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Questions Parents Ask
They ask some of these same things kids do Parents ask some of the same questions that the kids do: often they want to know what they are doing wrong. Again, I always try to explain that there's not necessarily anything that they are doing wrong and to focus on the hereditary part of it. In addition, parents often express confusion about the medicines we use to treat asthma, and they express confusion about the causes of the asthma and what the triggers are for their particular child. I really try and break those things down for them and tell them what we know about asthma, list the kinds of triggers that a lot of kids have, tell them about the triggers that we think their child has, how they can manage it control it so that their family can do the things it wants to do.Shari Nethersole, MD, Pediatrician, Department of Medicine Why their kid got asthma- Part I Parents often want to know why their kid got asthma. The answer that I generally give to that question is there are two big reasons. The first is that asthma is genetic, which means your child inherited genes which came from you and the other parent which predisposed him or her to asthma. The second big contribution to asthma is the environment, so a child who has a genetic predisposition for asthma usually doesn't instantly have asthma when they're born, but through gradual exposure to things which we call allergens, which come from the environment and through allergic responses, develops inflammation in the airways which then causes asthma. So if a child who has two parents with bad asthma grows up in urban Boston in a home with lots of dust mites and cockroaches he or she is probably going to have asthma, and a kid who has no allergy history in the family and who lives in Denver, Colorado in the mountains with no mice or dust mites is probably not going to get asthma. Those are two extreme examples that I use to help explain the genetic and the environmental components of asthma to parents.Hans Oettgen, MD, PhD, Associate Chief, Division of Immunology, Children's Hospital Boston Why their kid got asthma- Part II Sometimes it's confuses parents how they could have contributed genes for asthma to their child if they don't have asthma and the other parent doesn't have asthma. I often explain how genes can skip generations and even if you yourself don't have asthma, you can still carry the gene that predisposes to asthma and can pass that gene down to your child. In combination with certain other genes from the other parent, your child can wind up with a genetic tendency to get asthma. The environmental part is easier for people to grasp, because there is sometimes tangible evidence of what causes an asthma attack— a kid goes over to Grandma's house with the cat and starts wheezing or coughing, for example. People can really appreciate that environmental changes can make symptoms better or worse.Hans Oettgen, MD, PhD, Associate Chief, Division of Immunology, Children's Hospital Boston Parents express some frustration about the environmental component of asthma because sometimes they don't have control over their environmental conditions. If they live in an apartment that they don't own, for example, control of certain things is taken out of their hands. So they have a lot of questions about how the environmental things they cannot control will impact their child's asthma, and about what can I do to try and change and/or improve their environments. There are some things that parents can do that can minimize environmental triggers for asthma, like not having standing water in places or a pile of damp clothes around the house. There are approaches they can take to advocate on behalf of themselves for their environment. They can speak with the landlord or go to the Inspectional Services Division; they can even get legal advocacy if necessary. I help direct parents though that process and let them know that there are some other options besides “My landlord won't do anything about it so I'm stuck.”Shari Nethersole, MD, Pediatrician, Department of Medicine Concerns about environmental triggers For parents who live in the city, their concerns are often about environmental triggers. They have mice and mites and mold and carpets and maybe neighbors who smoke, all of which make their child's asthma worse. A big part of their concerns is that they don't have control over altering their child's environment, so they can't help to make their child's asthma better. Sometimes I write letters to landlords about the carpet or about the actual environment in the apartment and try to get them to change it. In addition to advocating for these families, we refer them to various asthma programs in the city, and some of the heath insurers, like Neighborhood Health Plan, have staff who will go out and do homes visits with families. Our community asthma program, the Community Asthma Initiative, is an option for kids depending on where they live in the city.Joanne Cox, MD, Medical Director Children's Hospital Primary Care Center, Associate Chief, Division of General Pediatrics, Children's Hospital Boston Do we have to get rid of our cat? “Do we have to get rid of the family cat?” is another common question parents ask. Ideally, you don't want a cat or any other feathered or fur-bearing animal in the house if the child is allergic to them. But families often have very legitimate reasons for having cats in the home. There are many families with whom we work whose ability to control their home environments are limited; the buildings in which they live may have cockroach infestation or rodent problems which the family cat helps to control. It's a negotiation point with parents— I encourage them to make the child's bedroom a safe haven from any cat allergens, to make that space as allergy friendly