When your child is prescribed medicines, especially for a long-term condition like asthma, most parents will have lots of questions about the benefits and risks. To help put your mind at rest, we answer some of your common concerns. Your child’s GP or asthma nurse can also answer any questions you have.
I’m worried that…
- My child needs to take medicines every day
- My child’s reliever inhaler will cause side effects
- My child’s preventer inhaler will cause side effects
- Steroid tablets do more harm than good
- Taking steroids might affect my child’s growth
- Taking steroids might cause my child to have mood swings
- Taking steroids might cause my child to put on weight
- Chickenpox might cause my child to become really unwell if they’re taking steroids
- VIDEO: Watch asthma nurse, Debby Waddell talk about children taking steroids for asthma
Some parents worry about giving their child medicines for a long-term condition such as asthma. Ask your GP or asthma nurse, or a pharmacist, to run through all the benefits of your child’s medicines with you, so you can remind yourself of all the reasons why they need them. You might also find it useful to consider what might happen if your child doesn’t take their medicines – such as breathlessness, wheezing, coughing at night, not feeling well enough to play in the park, or missing school if they have an asthma attack and need to spend time in hospital.
The risk of your child’s asthma medicines causing side effects is very low as long as they don’t use them too much. Reliever inhalers (usually blue) are safe and effective. Some relievers can temporarily increase your child’s heartbeat, give them mild muscle shakes or make them hyperactive, but this is normally just when they have to take more than a couple of puffs of an inhaler. If your child does have these side effects, they will usually wear off quickly. If they don’t wear off or they happen frequently, tell your GP or asthma nurse.
Remember that if your child is using their reliever inhaler more than three times a week, their asthma is not being well managed and they have a higher risk of an asthma attack. It is a sign that their airways are inflamed and sensitive and reacting to triggers around them. Make sure they are using their daily preventer inhaler, if they have one, to reduce this inflammation. And book in for an asthma review so their GP or asthma nurse can see how they're doing and assess their treatment.
Some children with asthma take a low-dose of steroids through preventer inhalers every day to reduce the sensitivity and inflammation in their airways. Using preventer inhalers is really common. These medicines have been used for many years to help adults and children with asthma. If these inhalers are used correctly, the medicine goes straight to your child’s airways and is unlikely to cause any side effects - very little medicine is absorbed into the rest of their body.
Your child’s GP or asthma nurse will help prevent side effects by always prescribing the lowest possible dose of steroids to manage their asthma well. Make sure your child goes for their regular asthma review (at least every six months) to check they’re on the right dose.
“I used to worry a bit about the boys taking steroids every day, but I know for a fact I wouldn’t be here if I hadn’t had them when I was four – they saved my life. There’s a panic attitude around about steroids, but when you really think about it the benefits far outweigh the risks." - Anna Bonnett, who has asthma and who has two sons, Gabriel and Beau, who both have asthma too.
“Both our girls are really good at taking their preventer inhalers. It’s like second nature. I think it’s because Emmie’s been so unwell in the past, they understand that asthma can be pretty serious. And when the girls were really little, even before they could really understand, we explained that the brown inhalers help to prevent asthma symptoms. I think children will be motivated to do something if they understand why they have to do it.” - Scott Brain, dad to Emelia, 8, and Elisia, 3, who both have asthma.
“An asthma nurse said something that’s really stuck with me – taking the brown preventer inhaler is more important than brushing your teeth. Kenji is religious about taking it now, morning and evening, and that reassures me that he’s doing everything he can to prevent symptoms or having another major asthma attack.” - Ernie McDade, whose son Kenji, 13, had his first asthma attack last year.
A small number of children may get a sore tongue or throat, a hoarse voice and/or a mouth infection called thrush from using preventer inhalers. You can help prevent these side effects by making sure they:
- use a spacer
- always rinse out their mouth and brush their teeth after using their inhaler or spacer
- if your child’s using a facemask with their spacer, wipe their skin under the mask with a damp cloth after every use.
“We keep the boys’ preventer inhalers and spacers next to their toothbrushes in the bathroom so they always remember to take it. They use it and then rinse out their mouths and brush their teeth, which helps them to avoid the side effects of the steroids in the preventer.” - Shakeela Riaz, who has two sons with asthma: Salis, 12, and Sami, 6
Many parents worry about giving their child steroid tablets, so you’re not alone. If your child’s asthma is managed well, they may never need to take steroid tablets. It’s important to remember that the steroids used to treat asthma are corticosteroids, which are a copy of substances the body makes naturally. Your child’s steroids are completely different to the anabolic steroids used by bodybuilders.
Your child will be given a short course of steroid tablets if:
- their asthma symptoms become worse - where there's increased inflammation and narrowing in the airways, and often a sticky mucus or phlegm is produced
- they have an asthma attack
The course usually lasts for up to three days, although it may be for longer depending on how long it takes your child to fully recover.
