Your Asthmatic Toddler May Be Flaring, Not Cranky – The Early Warning Symptoms

I’ve written a couple of times before that I wouldn’t turn this blog into a comprehensive asthma source. For one, the Internet isn’t hurting for good asthma pages–like here, here, and here.

And also?

Asthma Mom morphed into a blog also about air quality and pollution, children’s health, and of course a weekly collection of strange medical links and media.

So maybe you understand my reluctance. Despite it, though, I find myself writing about my kid, her history, my ruminations on breathing problems and healthcare, asthma research, and every other week or so I think, *Ooh, well. There’s that one thing about asthma that’s important to remember, so I’ll just post about it real quick.*

Enough weeks pass, and behold: I appear to be creeping up onto a somewhat comprehensive asthma site. I guess too much information isn’t a bad thing, right? It is, however, forcing me to rethink some of this site’s navigation, as I ran out of tabs for the static pages above months ago. This list from my days as the asthma editor will end up on a page and not just a post as soon as I fix that.

When I was first learning, the more I read about symptoms and early warning flare signs in young asthmatics, the more I started noticing some of them in AG’s behavior and remembering how she acted as a sick toddler, right before she flared.

The very early signs are incredibly easy to miss, but if you can recognize them then you have a better chance of heading off a flare right when it starts. Lots of times, what seems like bad or cranky behavior in a very young asthmatic can alert you to an attack. Even now, if my daughter acts unusually tired but she hasn’t been unusually active, I know breathing problems will (usually) follow.

Here are subtle, early signs of an asthma flare, followed by regular and emergency symptoms:


Early/Subtle Symptoms

1. Mood swings
2. Crankiness
3. Fatigue
4. Watering eyes
5. Dark circles under the eyes
6. Cold symptoms – coughing, sneezing, and runny nose
7. Trouble sleeping
8. Restlessness
9. Low exercise tolerance
10.Any changes in breathing
11.Any changes in peak flow readings

Flare Symptoms

1. Coughing fits
2. Wheezing
3. Shortness of breath
4. Tightness in the chest
5. Peak flow numbers in the yellow zone

Emergency Symptoms

1. Cyanosis – blue-tinted skin, starting around the mouth and resulting from lack of oxygen in the blood
2. Posturing – hunched-over shoulders while breathing
3. Retractions – drawing in of the abdomen under the ribcage while inhaling
4. Peak flow readings in the red zone
5. Major problems breathing
6. Severe coughing or wheezing that doesn’t improve with emergency meds
7. Severe tightness in the chest that doesn’t improve with emergency meds

Want to read more symptom information?

38 responses to “Your Asthmatic Toddler May Be Flaring, Not Cranky – The Early Warning Symptoms”

  1. Asthmagirl says:

    It’s all so true. The bad news is that sometimes as an adult you don’t recognize the clues that things could be heading in the other direction.

    One clue that I’ve noted is a total lack of energy. If I cannot get myself up and going, a peak flow reading often indicates that my lungs are funky…. low air, low energy.

  2. Amy says:

    Yeah, that’s one good thing about her having asthma since—well, birth, basically—hopefully she’ll get used MY recognizing her early symptoms and then continue the practice herself as she gets older.

  3. charmaine says:

    I guess this falls under anxiety, but just this fall I realized that my daughter starts to laugh in an almost nervous way when she is about to have an attack. She doesn’t seem tense or scared, it’s a happy laugh, but it just sounds different than her normal laugh. I think just knowing what’s normal for your child is important. This is a great post and I’m glad you decided to do it.

  4. Amy says:

    Thanks, Charmaine. ITA w/you about knowing what’s normal. It’s catching those little signs and symptoms and recognizing the patterns that made a huge difference in my child’s health.

