Asthma in Children

“My child keeps coughing or wheezing. Could it be asthma?”

“My child only coughs at night or when running. Is that normal?”

Asthma is a chronic condition involving inflammation and variable narrowing of the airways. Symptoms can come and go and may be triggered by viral infections, exercise, allergens or other irritants.

What Symptoms Should Parents Look Out For?

Common symptoms include:

Wheezing

Whistling when breathing

Recurrent Cough

Particularly at night

Shortness of Breath

Difficulty getting enough air

Chest Tightness

A feeling of tightness or discomfort in the chest

Exercise Symptoms

Cough or breathing difficulty during exercise

Viral Infections

Symptoms that become worse with viral infections

Symptoms may vary from day to day and may not always be present during a clinic visit.

“My child only coughs at night. Could this be asthma?”

It could be.

Night-time or early-morning cough can occur with asthma, particularly when symptoms are recurrent.

However, not every night-time cough is asthma. Post-viral cough, allergic rhinitis, reflux and other conditions may cause similar symptoms.

“Does wheezing always mean asthma?”

No.

Young children commonly wheeze during viral respiratory infections, particularly preschool children.

Asthma becomes more likely when symptoms are recurrent, triggered by exercise or allergens, occur at night, or occur outside viral infections, especially when there is a personal or family history of allergic conditions.

“Can my child have asthma even if there is no wheezing?”

Yes.

Some children mainly experience recurrent cough, although other causes of chronic cough should also be considered.

The diagnosis should be based on the overall pattern of symptoms and objective assessment when appropriate, rather than cough alone.

How Is Asthma Diagnosed?

The paediatrician will assess:

Symptoms

Pattern and frequency of symptoms

Triggers

Possible factors that bring on symptoms

Night-Time & Exercise

Symptoms occurring at night or during activity

Previous Episodes

Previous wheezing episodes

Allergy & Family History

Personal or family history of allergy or asthma

Treatment Response

Response to prescribed treatment

In children who are old enough and able to perform the test, spirometry and bronchodilator reversibility testing can help support the diagnosis.

In younger children, diagnosis may rely more on the pattern of symptoms, clinical assessment and response to treatment because lung function testing may not be practical.

“Does my child need a nebuliser?”

Not necessarily.

Nebulisation is one way of delivering inhaled medication, but many children can effectively use an inhaler with a spacer.

The appropriate method depends on the child's age, ability to use the device, severity of symptoms and clinical condition.

What Can Parents Do?

Avoid cigarette smoke and vaping exposure
Identify and reduce known triggers where possible
Encourage regular activity when asthma is well controlled
Use prescribed inhalers according to the child's asthma action plan
Attend follow-up appointments to review asthma control and inhaler technique

When Should Parents Arrange a Paediatric Assessment?

Consider an assessment if your child has:

Recurrent wheezing or coughing episodes
Frequent night-time cough
Cough or breathlessness during exercise
Symptoms repeatedly triggered by viral infections or allergens
Needing reliever medication frequently
Symptoms affecting sleep, school or daily activities
Previous emergency visits or hospitalisation for breathing difficulties

Seek Urgent Medical Attention If:

Your child is struggling or working hard to breathe
Breathing is very fast or getting worse
Your child cannot speak, drink or feed comfortably because of breathlessness
Lips or face appear blue or grey
The reliever medication is not providing the expected improvement
Your child becomes unusually sleepy, weak or difficult to wake

Frequently Asked Questions

Is coughing at night a sign of asthma?

It can be. Recurrent night-time or early-morning cough may occur with asthma, but other conditions such as post-viral cough and allergic rhinitis can cause similar symptoms.

Does every child who wheezes have asthma?

No. Wheezing is common during viral infections, particularly in younger children. Asthma becomes more likely when wheezing is recurrent or occurs with triggers such as exercise, allergens or viral infections.

Can a child have asthma without wheezing?

Yes. Some children may mainly have recurrent cough or other asthma symptoms. However, other causes of recurrent or persistent cough should also be considered.

Can children with asthma exercise and play normally?

Yes. With appropriate asthma management, most children can participate in normal physical activities. If exercise regularly causes coughing, wheezing or breathlessness, the child's asthma control should be reviewed.

Does my child need a nebuliser for asthma?

Not necessarily. Inhalers used with a spacer can deliver medication effectively for many children. The appropriate device depends on the child's age, ability, symptoms and clinical condition.

Will my child outgrow asthma?

Some children have fewer symptoms as they grow older, while others continue to have asthma into adolescence or adulthood. The course varies between children, so ongoing monitoring is important.

Take-Home Message

Recurrent wheeze, cough, breathlessness or exercise-related symptoms may be signs of asthma.

Early assessment and appropriate treatment can help children stay active, sleep well and participate normally in daily activities.

Concerned About Your Child's Cough or Wheezing?

If your child has recurrent coughing, wheezing or breathing difficulties, a paediatric assessment can help identify the possible cause and determine whether further evaluation is needed.

Southern Child Specialist Clinic in Johor Bahru provides paediatric assessment for asthma, wheezing, recurrent cough and other childhood respiratory concerns.

Book a Paediatric Consultation

Evidence & Guidelines

This information is based on:

Global Initiative for Asthma (GINA) – Global Strategy for Asthma Management and Prevention
NICE Guideline NG80 – Asthma: diagnosis, monitoring and chronic asthma management
British Thoracic Society / SIGN asthma guidance
Malaysian Clinical Practice Guidelines – Management of Asthma in Children