You might find it reassuring to know that:
- research shows that short, occasional courses of steroid tablets taken for no longer than three weeks are very unlikely to cause troublesome side effects
- steroid tablets are a powerful and effective treatment that can help to prevent a potentially life-threatening asthma attack, which is usually treated with even larger doses of steroids
- a healthcare professional will only prescribe steroid tablets if they think they’re vital to help your child.
If you’re worried, it may help to spend five minutes writing a list of the pros and cons of giving your child steroid tablets. For example, in the ‘pro’ column you may have, “Taking these tablets means Ellie’s symptoms clear up and she’ll miss less school” or “This short course of steroid tablets will reduce Harvey’s chances of ending up in hospital”.
A few children might need to take high-dose steroids in the long term – for example, a higher dose in their daily preventer inhaler, steroid tablets for longer than three months, or three or four courses of steroid tablets in a year. In these cases, steroids can have some side effects and part of your child’s management plan should include your child’s doctor explaining the possible side effects, as well as all the solutions you can try if side effects do occur.
There’s a myth that taking inhaled steroids stops children growing properly. Research does show there’s a slight link between inhaled steroids and growth – the expected reduction in adult height depends on the child’s age when they start taking steroids, the dose they take and for how long they take them.
Clinically, this reduction is described as ‘insignificant’. For example, if a child takes 400 mcg of Budesonide daily for three years, this translates as a 1.2cm reduction in adult height. This measurement is smaller than your average grape, so it’s a small price to pay for a medicine that can save your child’s life.
For this reason the most recent British Thoracic Society/Scottish Intercollegiate Guidelines Network on the management of asthma (that GPs and asthma nurses use) recommends that all children taking inhaled steroids for asthma have their height and weight checked at least annually.
If you’re weighing up the pros and cons of your child taking steroids, it might help you to remember that:
- taking a regular lower dose of steroids in a preventer inhaler to manage their symptoms well can mean your child will need to take fewer steroid tablets overall and lower your child's risk of a potentially life-threatening asthma attack
- children are more likely to be admitted to hospital following an asthma attack if they are not taking their inhaled steroids as prescribed
- poorly controlled asthma can itself affect growth
In other words, for children who need them, the benefits of taking inhaled steroids far outweigh the risks.
“My dad saw an article in the newspaper about how steroids can stunt growth and told me he’s worried about George and Lena taking their preventer inhalers every day. I spoke to the asthma nurse who reassured me that if asthma isn’t in control it can cause far more health problems. I believe doctors only prescribe steroids if the benefits outweigh the risks.” - Jayne Bettles, whose two children, George and Lena, have asthma.
Some parents of children with asthma tell us that when their child is taking steroids tablets they notice they become overactive, irritable and have mood swings. Their child may also behave like they used to when they were younger - for example, have a temper tantrum.
If your child’s taking a short course of steroids, this side effect is temporary and will go away when your child stops taking the tablets.
If your child’s taking steroids in the longer-term, bear in mind that most children who take them don't experience this side effect. And any medicine is only ever prescribed if the benefits outweigh the risks. If you do notice mood swings in your child, speak to your GP or asthma nurse about your concerns as soon as possible.
We know from calls to our Helpline that some parents find that when their child is taking steroids it makes them hungrier than usual. This can cause them to eat more and put on weight.
If your child’s taking a short course of steroids, this side effect will go away when your child stops taking the tablets.
In the longer-term, giving your child a well-balanced diet with lots of fruit, vegetables and wholegrains is recommended.
The most recent British Thoracic Society/Scottish Intercollegiate Guidelines Network on the management of asthma (that GPs and asthma nurses use) recommends that all children taking inhaled steroids for asthma have their height and weight checked at least annually, but if you think your child is putting on weight, don’t wait for this appointment. Speak to your GP or asthma nurse as soon as possible and they will talk you through some possible solutions.
For a small number of children, taking higher doses of steroids lowers their body’s resistance to viruses, such as chickenpox. If your child is taking steroid tablets or high-dose inhaled steroids and they come into contact with somebody who has chickenpox, the virus might cause them to become really unwell, so contact your GP or asthma nurse as possible. They will give you advice and may take a blood test to check your child’s immunity to chickenpox. If they aren't immune, they may be given an injection to protect them.
Whatever you do, though, don’t stop giving your child their prescribed steroids unless your doctor advises you to do so. If you do, your child’s asthma symptoms may come back and their risk of a potentially life-threatening asthma attack will go up. If you’re worried, remind yourself that health professionals only ever prescribe a medicine if the benefits outweigh the risks.
Still feeling worried about steroids?
It’s helpful for you to share your concerns rather than bottling them up. Sharing them means you’re on your way to finding solutions, whereas bottling them up might mean you’ll be less likely to give your child their asthma medicines exactly as prescribed. You can:
- speak to your child’s GP, asthma nurse or consultant again
- call one of our asthma nurse specialists on our Helpline on 0300 222 5800 (Mon – Fri; 9am – 5pm).