ARTICLES

Coping Strategies for School Children and Teens
with Asthma

Ten year old Lisa writes: "One day in gym class I was playing soccer and running hard. All of a sudden it got harder and harder to breathe. I knew I had to sit down to rest, so I did. But the teacher made me go back into the game. She was not my regular teacher so she didn't know I had asthma. I guess she thought I was just 'being lazy'. I barely managed to run for a few more minutes until the bell rang. Then I went to take my Ventolin and talk to my regular teacher. My teacher felt bad that this happened and went to talk to the other teacher about it. In the end she came to apologize. By then I felt better, so it was okay. But at the time I felt like crying when the teacher made me go back into the game, when I knew, I needed to rest. Sometimes it's hard to keep up with the others in your class if you have asthma."

The goal of asthma management is to allow your child to lead as normal a life as possible. This means that he/she should be able to participate in sports. However, each asthmatic child has a different level of tolerance to exercise. As well, there will be good days and bad days. On good days, there may be no problem, on bad days the tolerance level may be very low. How do we know when it's going to be a bad day? Outdoor exercise on a windy, dusty spring or fall day will often bring on an asthma attack; as well as outdoor exercise in temperatures of -20º C or colder. We know that high pollen count days in spring and grain dust in the air at harvest time causes problems, as does cold winter air. There are also times when the tolerance level is low because of a viral infection. Each child has his/her own "sensitive" times and it is very important to pay attention to these.

It can be very frustrating for a child with poorly controlled asthma (and/or allergies) to try to keep up with the rest of the class. Each child should be allowed to participate in physical activities until they reach their own "limit". Generally a child with asthma knows when they reach this level.

How children cope with asthma is often related to the attitude of the people around them regarding their condition. By keeping lines of communication open and allowing children to express their feelings about it, a healthy outlook about asthma is more likely to occur.

To determine how your child is coping with asthma you could ask him or her the following questions and then analyze the answers to help create an action plan for them to follow.

1. "What is the hardest part about having asthma, especially at school?"
(A typical answer might be: wheezing during gym…having a coughing fit…having to use an inhaler…being different).

2. "How can things be made easier for you at school?" (A typical answer might be: It would be better if there were no pets…or if the teacher would believe me when I can't run, play basketball, etc. and that I'm not trying to "wimp out…" or if the class would understand my asthma the way they do "Sally's" diabetes).

An allergic/asthmatic child's performance cannot be expected to be consistent. Achievement will be high on the days the child is feeling well. There will also be days when allergy and asthma-related problems surface. These are the days when your child's performance will not be up to your hopes, the teacher's standards and most important, your child's expectations of themselves. On these days the child needs a hug, not a scolding, plus some consolation for the positive efforts they make will ensure better days ahead. An informed and understanding teacher can do a lot to improve the overall well-being of an asthmatic child. In elementary school, write a letter to the teacher explaining your child's specific situation. This letter should include information explaining what can happen, what to do if it does happen, and what situations can cause the problems for your child (see sample below).

The letter to the teacher(s) should be available at the beginning of each school year. Also it is important to follow up with the teacher to see if there are any concerns regarding the information provided. Most teachers have had some experience with an asthmatic child since approximately 20% of children have some level of asthma. However, it is important for teachers to remember that they cannot compare one asthmatic child to another, as the degree of severity can be considerably different. It is also important to check the information in the letter has been made available to the gym teacher.

Many people don't believe that asthma can be a problem for your child. However, in reality, children may go through difficult experiences whenever they are around others who are not educated about asthma. What can we do to help avoid these psychological side effects?

1. Educate those around you about asthma and its effects. Talk to your family, write letters to teachers; speak to school groups, friends, neighbours, babysitters, etc. Help them to understand what asthma means for your child.

2. Listen to and believe the child. They are not going to "fake" an asthma attack because it really isn't "fun" to struggle for each breath.

3. Take your child to the doctor for regular check-ups. Asthma medication should be assessed regularly to help keep asthma under control. This will also prevent asthma attacks, which in turn will help your child's emotional status by allowing participation in most day-to-day activities.

4. Become involved with the Allergy/Asthma Information Association or your local Asthma Support Group. This will help you as a parent to learn more about asthma, as well as enable you to talk to others who are dealing with the same or similar situation.

