Raising Asthma: A New Test in Childcare

These days, more and more children are stricken with asthma. How will our childcare providers keep up?

By Owen C. Franklin

Cecilia Johnson, a childcare provider, inspects every corner of her daycare center for potential killers. Everything from carpet pile to stuffed animals can hide the microscopic allergens that trigger asthma attacks and choke children from inside their own bodies.

"I even have to watch the weather," said Johnson. "If it’s cold out, you check for runny noses so you can anticipate what could happen."

Attending to such a vigilant watch can be difficult in the frenzied company of toddlers. To make matters worse, many caregivers simply don’t know what to look for. The asthma epidemic of recent years is taking many people by surprise.

More and more children are getting asthma. According to the Department of Health and Human Services, the cases of asthma in children under four years old jumped 160 percent in the past two decades. While some experts blame increasing pollution, no one knows exactly what is causing this outbreak.

The effects, however, are all too clear.

"It can be potentially life-threatening," said Dr. Clifton Furukawa, the head of the Pediatric Allergy Division of the University of Washington School of Medicine. "In the very young, their airways are so small that a relatively mild virus can spark a relatively severe asthma attack."

For parents, raising a child with asthma can be a precarious challenge. Parents can face additional stress when forced to place their child in daycare.

"Let’s face it, most parents have to work," said Maryanne Ellis, executive director of the Maryland-Greater Washington, D.C. chapter of the Asthma and Allergy Foundation of America (AAFA). "When you go into a classroom, and you ask how many children have asthma, you’re going to see the hands go up."

For parents, this means entrusting a child with a life-threatening illness to another person’s care. For care providers, this means managing a complicated and unpredictable illness.

"There was a time when many childcare providers didn’t know what to do for a child with asthma," said Johnson. "I had one little boy who would go into an attack and I had no idea what was triggering the asthma."

Pinpointing asthma triggers in a controlled environment is hard enough. Hunting for these catalysts in the chaotic buzz of a daycare center is an entirely different task.

The triggers come in many forms: different animals, foods, plants, insects, dust and chemicals can all spark the allergic reactions that lead to so many asthma attacks. These allergens can be easily lost amongst a dozen or so squirming bodies.

"It can get crazy," said Johnson. "They [kids] can be wired up, fired up and ready to go."

Unfortunately, doctors say this clash of kids, which makes finding asthma triggers so difficult, is one of the biggest asthma triggers of all.

"You’ve got a lot of little children stuffed together," said Dr. Furukawa. "Children get more respiratory illnesses because there are so many more children to catch it from, and simple colds are a major trigger of asthma."

This list of risks is a heavy burden that some caregivers aren’t ready to bear. For years, parents of children with asthma were turned away at daycare doors. Unfortunately, this still happens today.

"Licensed day care providers were frightened to take children with asthma," said Ellis. "It was unawareness and fear because they did not have the ability."

But Ellis hopes a new program will help change all that. This spring, the Maryland-Greater Washington, D.C. AAFA will launch "Asthma and Allergy Essentials for Child-Care Providers." Once this pilot project is completed, it is expected to spark a national campaign.

The three-hour program provides basic information caregivers need to recognize and manage asthma. Facts about normal and abnormal lung physiology, warning signs, medications and environmental control are all part of the package.

On top of this, the course will stress communication between parents, caregivers and physicians.

"The point is to make the childcare provider a partner in the child’s care," said Ellis. "A child who’s two years old can’t take that responsibility, they can’t even communicate what’s wrong."

When it comes to asthma awareness, a little education goes a long way. Simple information — what asthma "looks" like, what you can do and where you can go — can provide a basic level of comfort. That comfort can be a great place to come from.

"People fear when they don’t understand," said Johnson. "But after taking these classes they say ‘oh gosh, I was fearful but now I know what I have to do.’"