The Asthma and Allergy Action Plan for Kids

A Complete Program to Help Your Child Live a Full and Active Life

Allen Dozor, Kate Kelly

• Verlag: Touchstone
• Jahr: 2008
• ISBN:
  9781439104378
• Thema: Medicine
• Thema: Medical Theory, Practice & Reference

Statistics show that up to 40 percent of children in the United States suffer from allergies and at least 10 percent suffer from asthma. That translates into almost five million American children affected by both allergies and asthma. And as Dr. Allen J. Dozor, head of one of the largest pediatric pulmonary practices in the United States, has seen among his patients, some of the most upsetting effects of allergies and asthma are the psychological wounds inflicted on a child's self-image. There is the constant protectiveness from caregivers, confusing limits and rules, headaches, obesity, shortness of breath, and sleep deprivation. In some cases these side effects, such as stress and obesity, cycle back to make the original condition worse.
Dr. Dozor's plan, developed over the last twenty years, is designed to empower both parents and children. His warmhearted but reality-based approach includes

• How to give the right amount of medication for best effects and no side effects
• Empowering your children to manage their own condition so that they can feel safe and secure
• Prevention and management in school
• Handling emergencies

And much more!

PART ONE
WHAT IS
HAPPENING
TO YOUR
CHILD?

ONE
An Unnecessary Burden:
Feeling Fair-to-Poor When
Good-to-Great Is Possible

Allergies and asthma are two of the fastest growing health problems for children, and their complexity challenges both doctors and parents. What causes a rash or mild wheezing in one youngster may cause another to be hospitalized. Lunchtime, a birthday party, or a school trip can be life-threatening for a child with severe food allergies. Allergies to insects or drugs can be medical emergencies. A child’s allergies or asthma affects everyone around them: parents, teachers, coaches, baby-sitters, and even schoolmates.

Every day I meet parents desperate for information: What is asthma? What are allergies? What’s the difference between croup, bronchitis, asthma, and pneumonia? Will our child grow out of it? Do we need to keep our children on medications? What are the risks? How can we prevent an attack from occurring? Should we get rid of the cat? Can we get a dog or bird? Should we move to Arizona? What about homeopathic remedies? Would acupuncture help? Should we buy an air purifier?

Some of the most upsetting effects of allergies and asthma are the wounds these chronic conditions may inflict on a child’s self-image and self-esteem: constant concern and protectiveness from parents and teachers; confusing limits and rules to follow; chronic symptoms such as fatigue, headaches, obesity, shortness of breath, itchy eyes, nasal congestion, poor sleep, chest pains, or stomachaches; and the inevitable comparisons children make to the unencumbered lives of siblings and friends. These issues all contribute to a child’s feeling that he is unwell, less able to succeed in life. These symptoms may lead to a vicious cycle of inactivity, poor physical conditioning, poor sleep quality, and the embarrassment of poor athletic and academic performance. All of this is usually unnecessary.

Not Sick but Not Well Either …

Children with allergies or asthma may not necessarily look sick, but they aren’t well either—you may know the look from your own child. These kids just don’t feel “perfect.” Maybe they are just sluggish, yawning more than they should. Their color may be a bit off; maybe their eyes are puffy or red, not as bright. Maybe they have “raccoon” eyes or look like they didn’t get enough sleep. Maybe they have chapped lips from chronic mouth breathing, or bad breath from chronic nasal or sinus congestion. Children with poorly controlled allergies or asthma may have decreased appetites, abdominal cramps, constipation, or irregularity.

Few people—even those closest to them—realize how often children with asthma and allergies find their lives significantly altered. While severe illnesses, late-night visits to the emergency room, or hospitalizations are rarely forgotten, less obtrusive illnesses often are. “Malady amnesia” sets in; once the discomfort passes, memory fades. After about six months, many parents forget when their child came home early from school. A parent may remember writing a note to excuse Susie from gym class, but be a bit hazy about what she told them happened during recess. Many parents don’t know if their child coughs frequently while sleeping. If allergies and asthma run in the family, everyone may be coughing, and parents may have become used to it. And of course, if there are two or more children in the house, memories blur.

Studies show that parents, physicians, and children often underestimate the frequency and severity of children’s symptoms. Consider these one-year statistics from “Asthma in America,” a recent national study conducted by the pharmaceutical company GlaxoSmithKline:

• 32% of children with asthma went to the emergency room for asthma.
• 9% of people with asthma required hospitalization for asthma.
• 29% of people with asthma had unscheduled asthma-related visits to their doctor’s office or clinic.
• 49% of children with asthma missed school because of their asthma.
• 30% of patients with asthma are awakened from sleep with breathing problems at least once a week.
• Only 22% whose symptoms are consistent with severe asthma actually describe their symptoms as severe.

