Author Archives: Jackie Aim

Setting boundaries and changing behaviours

Try to encourage your child to take their inhalers. Have an inhaler routine with your child which is relaxed for them and you. Be prepared to try again. Many children will need time to learn how to take inhalers. Give small children lots of praise when they do well and if they don’t take the 10 breaths they should, you have to change your behaviour. If you don’t change first, your child will continue to fight the inhalers because they learn that you will just give up and they think they won’t need to take them.

Here’s some tips in setting clear boundaries and sticking to them!

Try to reduce the amount of distractions while you are trying to get the child to concentrate on the inhalers.
Turn off the TV or game console and create a quiet environment.
Send other children to do something in another room while you are with the child taking the inhaler.
If the child takes about 2 breaths and then runs away it can be a fight to get their attention back, this can be frustrating for you but perseverance is important.
You can try a rewards system of chart and stickers for every time your child takes their inhalers. Give lots of praise and encouragement when they have done well. Don’t be tempted into giving sweets as a reward. Instead let the child choose a game or activity they want to do after their medication.
Get your child used to their inhaler. Let them personalise the inhaler with small stickers for example.
Be firm and set boundaries.
If your child won’t sit and take their inhalers try showing the child what you want them to do using a toy teddy or doll.
If all this fails, as a last resort try getting a big bath towel or a blanket and this then becomes the same as “the naughty step!” Try to cuddle the child rather than restrain. Tell the child that if they don’t take their inhalers you need to wrap them up like a baby. If the child still won’t co-operate, you can still try to get the medicine into their system.

Setting boundaries and changing behaviour may not be easy for you and takes practice! It can be challenging but consistency is important.

Nurse consultation

The following scene is an example of a consultation between a respiratory nurse and a mum of a child with asthma who is having problems getting her child to take inhalers. Respiratory nurses can give lots of tips about your child’s asthma.

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Scene 1

Nurse says “Hello Sarah”
Nurse thinks “She looks tired!”
Mum says “Hi Elaine”
Mum thinks “I’m exhausted. This is going to be another waste of time”

Scene 2

Nurse says “So I know you already know HOW to give Chloe her inhalers but I understand she’s not co-operating with you too well?”
Nurse thinks “Perfectly normal behaviour for her age – I can help a lot here”
Mum says “Well I’m trying, but she doesn’t want to take them and has a tantrum”
Mum thinks “To be honest I’m so tired fighting I haven’t really given them to Chloe for a few days, it’s just so much hassle. Easier not to bother!”

Scene 3

Nurse says “Well that is totally normal behaviour for her age and I can give you lots of tips and advice to get the medicine into her lungs more effectively!”
Nurse thinks “This won’t be easy for Sarah but it will be worth it in the end”
Mum says “Whatever you think is best nurse”
Mum thinks “Aye right!!”

Scene 4

Nurse says “OK there are 2 things you need to know. One is the practical side and the other is the emotional side. This is not going to be easy for the next week or so, but it will work”
Mum says “OK tell me …”
Mum thinks “Oh dear I’m too tired for this”

Scene 5

Nurse says “We call the practical technique clinical (or therapeutic) holding, and we use that in young children when you have tried different distractions and encouragements and your child still won’t co-operate. Remember, at Chloe’s age she will push her boundaries with you, to see how far you will let her go”
Mum thinks “She’s pushing her boundaries all right, about everything just now. Tantrums all the time. She’s not like that with her gran!”

Scene 6

Nurse says “You wouldn’t let her put her finger in a socket or touch the cooker, so you have strong boundaries for these things. Her inhalers have to be the same. They can be life saving medicines at times. You need to be like Supernanny!”
Nurse thinks “I don’t want to scare them but I do need them to take this seriously. Chloe had a severe attack last month when she was diagnosed with asthma and admitted to the children’s ward”
Mum thinks “I was so scared when she was unwell and couldn’t stop coughing and wheezing. I felt helpless and I don’t want to feel like that again”

Asthma triggers in school

There may be common environmental factors or ‘triggers’ that can affect your child’s asthma in school. For example; grass/tree pollens, dust mites, mould spores, exercise, not to mention school with lots of children are a great breeding ground for coughs and colds!

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It is important to let the school know if you have identified things that make your child’s symptoms worse so appropriate measures can be taken to minimise your child’s exposure to those triggers.

Schools can implement some simple measures, for example limiting the number of soft furnishings in the classroom or making sure windows are shut during high pollen counts in summer which may help prevent asthma attacks in susceptible individuals.

