From getting into a good medicine routine to worries about side effects, find answers to common concerns about your child’s inhalers and any other medicines they may be taking for their asthma, like steroid tablets or montelukast.
On this page:
- My child’s inhalers
- Montelukast (preventer tablets or granules)
- Taking steroids
- VIDEO: respiratory nurse specialist Debby Waddell on children and steroids for asthma
What do my child’s inhalers do?
Most children with asthma have two inhalers, a preventer and a reliever.
- Your child needs their preventer inhaler every day. It keeps the inflammation down in their airways and prevents symptoms and asthma attacks.
- Your child can take their reliever inhaler (usually blue) when symptoms come on. It quickly opens their airways when they react to triggers or have an asthma attack.
Ask your GP, asthma nurse, or pharmacist to explain what your child’s different inhalers are for and when they should take them.
Does my child need their asthma medicine every day?
Some parents worry about their child taking preventer medicine every day, especially if their child feels well and doesn’t have any asthma symptoms.
But taking their preventer inhaler every day, even when they’re well, is essential to lower your child’s risk of symptoms and asthma attacks.
Once you and your child are in a good routine of taking their preventer inhaler every morning and evening, the medicine can work away in the background keeping the risk of symptoms low.
Taking preventer medicine every day means your child can get on with school, playing, and seeing their friends without asthma getting in the way.
Don’t just give your child their reliever inhaler
Your child’s reliever inhaler cannot deal with the inflammation in their airways. It is only for when they get symptoms. Your child needs their preventer inhaler every day to keep the inflammation down in their airways and lower their risk of an asthma attack.
I keep forgetting to give my child their inhaler
The best way to make sure your child is taking their asthma preventer inhaler as prescribed is to tie it into something else they do every day, like brushing their teeth.
If your child uses their inhaler every morning and evening after brushing their teeth, it makes it easier to fit into a routine. It’s also a good way to remember to rinse out and gargle afterwards, which helps with side effects like oral thrush.
If you’re still struggling to remember, you could find out about medicines reminders and apps. For example, the NHS has a Health Medication Reminder Service and there are plenty of apps for your phone. You could even use digital assistants like Alexa, Cortana, or Siri to remind you.
I don’t know if my child is taking their inhaler in the right way
To get all the benefits from your asthma medicines, your child needs to use their inhaler in the best way. It’s a good idea to be there when they’re taking it, so you can make sure they’re using their inhaler correctly.
If you’re not sure if they’re using it properly, check with your GP, asthma nurse, or pharmacist. You can also watch our inhaler videos.
If your child is still finding their inhaler difficult to use, ask their GP or asthma nurse about other types of inhaler they might find easier.
Using a spacer makes it much easier for your child to use their inhaler correctly and make sure they’re getting the medicine they need.
Ask the GP or asthma nurse to check your child’s inhaler technique every time you go for an asthma review. You can also ask a pharmacist.
Does my child need a spacer?
If your child is using a pressurised metered dose inhaler (pMDI) it’s best to use it with a spacer.
- A spacer helps make sure the medicine gets into your child’s airways where it’s needed.
- Spacers are also helpful if your child finds it difficult to get the timing right when using their inhaler.
- If your child has symptoms or an asthma attack and is finding it hard to breathe, using a spacer with their reliever inhaler makes it quicker and easier to get the rescue medicine they need.
Spacers only work with pressurised metered dose inhalers – these are the ones which are aerosol, not powder. If you're not sure what type of inhaler your child has, check with your GP, asthma nurse, or pharmacist.
Ask your GP, asthma nurse, or pharmacist about spacers that are easy to use and carry around. And make sure you get a spare spacer to keep at school with your child’s emergency reliever inhaler.
Does my child’s preventer inhaler cause side effects?
A hoarse voice or a sore mouth are common side effects of the preventer inhaler. Some children might also get a mouth infection called thrush. The good news is, these side effects can be avoided with a good inhaler technique, and by using a spacer.
If your child is taking their preventer inhaler in the right way, the medicine does not stay in their mouth and throat but gets down into their airways where it’s needed.
It’s also important that your child rinses out their mouth, gargles, and spits out after using their preventer inhaler.
Every time you take your child for an asthma review ask their GP or asthma nurse to check their inhaler technique. You can also watch our videos.
Does my child’s reliever inhaler cause side effects?
Some children may feel a bit shaky or say their heart’s beating faster than normal after using their reliever inhaler. This is usually when they have taken more than one puff. This side effect usually passes quickly and is not dangerous.
