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Given: a 5 year old kid with what is believed to be false spasmodic croup. Once in several months he experiences a sudden asthmatic fit in the middle of the night - specifically he has a mild spasm in breathing passages, he perceives that as inability to breath, tries to breath deeper, that enforces the spasm, he thinks he's suffocating. Once he breathes through the inhaler for about ten minutes the spasm goes away and the kid is fine.

The physician says this will just end in a couple of years once the kid grows up. Currently the problem is how to teach the kid to not panic in such cases.

There're two ways of addressing the asthmatic fit. The current way for him is to cry and panic and then a lot of effort is required to calm him and convince him to breath through the inhaler. The much better preferred way would be to him recognize the situation once it starts developing, try to breath shallow (that stops acute spasms) and calmly get to the parents, ask them to prepare the inhaler and breath through it.

The kid is smart and curious, but he just wouldn't listen about what is happening to him - perhaps discussing the problem is associated with the panic he experiences or maybe he feels bad that he causes such problems to his parents or maybe it's just boring for him. Whatever.

Is there a way to teach a 5 year old to stay calm and properly address sudden asthmatic fits?

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4 Answers 4

I'm asthmatic and started when I was a toddler, but I learned early on that panicking only made things worse. I would disagree with those who say a 5-year-old is too young to learn to suppress the urge to panic, because I found I was able to starting around the time I was 4-5 years old. It takes education, practice, and most of all a calm parent who is willing to put a lot of time and effort into it, but it sounds like you are willing and able so I think you can do it.

A "panic button" is a great idea, as is being calm and having a ritual. You do your child no favors when you panic, as you probably well know. My mom did visualization exercises with me when I was calm and not having a hard time breathing--all of these exercises involved floating, being weightless, having no weight, tightness, or restriction on my chest, and having the air flow in and out (the "and out" part is absolutely crucial!!) of me very easily. Usually I'd be floating in the sky, or on a cloud, or on the wing of an airplane, but never under water. Then, when I was starting with an attack, she'd walk me through these visualization exercises, which helped enormously.

Dr. Mehmet Oz describes what an asthma attack/episode feels like here. He correctly states that "In patients with asthma, the trouble isn't with getting air into the lungs; it's with getting air out, and it feels like a vice is squeezing the bronchus." One of the best things that my mom did when helping me with my asthma attacks was to focus on my getting air out of my lungs. Part of your son's problem may not just be in the spasms, it may be that he is constantly sucking in air but can't blow it out and doesn't realize he needs to. Believe it or not, it's a hard thing to realize, and it's worse when you're a kid. When you feel like you're drowning, your first instinct is to try to get in more air--it takes training to learn to do the opposite of your instinct and breathe OUT. So at times when your son is not having an attack, you could try explaining this to him and helping him practice breathing out, not just in.

Good luck!

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Intriguing about breathing out. Could you elaborate on what you mean by a panic button? I guess you don't mean this. –  Torben Gundtofte-Bruun Jun 19 '11 at 9:16
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Haha that would be awesome, but I'm mostly referring to the cheap wireless doorbell that was suggested elsewhere...anything that can get your attention wordlessly (bell, air horn, etc.) will both help a child feel more in control and also get you in there sooner to help him keep from getting to that panicked state. Being really observant and not second-guessing yourself as a parent is very helpful, too. My mom got to the point where she could just tell I was gearing up for an asthma attack before I really showed signs; it helped get me faster treatment and also made me feel more confident. –  Corvus Melori Jun 20 '11 at 5:46

As Beofett already stated, lack of breathing brings about a sense of panic that is too powerful for most 5yo kids to counter. However, here are some things you can try to help lessen the duration of the panic reaction to something more manageable:

  • Get a cheap wireless doorbell unit and put the button by his bed, and the receiver by your bed. This way he knows that you are on your way without crying and panicking to get help. It's unlikely that he can be capable of coming to get you during an attack, and since you mentioned that you must prep the inhaler, he cannot directly counter the attack himself. He needs something that he can do to help bring about the end of an attack, rather than helplessly hoping you notice him struggling to breathe (which is how it probably feels from his perspective).

  • Be a breathing partner. We react instinctually to the patterns of people we are close to: think of the way you fall into step with someone if you walk and talk with them, or how lying next to your child as he falls asleep makes you sleepy. Try having him put his hands on your chest, and look at your face while you do the kind of breathing you want him to do. Try this when he's not having an attack and it may be easier when he is having one. It works with some kids, doesn't with others, but it's worth a shot.

  • Respond to attacks in a calm, predictable way. If he knows that you will respond immediately to the bell, and that you are not afraid, he will begin to see the end of the tunnel sooner, and feel like he has helped cause the situation to be resolved.

  • Create a ritual that follows every attack. Once the attack has fully subsided (not before, not ten minutes after), get him a drink of water and turn on some music, or tuck him in with a special stuffed animal. The idea here is to condition him to know this is really over now as soon as you bring the ritual into play. It will take time for this to take effect, but once it does, that ritual will cue him to calm down more quickly.

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+1 for the wireless doorbell. Great idea for giving him an accessible way to exert control over the situation! –  Beofett May 13 '11 at 16:35
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Maybe in addition to the ideas above, you could practice this ahead of time, kind of like a fire drill. Have him get into bed, ring the door bell (if you choose to do this, but also emphasize that it is only for emergencies in the future though), and go through the routine of what would happen next if he should experience an attack. He will certainly still be scared when an attack happens, but knowing what will happen next could be very comforting. –  Caterpillar's Leaf Sep 18 '11 at 0:02

At that age, kids learn more from copying you than from listening to you. It sounds like you are already acting calmly yourselves during an episode. Make sure to show him what to do more than telling. If it's happening so infrequently, it might be beneficial to roleplay it with him before bed every night until he can do it without prompting, then a refresher once a week or so.

Also, you might discuss with your pediatrician the potential of getting something like a pulse oximeter or apnea monitor, so you don't have to count on him informing you and can intervene before he becomes too panicked.

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Unfortunately, I think the answer is "no". Once he is older you can probably work with him to improve the situation (if it hasn't already cleared up by then), but at 5 years old it just may be too early.

Difficulty in breathing triggers an automatic fear response in the brain:

The interesting mind-body part of asthma is that the anxiety parts of our brain are very finely attuned to breathing problems, meaning that if people’s carbon dioxide levels go up or their oxygen levels go down, the brain very quickly tweaks the fight or flight response.

This fear response is then typically exasperated by the negative associations from previous experiences ("oh, no, this is going to be bad!").

There are techniques that can be used to help cope with the panic effect, but none of them are likely to be effective with a 5 year old:

  • How to Develop Emotional Asthma Control
    • Extra rescue inhalers. Keep them with you wherever you are, and in several places at home, at work, or in school.
    • Emergency numbers and cell phone. Keep your doctor's number and a cell phone close at hand at all times. Remember that if your asthma does spiral completely out of control, you should call 9-1-1 directly rather than calling your family or doctor first.
    • Daily corticosteroid use. If you use a daily, inhaled corticosteroid for asthma control, be sure to take your medication consistently.
    • Prep work. Be prepared for ups and downs, There will be seasons when your allergies and asthma triggers are worse.
  • Now the Hard Part: Learning to Relax
    • Yoga
    • Deep breathing
    • Meditation
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