  5. lpnmon says:

    This is another one of those things that should be told to you as soon as your kid is diagnosed with asthma. I don’t know how many time outs DS got and how many play groups we left early before I figured out that he was calmer and less aggressive with a couple puffs of albuterol. (sorry son.) I felt bad that I was practically using it as a behavioural aide, until someone pointed out to me how hard it was to be well behaved when you can’t breathe.

  6. Great article, I am about 3/4ths of the way through it. I will post some questions after I done. This is good stuff.

  7. Louise says:

    Hi Amy,
    After 15 months of no prednisone and managing colds fairly well, my son is in the middle of a really bad flare right now. This one came on completely differently. Normally, he comes down with a cold and the asthma follows 3 days later. This time I noticed a slight asthma cough 5 days ago, increased his symbicort (which I have room to do because for maintenance he only takes 2 puffs twice per day – max is 4 puffs). Sore throat came on 24 hrs later and full cold 4 days later, asthma so flared had to go on prednisone. I used to think that if asthma was controlled with preventative medicines, flares wouldn’t happen. I know now this is not the case. But my question is, how do you know if the asthma is controlled if your child gets symptoms every time he/she has a cold? After doing ths for 6 years, flares still unnerve me to no end. I sleep in my son’s room with a phone by my side and a quick change of clothes in preparation for a middle of the night ER trip, my stomach goes into knots and I can’t eat properly for days. Ater all this time, I really should be used to this…. but I don’t think I ever will be.

  8. Amy says:

    Louise, I don’t think there’s any “should” about it–asthma is so, so terrifying in a kid, no matter how long you’ve been dealing with it. It DOES get easier, I promise, but I still worry & my kid’s almost 11. I think we’ll always worry, at least a little, and I think that’s normal, you know?

    Anyway, the way I know my daughter is controlled–and illness is her worst trigger–is that she usually doesn’t end up in the ER or on prednisone when she’s flaring. Before we got good control of her asthma, just about every bad flare would involve acute care or oral steroids. Once we attained good control, we were able to help her recover from the flares w/out them.

    Plus, when she doesn’t react poorly to a trigger, she’s in good health. When she wasn’t in good control, she had little tolerance for exercise–which normally isn’t a flare for her–and she’d flare all the time.

    Hope that helps!

  9. Kate says:

    I have a 13 year old son with relatively well-controlled asthma. Unlike the first few years when almost every cold resulted in pneumonia and course of oral steroids, he makes it through most colds without severe trouble and just needs albuterol, rest, fluids, lots of steamy showers and addition of flovent to his maintenance routine.

    We are now experiencing his first significant flare since he had HINI (and pneumonia) in May of 2009. He is now in that limbo phase where he does not have diagnosable pneumonia (mild fevers, I doubt anything would show on x-ray yet, and only wheezing audible by stethoscope) but I can hear his lungs getting junkier and I can tell by his energy, mood, and from experience where this is heading.

    Wonder if others have advice on how to get through this phase and decrease the likelihood of pneumonia. Just moved and this is his first episode with new health care providers so they don’t now him and his patterns, yet. I feel as if I am just standing by and watching him get worse. Ugh!

  10. childcare says:

    Hello there, I discovered your blog by the use of Google at the same time as searching for a similar topic, your website came up, it appears good. I have bookmarked it in my google bookmarks.

  11. Rose says:

    Thanks for posting this. My toddler becomes very clingy right before a flare-up and definitely more difficulty sleeping.

  12. Francesca says:

    This is such an excellent list. Our 2 1/2 year old has severe asthma and he has struggled with it since 4 months old. In infancy, he would wake up too early – around 5 in the morning – agitated and unable to sleep. He was also inexplicably fussy during the day and never became a “settled” baby. Tonight, he has nearly every early warning sign listed above. Usually a great sleeper, he could not fall asleep. We gave him 2 puffs of albuterol and 15 minutes later he fell asleep. We will be upping his daily Flovent to try to stop this flare up. Two years in and we are not used to it. Caring for a child with severe asthma is stressful and it’s something other parents don’t and can’t understand.

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