Asthma and the ER: When to Go

When to go to the ER for Asthma

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By Selena (bio below)

My daughter is a little over 3 years old now, but this story takes place when she was one month shy of her second birthday.  The night was mostly a blur, but I recently worked on jogging my memory about the series of events that led up to my daughter’s asthma attack and my debate on when to go to the ER for asthma treatment.  It’s important to remember things and to learn from experiences, even if they aren’t always pleasant.  I also think it’s important to share what you learn, so allow me to share this story.  I know I get nervous, sometimes, reading stories and wondering, “oh my goodness, how will it turn out?”, so I will ease your tension and suspense and let you know that everything ends up being OK, but it was definitely a stressful, worrisome time.

It was close to midnight and I heard a sound coming from my daughter’s room.  It was a small sound, but as many of you know, “Mommy Ears” are a little more sensitive.  It sounded like there was a “kuh” sound at the end of each breath that my daughter was taking.  I didn’t want to disturb her in her sleep, but it just didn’t sound right.  I went into her room and turned on the light just a little bit (we have a dimmer switch in her room).  She woke up, but seemed a little more lethargic than normal.  I picked her up out of bed and took her to the rocking chair.  My husband came in and I told him that she just didn’t seem right and seemed to be having a little trouble breathing. We tried running a hot, steamy shower, to help break up congestion (we thought she might have had a cold/chest congestion). Aside from us all getting frizzy hair and a little damp, it didn’t seem to do a whole lot for her breathing.  Her nose was a little less stuffy, though, and I decided that I was going to hold her upright in the glider. Around 3 or 4 in the morning, I turned the light back on and we looked at her, again.  Her nostrils were flaring a little bit, but I didn’t know what to make of it.  I took off her footie pajamas, to give her a fresh diaper and I saw that her chest was caving inward a little, instead of outward and I thought that seemed odd.  Her breathing seemed more labored, so I gave her one of her ProAir treatments, with the puffer-spacer we had been given at an earlier pediatric visit. I wasn’t sure if she was getting enough full breaths to take in the medicine, but I gave her a few puffs.  We hadn’t had much experience with the puffer-spacer, so I wasn’t sure if I was doing it right.  I had my husband bring her a little bottle of her hemp milk, but she could barely hold the bottle.  We were worried sick and called the nurse line around 6:00 a.m.  After describing her symptoms, we were told to go to the ER, right away.

We arrived at the ER at 7:00 a.m. and she was lethargic and definitely not her usual perky self.  They took us back pretty much right away and did a chest X-Ray.  They then took us to a room and gave her an albuterol treatment and some prednisolone (oral steroids). Her oxygen levels started to improve and they told us that she had bronchitis and an ear infection.  They also prescribed an antibiotic. After getting her medications, she improved shortly thereafter and we were so relieved. We felt just awful for waiting so long to take her in, but we imagined in our heads that we’d be sitting in an ER waiting room for hours on end.  (The last time we were in the ER, it was because I had food poisoning and we waited 7 hours to be seen.)

Lessons Learned: When to go to the ER with Asthma

I get a little queasy when I recall how she looked that night and I now know I should have taken her in sooner.  I feel a pit in my stomach when I realize that we were very lucky that things didn’t get worse.  The “what ifs” nag at my mind, but as with most of these types of situations, I remind myself to learn the lesson and plan to do better next time.  Beating myself up over it isn’t helpful.  The helpful and useful thing to do is to identify the mistakes and learn the proper measures to take, if there is ever a “next time”.

  • If you ask yourself the question, “should we go to the ER?” then the answer is probably “yes”.  A child should not have trouble breathing, aside from a stuffy nose.
  • When you go to the ER with a child who’s having breathing difficulty you will probably be seen fairly quickly.  They will at least do a quick assessment to evaluate the severity of the breathing issue.
  • If you have home-care options, as we do now (nebulizer, rescue inhaler), then you can administer those treatments as needed, without making a trip to the ER if improvement is seen. But it’s best to head to the ER if things don’t improve quickly. 
  • If the asthma attack happens during normal business hours (and how come it hardly ever does?) you can certainly call your pediatrician’s office to see if they have the ability to treat your child for their symptoms. But make sure you speak to a nurse right away and don’t leave a message and wait for a call back. If you cannot reach anyone, head to the ER.