If they’re using their preventer inhaler regularly as prescribed, your child shouldn’t need to use their reliever much, or at all.
See the GP or asthma nurse for advice if your child is getting side effects regularly. They can look at your child’s triggers and review their preventer treatment.
Video: Help your child understand their asthma medicinesShakeela reveals how she helped her son understand why he needs his asthma medicines.
Transcript for ‘Help your child understand their asthma medicines’
0:03 Salis said to me recently that his brown inhaler isn’t doing anything,
0:08 so mummy, I don’t want to take it, it’s not doing anything,
0:12 I love my blue inhaler and I just want to take that.
0:14 And I said to him, Salis, you need to understand,
0:17 the brown inhaler is actually working in the background,
0:20 it’s not going to give you immediate relief of your asthma symptoms,
0:24 but, in the long run, it will prevent a major asthma attack.
0:28 So, that actually helped him understand why it’s so important to take the brown inhaler.
My child gets embarrassed using their inhaler in front of friends
Children can sometimes feel self-conscious and embarrassed using their inhaler in front of friends.
The good news is that if your child is using their preventer medicine every morning and evening as part of their daily routine, they’re less likely to need to use their reliever inhaler when they’re at school or playing with friends.
But make sure your child understands that if they start getting symptoms, they need to use their reliever inhaler as soon as possible. Talk to them about how they feel and encourage them not to feel embarrassed about it because lots of children have asthma, and use inhalers. And some celebrities do too, like David Beckham.
If your child feels embarrassed about using a spacer with their metered dose inhaler, you could ask their GP or asthma nurse about using a dry powder inhaler instead. This is smaller, and your child won’t need to use a spacer with it.
If your child often needs their reliever inhaler at school, when playing with friends, or is using their reliever inhaler three or more times a week, see their GP or asthma nurse for a review. It is a sign that their asthma is not well controlled.
Will my child get too used to their inhalers?
Parents often tell us they are nervous about starting their child on a preventer inhaler, in case they ‘get used to it’ and end up always having to take it.
If your child has just been told to use a preventer inhaler, it’s because they need to treat the inflammation in their airways. Without regular preventer medicine, the inflammation will build up and put them at risk of symptoms and asthma attacks.
Once your child is in a good routine with their preventer inhaler and their asthma is doing well, their GP or asthma nurse may be able to reduce the dose of preventer medicine they take. Most children can manage their symptoms well on a low dose.
Sometimes asthma symptoms go away completely as your child grows up. In that case, with your GP’s advice, your child can come off the preventer inhaler.
But if your child has been given a preventer inhaler to use, do use it every day as prescribed to help your child avoid asthma symptoms.
Don’t forget to go to all your child’s asthma reviews, so you can check they’re still on the right treatment plan.
My child’s preventer inhaler’s not working
When your child first starts using a preventer inhaler it takes a few days for the medicine to start working. It may be a few weeks before you see the full benefits.
It’s important to keep taking it every day as prescribed so the protective effects start to build up. After a few weeks, you should notice your child has fewer symptoms and does not react to their triggers so much.
Whenever your child starts any new medicines, they should get a review appointment six to eight weeks later so the doctor can check how well they’re working.
If a preventer inhaler is not dealing with your child’s symptoms, even after a few weeks, go back to their GP or asthma nurse to review their treatment. It’s also a chance to check your child is using their new inhalers in the right way.
Does my child need a reliever inhaler at school?
Your child must always have a reliever inhaler to use if they need to, including when they are at school.
Although some schools keep emergency relievers, it’s always better if your child has their own spare reliever, and spacer if they use one, at school. Make sure your child knows where their inhaler is kept and can access it easily – it shouldn’t be locked away.
Keep your child’s reliever and spacer in their original boxes, with the prescription label attached and instructions included. It’s also a good idea to label your child’s inhaler with their name and class.
Find out more about keeping your child safe at school and nursery.
How do I know when there’s no medicine left in my child’s inhaler?
Some inhalers have a dose counter on the side of the inhaler which tells you how many doses are left. Dry Powder Inhalers (DPIs) also have an indicator that changes colour when it needs replacing.
If your child’s inhaler does not have a counter on the side or a colour indicator, you need to work out yourself how many doses they have taken, and how many are left.
You can do this by:
- Reading the patient information leaflet that came with their inhaler to see how many doses their inhaler has in total.
- Working out how many doses, or puffs, your child will be taking every day. For example, two puffs morning and evening is four puffs a day of their preventer inhaler.
- Dividing the total number of puffs in their inhaler by the number of puffs they use every day. This will give you the number of days their inhaler will last for.
