Reaching the youngest patients with asthma
There’s no debate; children under 8 with asthma need to get control of the disease. But experts still are not sure about how effective education programs can be for them. The 4- to 8-year-old group is "very key," says Frederick Leickly, MD, associate professor of medicine at the Indiana University School of Medicine in Indianapolis, and a pediatric pulmonologist at Riley Hospital for Children.
"Some savvy 4-year-olds can do some of what they need to do to monitor asthma," Leickly says. If they can learn to prevent problems, "we might nip this thing before it becomes severe, persistent asthma."
He’s found that some children even tell on their parents who smoke around them. "It’s not all kids, but there are some who take to it."
Programs aimed at young children also can help educate parents, who must take primary responsibility for managing their children’s diseases at these young ages. "Unfortunately, primary care physicians don’t have a lot of time for that," Leickly adds. "Parents have to buy in, have to see the cause and effects."
Educational programs aimed at children under eight remain rare, and Leickly says he welcomes more. The bottom line is this age group is tougher to teach. Some 4-year-olds are starting to read while others can’t say how old they are. It isn’t until they are in school that some learning discrepancies even out.
Another major hurdle is getting children to apply what they have learned. Knowing that cats can trigger attacks is one thing. Avoiding that friend’s house with the cat is another. "Putting all that knowledge into action is a big factor," he says.
And making that leap "is a step probably half of kids this age can’t make," says Peyton Eggleston, MD, professor of pediatrics and pediatric immunologist at Johns Hopkins Children’s at Johns Hopkins University in Baltimore.
"This is the Santa Claus group," Eggleston says, who has worked with educational programs for preschool and school-aged children.
Just getting the point across to a young child that he or she has asthma can mark a big step. "You’re only educating the child to a limited extent," he says. "A child at this stage is so dependent on the parents for guidance."
Until children reach 9 or 10, few are responsible for taking their medications, even bronchodilators — just as few are allowed to cross the street alone.
Parents also must learn to apply what they have learned. Many have plenty of "book learning" about asthma but few can incorporate what they know into real life situations.
Eggleston was involved with the National Cooperative Inner City Asthma Study, which found parents scored high on their factual knowledge about asthma. But when presented with realistic situations, "they very frequently picked inappropriate behaviors even though they knew the facts," Eggleston adds. "That’s a more difficult step that still takes a lot of reinforcing."
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