Bottom Line: When we called our insurance company’s nurse line that morning, she told us “if the child is wheezing, flared nostrils, has labored breathing, rapid shallow breaths, but no blue lips, then go to the ER.” (That was a pretty accurate description of Morgan…)  She said, “if their lips turn blue and/or there’s wheezing that can be heard across the room – dial 911.”  I wish I had known that 7 hours before I made the phone call, as I could have saved my daughter a lot of discomfort and danger. Again, no need to dwell, but these are things I needed to know for the future and I wanted to share it with you.

 

Read More about Asthma:

Using Epinephrine to Treat Allergic Asthma Attacks

Naturopathic Approach to Allergies, Asthma and Eczema in Kids

Salt Therapy: A Natural Remedy for Eczema and Asthma

 

Bio: Selena is a stay-at-home mom to her 3-year-old daughter, Morgan, who has several food allergies.  Her daughter also has allergy-induced asthma and eczema. She writes about her daughter’s experiences in her blog Amazing & Atopic.

8 Comments

  1. Tracy Bush on January 17, 2012 at 12:16 pm

    Wow, this reminds me of the trip we had to the ER with my son when he had a major asthma attack! I completely know the feelings that surround it and the after “what ifs”. The good thing is that our children are ok and that we know what to do next time.

    • Jennifer on January 17, 2012 at 2:17 pm

      Same here. We had and ER trip for asthma. Scary. Never want to repeat. Ever!!!!

  2. Susan H.H. @ The Food Allergy Chronicles on January 17, 2012 at 1:51 pm

    Thank you Selena for sharing your story. A learning experience for all who read it. Is Morgan’s asthma under control with/without puffers now? Susan H. @ The Food Allergy Chronicles

    • selenarae on January 17, 2012 at 2:38 pm

      Yes, thankfully! Once we identified her triggers (mostly food allergies), she hardly had any episodes. We do a “preemptive” albuterol/nebulizer treatment when she starts to get any kind of suspicious-sounding cough and we usually only need one treatment with her “fishy mask”. When she had ear infections or bronchitis, other than that ER incident, we would do the nebulizer treatments ever 4 hours, during the waking hours and luckily, it was always enough to keep things in check. I’m grateful that her asthmatic episodes are infrequent and mild. There was a period when we were first learning about her “reactive airway” that the pediatrician put her on a daily dose of ProAIR HFA. We did two puffs with the puff-spacer for a couple of months during “cold season”. We haven’t had a need to return to that kind of dosing schedule.

      • Jennifer on January 17, 2012 at 3:28 pm

        Tristan used to have really bad asthmatic episodes when he’d catch a virus. It’s been 10 months since we cut out all his food allergies, which were triggering his eczema. Now that I think about it, it’s been since mid summer since his last asthmatic episode and he’s been sick plenty of times since then. I wonder if he’s grown out of the asthma or if his body is healthier and stronger to fight off such an episode now that his food allergies have been removed. This is an interesting revelation for me.

        I’m really happy that your daughter’s asthma is under control and really infrequent. Breathing is not something we can take lightly. Very scary to seem our little ones struggling for a breath.

    • Jennifer on January 17, 2012 at 2:17 pm

      I’ll approve and let Selena know about your question.

  3. Bethany on January 19, 2012 at 10:22 pm

    We had a few times when our son (now 4) first had breathing problems (at 14 months) where my husband and I would go back and forth on whether we should take my son to the ER or wait it out to see if his breathing got better. We soon learned that, like you said, that somethings are not worth waiting out. Thankfully everything turned out well. This past summer we found he has multiple food allergies and his diet has changed. He may get congested but no longer seems to need the nebulizer. We found that the nebulizer is very helpful to have at home since the wheezy breathing usually happened in the evening and/or during the night. Glad to hear your daughter is getting better!

    • Jennifer on January 20, 2012 at 10:57 am

      Bethany – your son’s situation sounds similar to ours. Tristan’s asthma and eczema cleared up after we removed his food triggers. Thank goodness we both determined that food was causing all this! I’m happy your son is better.

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