An inhaler with 200 puffs in total, where four puffs are taken every day will last 50 days (200 divided by 4).
Take note of the expiry date, especially if your child does not use their reliever inhaler that often, for example, if your child has a spare reliever in school. Do not use it after the expiry date.
Why has my child been given montelukast tablets or granules as well as their preventer inhaler?
Your GP might prescribe montelukast as an add-on treatment. This means your child needs to take montelukast as well as their usual preventer inhaler to give them the extra support they need with their symptoms. Montelukast comes as a hard tablet, a chewy tablet, or granules.
Montelukast relaxes the airways in your child’s lungs to make breathing easier and to help prevent asthma attacks. Alongside your child’s preventer inhaler, it also reduces inflammation in their airways.
Find out more about how montelukast works as an add-on treatment to help asthma.
Does montelukast contain steroids?
Montelukast is not a steroid - it works in a different way to reduce inflammation. For some children it is a good alternative to higher doses of inhaled steroids.
Alongside their usual steroid preventer inhaler, montelukast can improve your child’s asthma symptoms and stop them needing their reliever inhaler so much.
Will my child always have to take montelukast?
Always take your child to regular asthma reviews so you can talk about their asthma medicines and how well they’re working for your child.
The GP or asthma nurse should review your child’s treatment four to eight weeks after they start taking montelukast.
If montelukast has had no effect after your child has been taking it for four to eight weeks, you can talk about other treatment options.
Your GP or asthma nurse should consider treatment options, including stepping down a dose or reducing add-on treatments, each time your child goes to a review. The aim is always to manage your child’s asthma on the lowest dose possible.
I’m worried about the side effects of montelukast
Like all medicines, montelukast can cause side effects. Always read the patient information leaflet so you’re aware of what side effects to look out for, and when you need to go straight back to your GP or asthma nurse.
The most common side effects are diarrhoea, stomach-ache, sore throats, and infections.
It’s worth remembering that these side effects can often go or improve after two to three weeks of taking the medicine.
But there have also been reports of less common side effects, such as nightmares, sleepwalking, anxiety, depression, irritability, or extreme distress. If you notice any of these in your child talk to their GP as soon as possible.
Get help urgently if montelukast is affecting your child’s mood
Get an urgent same-day appointment with the GP or call 111 if your child’s mood is affected by taking montelukast. If your child is showing signs of feeling extremely distressed, stop taking the medicine. Get immediate help by calling 999 or going to your nearest A&E.
Find out more about montelukast, its benefits, and possible side effects.
Does my child’s inhaler contain steroids?
The preventer inhaler your child takes every day contains steroids, called corticosteroids. It’s the steroids in their preventer inhaler that keep the inflammation down in their airways.
If your child is taking their inhaler in the right way, using a good technique, it’ll be easier for the medicine to get straight to their airways. This means it’s less likely to cause any side effects and very little medicine is absorbed by the rest of their body.
Your GP or asthma nurse will always aim for the lowest possible dose of steroid medicine to keep your child well with your asthma.
I’m concerned about my child taking steroids
A lot of parents worry about their child taking steroids, so you’re not alone. It’s important to remember that inhaled corticosteroid medicine is the best way to treat your child’s asthma, lower their risk of symptoms, and prevent asthma attacks.
The steroids used to treat asthma are completely different to the anabolic steroids used by some weightlifters and bodybuilders to improve physical performance. They are corticosteroids, which are a copy of substances the body makes naturally.
The GP or asthma nurse will always aim for the lowest dose of steroid medicine to keep your child well with their asthma.
Take your child to regular asthma reviews to make sure they’re on the lowest dose of steroid medicine to keep them well with their asthma.
Why does my child need extra steroids?
If your child has been prescribed a higher dose of steroids, either in their inhaler or as oral steroids (usually prednisolone) it is because they need extra help to deal with their asthma symptoms or an asthma attack.
Extra steroids are usually only prescribed for a short time - up to three days or until your child is fully recovered from a flare-up of their asthma symptoms.
A few children may 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.
Keep in touch with your child’s GP or asthma specialist so you can stay on top of any side effects.
If your child is taking high doses of steroid medicine, they should carry a steroid card which their GP, asthma nurse, or pharmacist can give them.
Can taking steroids affect my child’s growth?
There is a very small risk of steroids affecting your child’s overall height as an adult. But this is such a small reduction in growth, it is described as ‘clinically insignificant.’
It also depends on when your child starts taking steroids, what dose of steroids they’re on, and how long they need to take them.
