When to Call a Doctor or 911

If your child has been diagnosed with asthma and has an asthma action plan (which tells you what medicines to take during an asthma attack), do the following.

Call 911or other emergency services immediately if your child has severe asthma symptoms (in the red zone of the asthma action plan) and you have followed the plan, but:

• Your child is still having severe difficulty breathing.
• 20 to 30 minutes after taking the extra quick-relief medicine, your child does not feel better and/or his or her peak expiratory flow (PEF) is still less than 50% of the personal best measurement.

Call your doctor immediately if your child:

• Has asthma symptoms that get worse and you feel there is nothing else you can do at home.
• Has had an asthma attack in the red zone, and 6 hours after taking the extra medicine the following are true:
  • The child still requires inhaler medicine every 1 to 3 hours.
  • The peak expiratory flow is below 70% of the personal best measurement.
• Is in the yellow zone of the asthma action plan and continues to have a peak expiratory flow below 70% of the personal best measurement in spite of home treatment using the asthma action plan.
• Is having a first attack of asthma symptoms, and they include wheezing, chest tightness, and moderate difficulty breathing.
• Is coughing up yellow, dark brown, or bloody mucus.

Call your doctor if your child:

• Has asthma symptoms, you do not have an action plan, and the symptoms are mild (chest tightness, cough, and slight shortness of breath or tiring easily during exercise).
• Is having symptoms in the yellow zone almost every day, but inhaler medicine is providing quick relief.
• Has asthma and his or her PEF has been getting worse for 2 to 3 days.

If your child has not been diagnosed with asthma but has asthma symptoms, call your doctor and make an appointment for an evaluation. Many children and teens with frequent wheezing have asthma but are not diagnosed with the disease. Children and teens who are less likely to be diagnosed with asthma include:¹⁸

• Girls, especially teenage girls.
• Smokers or those exposed to household cigarette smoke.
• Those with low socioeconomic status.
• Those who have allergies.
• African Americans, Native Americans, or Mexican Americans.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your child's symptoms or condition without using medical treatment.

If you think your child has asthma, watchful waiting is not appropriate. See your doctor.

If your child has been getting treatment for 1 to 3 months and is not improving, ask your doctor whether the child needs to see a specialist (allergist or pulmonologist).

Watchful waiting may be appropriate if your child follows his or her asthma action plan and stays within the green zone. Monitor your child's symptoms, and continue to avoid asthma triggers.

Who to See

Health professionals who can diagnose and treat asthma include:

• Pediatricians.
• Family medicine physicians.
• Nurse practitioners.
• Physician assistants.
• Internists.

Your child may need to see a specialist (an allergist or pulmonologist) if he or she:

• Has moderate persistent to severe persistent asthma.
• Has other medical conditions that make it hard to treat asthma.
• Needs more education or has difficulty following the asthma action plan.
• Is not meeting the goals of treatment after several months of therapy.
• Has had a life-threatening asthma attack.
• Needs skin testing for allergies or may get allergy shots.