5. But most of all, have fun with your child so that he/she develops a positive attitude so important for coping with asthma on a daily basis.

Unique circumstances for teens with asthma include less parental involvement in schooling, i.e., field trips, track & field days, and/or busing. There is also the issue of more exposure to allergens including the addition of vending machines, concessions, or a cafeteria in junior high and high school (e.g., peanut allergy issues). Sometimes exposure to friends who smoke, or use of scented personal care products such as hairspray, cologne, aftershave, etc., will trigger an asthmatic's sensitivity. Teens are notorious for having altered sleep patterns such that they want to stay up late at night and prefer to sleep late during the day. However, early classes at school often prevent them from getting adequate sleep. This in turn causes them to get "run-down", encouraging viral infections. Rescue inhalers need to be available at all times - especially when playing sports or participating in classes where asthma triggers are prevalent (e.g., industrial arts). Teens are learning to test their independence and are developing their own sense of worth and self-esteem. They tend to put more importance on what their friends think than what their parents say. It is important to allow your child to start making their own decisions, but with some subtle guidance from you.

In conclusion, coping skills from asthma vary from one child to another, and from one teen to another. But no matter what age your son or daughter is, you can continue to advocate for your child. In the younger school years writing a letter (see below) to the teacher/s is helpful; even in the junior high school years. By senior high school, there is generally less parental involvement in schooling. By then, the teen can usually speak up for themselves, however in certain situations, the parent may still need to assist on the teen's behalf (e.g., Phys. Ed. Teacher doesn't acknowledge limitations due to asthma). As a parent, it is important to assess each situation on an individual basis. Encourage your child/teen to participate in sport; get enough rest; and limit social activity when necessary. Above all, whether child or teen, see your doctor for regular checkups to determine whether the medication being used is controlling the asthma to its best potential.

SAMPLE LETTER for the Teacher
Date
Your address and phone number

RE: Lisa Smith
Dear xxx
Lisa Smith is a moderately severe asthmatic. Her asthma is controlled by a daily medication routine at home. There are times, however, where she may require medication at school. Certain physical activities seem to cause problems. Endurance exercise such as running and skipping; sports such as soccer, floor-hockey, volleyball and basketball may cause an asthma attack. She should be allowed to participate until she reaches her own well-known limit. At this point, she must be allowed to rest. There may also be times when she will need to spend recess indoors, especially during cold, windy or wet weather, or when her asthma has flared up.

An asthma attack is characterized by increased coughing, wheezing, shortness of breath, struggling to breathe, and in extreme cases, cyanosis or bluish lips. If Lisa appears to be having an asthma attack at school:
1. have her sit down to rest, not lie down.
2. speak to her calmly, don't panic
3. encourage her to use her medication (Ventolin) which she carries in her backpack
4. call me at the provided phone number.
If you are unable to reach me and the breathing difficulty continues after using the Ventolin, please call an ambulance to take her to ____________ Hospital Emergency Department. Her doctor is ___________ and her Health Care number is ___________.

Lisa's asthma attacks have been triggered by exposure to animals (e.g., cats, dogs, etc.), dust, pollens, smoke, exercise, cold air, and viral infections. Strong odours such as perfumes, paints and chemical cleaners may also cause problems.

Please help us monitor Lisa's asthma by contacting me if she needs to stop physical activity, miss recess outdoors, or seems to be overusing her medication due to asthma symptoms. If you have any questions or other concerns about her asthma, please feel free to call me at the provided phone number.

Yours sincerely, Mrs. Smith

Allergy/Asthma Information Association,
Box 100, Toronto, Ontario M9W 5K9
Phone (416) 679-9521 or 1-800-611-7011  Fax: (416) 679-9524
Web site: http://www.aaia.ca
E-mail: national@aaia.ca   

Terms of Use: The information on this site does not constitute medical advice and is for your general information only. We cannot be held responsible for anything you could possibly do or say because of information on this site.   Consult your family physician or allergist for specific questions or concerns.

This article courtesy of the Allergy/Asthma Information Association at www.aaia.ca and the Calgary Allergy Network web site at www.calgaryallergy.ca. May be reproduced for educational, non-profit purposes with proper attribution.
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