be checked for asthma.

What are some overlooked asthma symptoms?

Dr. Palfrey: One symptom that people often don’t know about is what we call night cough. Sometimes a child will just wake up in the middle of the night, they won’t have a fever or a cold or anything, they’ll just be coughing. And that can actually be an early symptom and early sign of asthma.

How does a doctor confirm that a child has asthma?

Dr. Palfrey: The first is a very good physical exam, just listening with the stethoscope to hear whether there is wheezing and to confirm that that’s there. And that’s probably the most important thing that will happen. Often times when the child has had their first attack of asthma the doctor may consider doing a chest x-ray, just to see if there is something else going on. The third thing that they will do, not always, but sometimes is to get what are called pulmonary function tests. And that’s often done when the child has somewhat severe asthma, just to make sure that we have a baseline of how the air is moving in and out of the lungs. And then the fourth thing is that if there is any aspect of allergy that’s involved, the doctor may ask his -- the allergy colleague to do allergy tests.

What can parents can do to help manage their child’s asthma?

Dr. Palfrey: The family really needs to understand the medication that the child is taking, do as best as they can to do them at the proper times. And then really understand when the child is beginning to get into trouble, because we want them to act quickly at that time. And finally work with the doctor to identify the triggers, the things that might be setting the allergy, setting the asthma off.

What is an Asthma Action Plan?

Dr. Palfrey: Is this a child who’s got mild asthma? Is this child who’s got moderate asthma or more severe asthma? Depending on what that is and individual characteristics of the child, the doctor will set up an asthma action plan, and it will really give the family an idea of what to do when there is no wheezing, when there’s wheezing and when the child is really sick. And it’s generally a color-coded plan, usually with three zones of green, yellow and red. When the child is in the green zone, generally they just will be on their controller medicines. Maybe occasionally they’ll be taking a bronchodilator, but not much. When they are in the yellow zone, they’ll probably be taking more medicine, maybe they’ll be taking both their controller and quick relief. And when they’re in the red zone, that’s generally when they are coming into see the doctor to be taken care of. And this just gives the family a very concrete way of managing the asthma themselves and understanding how to partner with the physician and nurse to take care of the child. And we found these to be very, very effective for families.

How are Asthma Action Plans useful?

Dr. Palfrey: One of the great things about the asthma action plans is that they can be shared. So, they’re shared between the family and the doctor, obviously. But, what a great thing to give to the daycare center or to the school. So that everybody’s on the same page in terms of how the child is doing, what’s needed during the day, etc. So what we’re tending to do with the asthma action plans is to work with schools and daycares to let them know how many children in their class, for instance, have asthma; the things that they need to look for; the triggers; what zones they are in.

To learn more about childhood asthma, visit Be Smart. Be Well. Childhood Asthma.

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