Most patients overestimate how well controlled their asthma actually is. Chronic low-level difficulties such as mild sneezing or coughing frequently go unaddressed, yet over time can be quite debilitating. That stuffed-up congested feeling can make it difficult for a child to function at an optimum level, whether it’s sitting still for story hour in kindergarten or taking an oral French exam in high school.

Allergies or asthma can significantly interfere with participation in sports, school trips, physical education classes, and play activities. They might not sleep as deeply, or dream adequately. They may not awake fully rested. They may not be as alert or have a normal attention span. Peer relations may suffer. They might not do as well on tests and other school activities. Teachers, counselors, and administrators may notice behavioral problems or that a child’s school performance has slipped.

Obesity and Asthma

Both obesity and asthma are occurring with increasing frequency, and no one is sure why. Clearly there is a relationship between these two serious problems. Kids with poorly controlled asthma are more likely to be overweight, and it is more difficult to control asthma in kids who are obese. Good asthma control may help kids exercise more and burn more calories, which would help decrease obesity.

Worrying About Life-Threatening Allergic Reactions

Severe illness is more obvious. Those with more serious forms of asthma may have been recently hospitalized or they may be going through a spell when they cough all night, depriving them of sleep and terrifying anxious parents.

These problems ripple through a community, affecting life in the classroom and at friends’ homes. Is a classroom rabbit worsening a child’s allergies? What about Grandma’s cat? Can a child safely attend summer camp? I hear these worries every day.

Parents of children with food allergies live with a special burden. Every day they wake up and go to sleep worrying that they will slip up, that their child will eat something cooked in peanut oil, for example, and experience a life-threatening emergency.

Allergies to insect stings or latex may cause severe reactions, even anaphylactic shock. These parents find they must live a life of hypervigilance.

I remember Rachel, a teenager whose mother lived in deadly fear that her child would be exposed to peanuts. For fear that the smell from someone’s bag of peanuts would take her daughter’s life, Rachel’s mom never allowed her to fly. And despite the fact that most airlines have responded to these concerns by banning peanuts, Rachel’s parents still have not overcome their fears. My heart goes out to families who must live with these fears. My goal is to do whatever I can to lessen their burden.

Living with a Chronic Condition

One of the most difficult parts of living with allergies and asthma is coming to grips with their chronic nature—they are an “always” affair. Most childhood illnesses come and go, with an end in sight. Allergies and asthma worries never seem to end—sometimes on the front burner, sometimes on the back, but always there. This is very tiring for children, their parents, their siblings, their friends, and even for their physicians.

It gets to the point where parents don’t even complain when their children fall asleep in school because of their medications, have nosebleeds from their nose sprays, or seem jittery from their inhalers. Many children and their families are accustomed to living with these chronic discomforts as well as low-level nasal stuffiness, itching, rashes, coughing, and fatigue—they’re just not a “ten.” Maybe they’re a “nine,” or sometimes an “eight.” Not enough families speak up when their child coughs or wheezes after running the mile run in gym. Physicians often don’t ask and parents often don’t tell them that their child wakes up in the middle of the night because they can’t breathe through their nose or need their inhaler. In fact, many children don’t even tell their parents.

This level of discomfort is unnecessary. With attention and persistence, solutions can be found. I have heard from countless families over the years about the remarkable changes they see in their children when their symptoms are well controlled. Their children simply feel better. They sleep better, eat better, and participate more fully in family life, school, and activities with friends. Parents often notice their children are in a better mood, fighting less with their siblings, complaining less as they head off to school.

The Problem with the Do-It-Yourself Route

Seeking scheduled professional medical care is difficult, expensive, and time-consuming. Everyone is so busy it is quite understandable when a mother or father decides to run to the nearest drugstore for an over-the-counter (OTC) remedy that might offer some relief. This can be very confusing, since there are literally hundreds of medications for respiratory symptoms. Well-known brand names are often attached to many different products. For instance, let’s say you’re advised to give your child Robitussin, one of the most well-respected and established brands. Should you buy Robitussin expectorant, Robitussin DM, or Robitussin Cough and Cold? Should you choose regular strength or extra strength? When should you choose the “children’s versions” as opposed to the regular ones? And now they all come honey flavored? What would you guess is in Robitussin Honey Flu? (Not the flu, I trust.)