During coughs and colds your child may need extra puffs of their reliever medicine, it is important you let the school know if this is the case.

Physical Education – PE

Exercise is important for keeping healthy and all children should be encouraged to take part in PE, including those with asthma. Exercise is a well known asthma ‘trigger’ however it is not a reason to be refused physical activity altogether.

If your child experiences symptoms with exercise they should take their reliever inhaler 10 minutes before activity.
If your child is experiencing ongoing symptoms with exercise or having frequent asthma attacks during activity they should seek a medical review as it may be their asthma is not under control.
Warming up before sport is important for all children but especially for those with asthma.
Children should have their reliever medicine available during PE.

Important

If asthma symptoms occur during sport (or at break time) they should:

STOP, take their inhaler.
Sit out for at least 5 minutes and join in again if or when they feel better.
If they are not getting any relief from their inhaler it should be treated as an asthma ‘attack’ and appropriate treatment given.
If your child has an asthma plan make sure the school also have a copy to refer to in an emergency. It will tell school staff exactly how much of the inhaler to give. They will also have your contact details and will know when to contact you.
Any child who has an asthma attack at school should be supervised at all times until the ambulance arrives or until the child has recovered fully.

Example of an asthma management flowchart used in schools

Adapted from Edinburgh City Council Symptom and action flowchart for Asthma attack

Adapted from City of Edinburgh Council Symptom and action flowchart for Asthma attack

Role of the family

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It is your responsibility to make sure the school is fully aware of your child’s condition and they have the necessary medication at school.

It is your responsibility to make sure medication is in school, fully labelled and still within use by date. Make sure you have signed the appropriate form to enable the medicine to be given by school staff.
When your child is old enough (usually around primary 4 or age 9) and you feel they are able and can be encouraged to carry their own inhaler. Check with your school first – different schools have different rules on this! It is essential a spare inhaler is available in school for emergency use should your child lose their inhaler or leave it behind.
Remember that if your child attends after school care or clubs they should also be aware of your child’s asthma needs and have access to the inhalers your child may need.
Emergency contact details should be kept up to date.

If you have concerns regarding your child’s asthma in school talk to the head teacher, they have ultimate responsibility for children with medical conditions in school. The school can only manage a problem if they know it’s there in the first place!!

Role of the school

Children with asthma should be easily identified, for example on the class register.
Asthma education for staff members should be offered.
An asthma healthcare plan or flowchart should be completed for individual children with asthma.
A reliever inhaler and spacer for each child should be easily available for use in an emergency (not in a locked drawer or room!).
Legislation has been passed to allow your school to give a child with asthma a reliever inhaler if they have an acute asthma attack and the child has lost or forgotten their own inhaler. This will only be available if you have told the school that your child has asthma and uses a reliever inhaler. Check with your school about their asthma policy.
Medication should be taken along with the child if they are out of school on a vacation or trip.
Children with frequent school days lost due to their asthma should be identified and encouraged to contact their healthcare professional for advice.
Children should be encouraged to take part in exercise/activities and if necessary given their reliever inhaler (usually blue) beforehand.
Schools should aim to maintain a healthy indoor and outdoor environment.
Staff should know how to deal with a child having an acute wheezy episode and know when to seek urgent medical advice.

Children with asthma have the right…

To be educated in a safe and healthy environment.
Not to be stigmatised or made to feel different as a result of their condition.
To participate in all educational and recreational school activities along with their friends.
To have access to their medication.
To have access to people trained in managing their condition.
To have their education adapted if necessary (e.g. so they can still take part in some physical education activities).

Information taken from European Academy of Allergy and Clinical Immunology (EAACI).

What can you expect from your school

Each area or council will have a slightly different approach to managing medical conditions such as asthma in school, and legislation, education and health care practices vary between individual schools and areas.

Although teachers have no specific duty or legal responsibility in terms of health provision (they are not medically trained) they are required under a duty of care to help if a child needs medical assistance.

There are some basic needs or ‘rights’ you can expect from your school to keep your child safe and ensure they are fully integrated into school life despite having asthma.

Asthma and school

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Allergic conditions such as asthma, eczema and food allergies are becoming more common and it is thought at least a quarter of school age children are effected.

It is estimated there are on average two children in every classroom with asthma.
Most teachers and school staff are therefore experienced in dealing with asthma and other allergic conditions.
Children spend a huge amount of their time at school and it is important you as a parent or carer feel your child’s asthma is being well managed in the school environment.