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Asthma education for children and their families can improve outcomes. This includes making the time to:
- Help the caregiver understand any uncertainty around diagnosis
- Address concerns of the child and carer
- Assess the impact of asthma on day to day activities
- Help carers understand the role of each treatment and how they work
- Explore practical solutions to improve adherence
- Explain what to do when symptoms worsen
Help caregivers/whānau understand any uncertainty around diagnosis
Confirming a diagnosis of asthma in children, particularly in younger children, is difficult even for the most experienced
health professional and can often create uncertainty for the family. It is important to be honest about the diagnosis
if there is uncertainty. If the diagnosis suggests that this child is a “wheezy infant” call it that.
These difficulties may be interpreted by families as inaccuracies, creating a sense of unease. The result can be quite
profound with many parents not ‘believing’ the diagnosis or that a diagnosis cannot be made with certainty and thus do
not engage in the education session or treatment protocols. This may lead to anxiety in the parents and reluctance to
Address the concerns of the child and carer
It is important to establish what the concerns of the child and carers are and to address these. This sounds like common
sense but is often missed as health professionals tackle what they see as the problems. Often the problems are linked
and a common theme can be sourced and so begins the foundation to work together. A good question to ask parents or an
older child is “what is worrying you most?”
Assess the impact of asthma on day to day activities
Key questions to ask include
- What triggers cough and wheeze, what time of the day does it occur?
- Have there been any acute attacks? How severe was the worst attack?
- Have you had to seek emergency or after hours medical care?
- How does the asthma affect the child’s life? Does it limit activities? Have they missed any school?
- How often has the child had to use reliever treatment? How effective was it?
Help carers understand the role of each treatment and how they work
Written asthma management plan are particularly useful in helping children and carers understand the role of each treatment.
A good example of this is in explaining the value in continuing inhaled corticosteroid for long periods of time not short
Explore practical solutions to improve adherence
There are a number of practical solutions that may help children and carers adhere to medication regimens, these may
- Keeping the inhaler in sight so it’s not forgotten, aligning it with an activity done every day like cleaning teeth,
setting the cell phone on alarm (great for older children) or addressing roles and responsibilities in the family. Surprisingly
many parents have a very unrealistic expectation of young children to self administer their medications independently.
- If the child is moving between two homes on a regular basis then perhaps two sets of medication may be more realistic.
Education to both parents/grandparents or other family members may be necessary.
- The parents approach should be firm but kind – there are no choices, the medication will be given. The child may have
a choice “before your story or after” – “when” not “if”. Having a treat like a story or sticker afterwards may help but
lengthy discussions or negotiations usually do not. Reassure and encourage the parents in this approach while acknowledging
- Inhaled therapy should be introduced to a child in an age appropriate way – for example demonstrate how to use an
inhaler and a spacer on a toy to a young child. Show them an appropriate hold to ease delivery and demonstrate constant
praise to both the child receiving the inhaler and the parent giving it.
Adherence/Compliance with prescribed treatment
The main reasons for poor adherence would most likely fall into five categories:
- Parents do not understand the treatment which leads to confusion
- Parents are uncertain of the diagnosis (see above)
- Parents fear the medication (steroid)
- Parents may be disorganised or busy or maybe it is just not a priority in their busy often chaotic lives
- Parents experience difficulty in administration of treatments (address below)
To tackle these issues the key is to find the source of the problem and then work together to find solutions. These
- Addressing the concerns around the medication
- Helping parents understand the role of each treatment and how they work.
It takes time
In older children it is important to establish why they don’t take their medication. Are they embarrassed? Do they believe
they don’t have a problem? Are they disorganised? Or maybe even they can’t be bothered. Educators need to negotiate what
support these children require to acknowledge the difficulties of what we are asking them to do. Educators need to work
beside them not at them to find solutions, to find out what is important to them such as sports and encourage and reward
achievements. The carer’s role here may be to remind but not to nag.
When to call for emergency help
This is one of the most stressful times for parents of a child with asthma – when to call for help if things go wrong
and a fear of missing something important.
- Acknowledge the experiences they have had
- Discuss the calls they have made and congratulate them on doing it to build a parent’s confidence
- Introduce self-management plans to assist in when to get assistance and symptom diaries to help guide management.
Plans need to be relevant to the child and experience of the family, clearly written and understood. Plans will not be
effective if the parent doesn’t accept the diagnosis
- Discuss the plan and encourage questions
- Review at each visit
Asthma education of the child and the family should lead to an understanding of good control of asthma and the role
of medications in achieving this, including how to use inhaler devices and what to do in the case of an exacerbation.
Dr Cass Byrnes, Paediatric Respiratory Specialist, Starship Children’s Hospital – (from a talk presented
at the Respiratory Educators’ Conference 2008)
Carol Fitzgerald, Respiratory Clinical Nurse Specialist, Otago District Health Board
Paediatrics at a glance – The respiratory examination. 2nd edition. Miall, Rudolph & Levene, 2007.
Tu Kotahi Māori Asthma Trust
Tu Kotahi Māori Asthma Society was established due to a need to reduce the barriers for Māori in receiving
quality asthma care.
As well as providing education in homes or in other setting where whānau feel comfortable, the service enables
other social and health issues that may be impacting on a child’s asthma to be addressed.
Tu Kotahi Māori Asthma Society suggests that housing, heating, budgeting, transport and the cost of healthcare
and prescriptions are some of the complex factors that should be factored into an overall asthma management plan. They
recommend the following when developing an asthma management plan:
- Consider a simple pictorial management plan including pictures of inhalers and spacers. This simplifies the instructions
for giving medications and can be followed by anyone in the whānau involved in the care of the child.
- Personalise the plan, including the child’s name. This can be provided to all caregivers, and the school.
- Demonstrate how to use the medication with a spacer and provide simple information that reinforces both technique
and maintenance of the medication and spacer
- Consider using a doll or teddy bear as a teaching aide when demonstrating how to use a spacer to younger children
and whānau. Spacers are less likely to be used if the learning experience is traumatic.