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Even if no one smokes in your home, don’t forget to speak to your child’s caretakers (baby-sitters, relatives, friends’ parents, neighbors, a parent who carpools and smokes in the car) about the importance of avoiding environmental tobacco smoke. Identify other places where your child may be exposed to tobacco smoke. If your child is old enough to understand, talk with him about appropriate steps he can take himself to avoid smoke exposure.

If parents or caretakers continue to smoke, they should always smoke outside and wear a “smoking jacket” that they keep away from the child when they come back into the house. Many adults assume that if they “just step outside” to smoke that they’re protecting a child from smoke exposure. But smoke residue settles on their clothing, skin, and hair, and they bring it back inside. If they smoke several times a day, these adults are actually contributing a considerable amount of smoke allergen to a child’s environment. Smoke from a fireplace or wood-burning stove may also cause a child to wheeze.

Communication

Good communication within the family is essential to manage asthma successfully. Open, honest communication may prevent resentment among family members as well as prevent catastrophic events. For example, sometimes relatives don’t take a child’s asthma seriously enough, even when they are solely responsible for his care. They may forget to give a child his medicine or pay little attention to his asthma symptoms. They may not think that the medicine is helping, or they are concerned that the child will become dependent on it or habituated to it.

Communicating important information to responsible family members is a valuable starting point. They should understand that asthma is a chronic disease. They should appreciate the importance of avoiding common and specific asthma triggers. And they must know how to treat acute attacks.

Your child’s written asthma management plan should be easily accessible and understandable to all family members and other caretakers whenever they are responsible for looking after your child.

Basic information that every responsible relative and caregiver should know includes:

What daily controller medicines your child uses the name of the medicine, the dose, and when, how, and why he takes it

What quick-relief medicines your child uses the name of the medicine, the dose, and when, how, and why to use it

Where these medicines are located in your home

The symptoms of an asthma flare

What to do to treat a flare

When and how to get emergency help

Feeling and Family Members

Other members of the family are often affected by your child’s asthma. A family may not be able to keep a pet, for example, which affects all members of the family. Holding family meetings to talk about feelings or having one-to-one conversations between parents and siblings of the child with asthma can be very helpful. You can address sibling resentment by making the management of your child’s asthma a team effort with everyone doing his or her part to keep your child healthy. All members of the family should attend asthma education classes or occasionally accompany your child to a medical visit to learn more about asthma. Even when there’s little or no resentment about the limits asthma may put on your family, this team approach could be applied to help the entire family achieve a valuable goal.

Brothers and sisters may have trouble understanding why their sibling with asthma gets all the attention. When two children share a room, for instance, problems can arise. The child without asthma may not be very happy about having to keep his toys in another room or jammed into the closet each night. He may want to sleep on. the top bunk, even though his brother with asthma should sleep up there to avoid having tiny particles of dust rain down on the lower bunk.

“Why do I have to clean my room and you never make her? She always gets out of vacuuming her room!” is a common sibling complaint. A child with asthma has to stay away ftom things like dust, so her siblings may feel she’s being pampered by getting out of household chores. When the whole family has to cancel an activity because the child with asthma is having a flare, the other children will naturally be angry and resentful. This is a difficult problem for every parent. Your child with asthma probably is getting more of your time and attention than your other children because she’s not feeling well. Explain the situation to brothers and sisters as matter-of-factly and honestly as you can. This will help them realize why they all need to help keep asthma triggers down. And it will also help them understand that the sibling with asthma isn’t deliberately having flares just to ruin everyone’s day. Look for compromise solutions that fairly satisfy everyone as much as possible.

A child with asthma might not be able to help with the vacuuming or dusting, for example, but there are always dishes to wash.

Communication with a Child Who Has Asthma

As your child grows older, she may start to resent not being “normal.” She doesn’t like missing school or being away ftom her friends because she has a doctor’s appointment or is having a flare. And she probably doesn’t like being reminded to take her medicines.

Allow your child to communicate her frustrations. Help her work through these feelings by using problem solving activities that will encourage her to continue controlling her asthma. For example, ask her what happens if she stops taking her everyday medicines? Walk her through the consequences from a mild flare through hospitalization. Then ask her how it feels to be symptom free when she controls her asthma by taking her medicines.

Most children with asthma feel there is something “different” about them. It is important to discuss these feelings with your child. Allow her to talk about feelings of inadequacy, embarrassment, and other emotions without telling her that she “shouldn’t feel that way.” Instead of trying to talk her out of her valid emotions, acknowledge her feelings and show that you understand by responding along these lines: “I know you hate to miss basketball practice because you love to play.” or “Yes, it’s tough when other kids treat you differently.”

Then move on to help him figure out ways that can help him feel less different. Problem solve with your child ways for dealing with specific situations. For example, some children are self-conscious about using an asthma device at school. Carrying a spacer around can be noticeable by classmates, but a Diskus that fits into a pocket or purse may be more acceptable. Your child can easily use it in a bathroom stall without being noticed.

You could also emphasize that good asthma control will allow your child to do whatever she wants to do without needing to take out the dreaded rescue/quick-relief medicine in public. Help your child set one realistic goal at a time when discussing her asthma management. Talk about what she can do and what you will do to help her reach this goal.

Age-Appropriate Behaviors

Just as children reach milestones in physical growth and development at various ages, their acceptance of asthma as a daily reality in their lives will change with each developmental stage. It is important for parents to understand what reactions to expect. Toddlers, who often resist asthma treatment and are too young to understand its importance.

Whatever your child’s age, keep in mind that her reactions and behaviors will change as she grows and develops. Your expectations about her responses to having asthma will need to be flexible enough to adapt to her feelings and behaviors. But one constant remains: as her parent, you will always need to support and encourage her in managing this disease.

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