If your child has asthma, one of your main goals may be to avoid trips to the emergency room (ER) for breathing problems. That makes perfect sense, but it's also important to know when going to the ER is the right choice.

You'll do a better job of making that decision if you discuss this issue with your child's doctor before your child has a severe flare-up. After discussing it, your instructions should be spelled out in your child's asthma action plan. The plan should list peak flow meter readings or specific symptoms that will serve as your cue to go to the ER. If your child is old enough, he or she should know about these important cues as well.

Some general signs that indicate you should seek help very quickly by getting to the doctor (or if the doctor isn't available, getting to the ER or calling an ambulance) include:

• if there are changes in your child's color, like bluish or gray lips and fingernails
• if your child is having trouble talking
• if you can see the areas between your child's ribs and at the base of the neck pull in as he or she inhales (these are called retractions)
• if your child uses his or her rescue medications repeatedly for severe flare-up symptoms that don't go away after 5 or 10 minutes or they return again quickly
• if your child's peak flow reading falls below 50% and doesn't improve with medication

Going to the ER

Some advance planning can make trips to the ER less stressful for you and your child. Here are some ways you can make it a little easier:

• Know the location of your closest emergency room. If there's a children's hospital ER nearby, use that one and have the address and phone number for it readily accessible (it can be written on your child's action plan).
• If you have other children, try to make arrangements with a relative or other caregiver who can care for them in an emergency situation. But don't let the lack of a babysitter delay your trip to the ER. Someone can always come to the hospital and pick up your other children.
• Take along a copy of your child's asthma action plan or a note with the names and dosages of any medications your child is taking, so that you can inform the medical staff at the emergency room.

Preventing ER Trips

Well-managed asthma is rarely life threatening. People who have died from asthma usually haven't taken their medications as prescribed and have a history of repeated severe asthma flare-ups and emergency care. If you and your child take asthma seriously and work to manage it, you can reduce the chances that your child will need to go to the emergency room.

Here are some steps to take:

Follow your child's asthma action plan.

It's important to monitor your child's asthma using a written plan your child's doctor has helped you create. This plan will outline your child's day-to-day treatment, list symptoms to watch for, and give detailed, step-by-step instructions to follow when your child has a flare-up.

Help your child avoid triggers.

Your child's doctor should be able to help you identify the triggers that can cause asthma flare-ups. These may include animals, dust mites, mold, tobacco smoke, cold air, exercise, and infections.

Make sure your child takes his or her controller medications.

Your child should take these medications as prescribed by the doctor, even when he or she is feeling fine. Skipping controller medications can cause the lungs to become more inflamed, which can lead to a decrease in lung function. (This can happen without your child even experiencing any symptoms). It also puts the child at risk for more frequent and severe flare-ups.

Keep rescue medications with your child.

Many kids must go to the emergency room simply because they didn't have their rescue medications handy. Your child should have his or her rescue medication accessible at all times.

Make your child a partner in his or her asthma management.

As soon as your child is old enough, make sure he or she understands the asthma action plan and the importance of following it. Some children with asthma, especially teens, resist taking controller medications and rely instead on their rescue medications to help them on an as-needed basis. This is never a good idea and will increase your child's chances of needing emergency care.

Know the early signs of a flare-up.

Every child's asthma is different. Some children cough only at night, but others have flare-ups whenever they get a cold or exercise outside. Get to know your child's asthma and pay attention to what happens before he or she has a flare-up, so that you know the early warning signs. These signs may not definitively mean that a flare-up will happen, but they can help you to plan ahead.

A peak flow meter is an extremely useful tool in helping to determine if your child might be getting ready for a flare-up. Your doctor can give you specific number ranges to look for.

Other early warning signs of a flare-up may include:

• coughing, even if your child has no cold
• tightness in the chest
• throat clearing
• rapid or irregular breathing
• inability to stand or sit still
• unusual fatigue
• restless sleep

Maintain good communication with your child's doctor.

Be sure to call him or her at the early sign of a flare-up if you have any concerns. Being proactive means you may keep your child's symptoms from worsening and can make a trip to the doctor's office instead of the emergency room.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: April 2007