These products may include any number of ingredients, in a bewildering array of strengths, and are designed to help some or all of the common symptoms: itching, sneezing, nasal congestion, coughing, wheezing, fever, or body pains. OTC remedies are often short-acting, have limited effectiveness, and may cause side effects. A parent would never give a child a sleeping pill before sending him off to school. Yet when administering over-the-counter allergy/cold remedies, parents have often done almost the same thing—the poor kids are lucky to be able to keep their eyes open, let alone focus on the classroom lesson until 3 P.M.

One of the ironies of our American healthcare system is that many of the older over-the-counter medications may actually have more side effects than newer medications available only by prescription.

One striking example of the complexity of this situation involves the most common allergy remedies, antihistamines. The first generation of antihistamines, now more than twenty years old, was a great advance, and these medications remain important. An old-fashioned first-generation antihistamine is still the best choice during a severe acute allergic reaction. However, because these medications are short-acting and may cause drowsiness, delayed reaction time, and a dry mouth, the pharmaceutical industry has worked hard at improving on them, successfully developing second-, third, and even now fourth-generation antihistamines with fewer side effects and longer durations of action. These advances are great for people with chronic allergies.

One of these newer antihistamines, loratidine (Clariten), is now available without prescription, which is great for many people who only need such a medication once in a while. However, these newer medications are expensive, and as long as they require a prescription, they are covered by most U.S. health insurance plans. Once they become non-prescription, the money to pay for them comes directly out of consumers’ pockets. Not surprisingly, insurance companies have been vocal advocates of this “improved” access to newer medications, but consumer advocates or patients who need these medications for months or years are not so happy with this shift in expense.

Whether the best medicine for your child is prescription or over-the-counter or some combination of the two, it is still advisable to consult a doctor.

Looking for Natural Cures

More and more parents come to my office looking for natural cures, and I don’t blame them. We all want to offer our children a cure that will help while causing no harm. Alternative approaches to allergies and asthma appear at a dizzying rate. Homeopathic remedies, herbal medicines, vitamin and mineral therapies, etc. have taken over huge sections of our pharmacies, health food stores, and supermarkets.

Very few of these approaches have been proven to be either effective or ineffective, because the industries profiting from these approaches are quite happy to remain in the shadows, away from the prying eyes of the FDA and other regulatory agencies. Does this mean these natural remedies don’t help? No. But can you believe the claims on these packages? Sadly, this answer is also no.

The massive amount being spent on these products is a testament to the sad state of affairs for many children with allergies and asthma. Parents are rightly concerned about side effects of medications and yet they really don’t want their kids to suffer, so they will try anything for their children.

Prescription medicines are getting better and better, and the side effects are also being reduced. The best approach for any family is to work with a medical professional to find the right combination that helps your child with few, if any, side effects.

In the Doctor’s Office

My job is to evaluate children referred from other physicians: pediatricians, family physicians, and allergists. These are kids who are not doing well, children who have not responded adequately to their physician’s approach. I see children who are coughing, sneezing, and wheezing despite many visits to many different physicians.

Every week I meet patients who are suffering needlessly: infants who have already been hospitalized once or twice; kids missing school twenty or more days each year; athletes who have given up sports; teenagers who wake up sneezing and coughing two hours earlier than necessary and are already suffering from a headache. I meet children of all ages used to jitteriness, sleepiness, and stomach pains from their medications.

Primary care physicians usually refer these children to me because they are concerned something is being missed, that they must suffer from something other than just allergies or asthma. And indeed my first goal is to make sure they don’t suffer from rarer conditions. About 5 to 10 percent of children thought to have difficult-to-control allergies and asthma do turn out to have a complicating or modifying condition. The vast majority of the time, however, there is no underlying rare diagnosis. Most of the time the problem is not the diagnosis, it is the prescribed therapy that has proved inadequate.

There are many reasons for this failure to adequately control children’s symptoms. It’s not easy. It can be very time-consuming to manage these conditions. There is a lot of “trial and error” involved, and every child ends up req...

Inhaltsverzeichnis

• Cover Page
• Title Page
• CONTENTS
• INTRODUCTION
• PART ONE
• PART TWO
• PART THREE
• PART FOUR
• PART FIVE
• PART SIX
• APPENDIX RESOURCES
• ACKNOWLEDGMENTS
• INDEX