and allergy safe as possible. If you have a cat in the house and you need that cat to help minimize the rodents in your house, or even if the cat is a beloved family pet that you can't part with, I tell families to keep the cat out of the bedroom and keep the cat off of the child's bed. If there is a safe haven for the child that's as clean and allergen-free as humanly possible, we know that he will have the best chance of breathing than he would anywhere else in the house.Amy Burack, RN, MA, AE-C, Community Asthma Programs Manager, Children's Hospital Boston Parents think their kids are on too many medications A lot of parents think their kids are too many asthma medications. Understandably, they are focused on the “here and now” and they want the medicines that are going to help their kid feel better fast. They are less willing to fill the prescriptions for the medicines for which there is no immediate positive effect, even though those medicines can often reduce long-term complications for their child.Elizabeth R. Woods, MD, MPH, Associate Chief, Division of Adolescent/Young Adult Medicine, Director, Children's Hospital Boston Community Asthma Initiative Some parents are really hesitant about using the controller medicines, the inhaled steroids, because they have the word “steroids” in their name. I make sure that parents understand that these inhaled cortical steroids are different than the steroids they hear about on the news, that they are not the same steroids that athletes abuse and that they don't do the same kinds of things or have the same kinds of side effects. Parents often worry that if their child takes steroids every day that the steroids will build up over time. There is some absorption you get of the inhaled steroids into your body, but the amount is much less than is absorbed during a five-or-six-day course of oral steroids which are used during asthma attacks. In other words, if a child has two bad asthma attacks over the course of a year and they need to come into the hospital and take the oral steroids for several days each time, the amount of steroids absorbed during those two asthma attacks is more than the kid would get using inhaled controller steroids every single day for a year. I explain to parents that these steroids have been studied and there are no significant side effects from using inhaled steroids on a daily basis. So I try to point out that it's a risk/benefit thing: there are very few risks and a lot of benefits. Shari Nethersole, MD, Pediatrician, Department of Medicine What is this steroid business? Parents all have concerns about medications: “What is this controller medication steroid business?” We hear a lot of that, and so we spend a lot of time overcoming the myths associated with inhaled steroid use. We make sure parents know that the inhaled steroids we use to treat asthma aren't the “roids” that the athletes use, and that their kids won't build muscle, bulk up or have the other dangerous side effects associated with anabolic steroids.Amy Burack, RN, MA, AE-C, Community Asthma Programs Manager, Children's Hospital Boston Side effects of preventative medicines I think that some families are worried about side effects from preventative medicines since they should be taken all the time. The most common preventative medicines that we use are steroid inhalers, and families have concerns about giving their children steroids every day. So we talk with them about the fact that the steroids only go to the lungs and are not absorbed systemically, that there isn't a lot of published data saying that they negatively affect the child's health, and there is a lot of published data that says that they really help control the child's asthma.Joanne Cox, MD, Medical Director Children's Hospital Primary Care Center, Associate Chief, Division of General Pediatrics, Children's Hospital Boston How can she have asthma? She doesn't wheeze! “How can my child possibly have asthma? She doesn't wheeze” is something we hear from a lot of parents. There are plenty of children with asthma who don't wheeze but who cough incessantly. There are some children whose asthma is so severe that they not only don't wheeze or cough, there are no breath sounds at all; the airways being so inflamed and narrowed that air can't move around enough to generate any sound. Parents need to be educated that each child with asthma is different in terms of severity levels, signs and symptoms, triggers and response to medications. What applies to one child, doesn't necessarily apply to the next. I like to reinforce with parents that their children are unique and special in every way- including how their asthma affects them.Amy Burack, RN, MA, AE-C, Community Asthma Programs Manager, Children's Hospital Boston Often times parents come in to our offices having been being seen by their child's primary care physician, but have never been told that their child has asthma. When they first hear the word they say “Well, I didn't know s/he had asthma.” What we try to do is emphasize the fact that their child is still the same child with the same set of symptoms, but we are just labeling it differently so that they can understand better what to expect and what medications are to be used and what they ought to be aware of as triggers. It's often times a shock to parents— even when they have been dealing with this awhile and the child has been receiving all the asthma medicines— somehow it's never been made clear to them that the possible diagnosis for their child is asthma. Frank Twarog, MD, PhD, Senior Associate, Department of Medicine, Division of Immunology |
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Hospital Boston Department of Psychiatry. All Rights Reserved. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. Updated: June 5, 2007 |
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