If this is something you’re worried about, it’s worth knowing that asthma that is not well controlled can also affect how well your child grows.
The doctor or asthma nurse will check your child’s weight and height at least once a year at their asthma review.
Will taking steroids make my child put on weight?
If your child is on a high dose of steroid medicine for a long time, one of the side effects is an increase in appetite, which could mean they put on a bit of weight.
Talk to the doctor or specialist if you’re worried about their weight. You can also make sure your child has a healthy, balanced diet and is getting some exercise.
You might feel reassured that the doctor or asthma nurse will keep an eye on your child’s weight and height and check it at least once a year at their asthma review.
Can the steroids in my child’s preventer inhaler end up in the rest of the body?
If your child is using their preventer inhaler well, with a good inhaler technique, the steroid medicine will go straight to their airways where it’s needed and very little medicine will end up in the rest of their body.
Your child can lower your child’s risk by:
- using a good inhaler technique
- using a spacer (if your inhaler is an MDI inhaler)
- gargling and rinsing out afterwards
- checking you’re on the lowest dose possible to keep your asthma controlled.
Take your child along to their regular asthma reviews so you can talk about their medicines and check how well they’re taking their inhaler. It’s also a chance to check that your child is on the lowest dose possible to keep them well.
Steroid tablets make my child have mood swings
Some parents tell us that when their child is taking steroid tablets (usually prednisolone) they notice they become overactive, irritable, have mood swings, or even temper tantrums.
Most children will only need a short course of steroid tablets to help them deal with an asthma flare-up or attack. Once they have finished the course, any side effects will go.
If your child has been taking prednisolone for two weeks or longer, it’s important not to stop suddenly. Your child’s GP or asthma nurse needs to reduce the dose gradually before they come off it.
I’ve heard that chickenpox can be worse for children on steroids
Children taking high doses of steroids, either in their inhaler or as steroid tablets, could be more at risk and feel very unwell with chickenpox.
If your child has come into contact with someone with chickenpox, ask your GP or asthma nurse for advice. They can check your child’s immunity and give extra protection if needed.
Does my child need a steroid card?
Most children with asthma take a low dose of steroid medicine to stay well with their asthma and do not need to carry a steroid emergency card.
But if your child is taking high doses of steroid medicine, either in their inhaler or as steroid tablets, or because they take a combination of medicines containing steroids which together add up to a high dose, they should carry a steroid card which you can get from your GP, asthma nurse or pharmacist.
If your child ever needs to go to hospital due to illness or an accident, it’s important that doctors know they take steroids so they can plan treatment.
Find out more about steroids and steroid cards.
At your child’s next appointment, ask their GP or asthma nurse what dose of steroid medicine your child is taking and if they need a steroid card.
Video: Your child and asthma steroidsAsthma UK Nurse Debby Waddell answers your common concerns about children taking steroids for asthma.
Transcript for ‘Your child and steroids’
0:05 It's really understandable that you have concerns about your child taking inhaled steroids, as most parents do.
0:11 But it's important to remember that these inhaled steroids are safe and effective.
0:16 If taken in the correct way, either using a spacer or a device that your healthcare professional
0:22 chooses with you for your child, the medication will go straight down into the lungs.
0:26 So, the benefits to your child of taking the regular inhaled corticosteroid every day in the correct way far outweigh the risks.
0:38 A small number of children may get side effects such as a sore throat, a hoarse voice, or a sore tongue if they use a preventer inhaler regularly.
0:47 However, you can reduce the risk of side effects by making sure your child always uses their spacer correctly,
0:53 by making sure that they rinse their mouth or brush their teeth after they use their inhaler,
0:59 and also, if they have a face mask attached to their spacer, to wipe under the face mask with a damp cloth around the mouth area after they've used it.
1:07 It's so important that you take your child for their regular scheduled asthma review with their doctor or nurse
1:12 at least every six months, so that they can check the dose your child's on and check that it's the lowest dose possible.
1:21 Although there is a link between inhaled corticosteroids and growth, research shows
1:26 that children who have asthma that is poorly controlled is also likely to impact on their growth.
1:32 It's really important though that, at your child's asthma annual review,
1:36 that your child has their height and weight checked
1:39 and your doctor or nurse will plot that on a growth chart to make sure
1:42 that they're reaching their milestones.
1:44 It's understandable that you have concerns when your child is taking inhaled steroids but
1:49 one reassuring piece of research shows us that a child who is taking a typical dose of budesonide,
1:55 400 micrograms, regularly, will have an average of 1.2 cm reduction in their adult height.
2:03 So, in other words the impact of inhaled steroids on growth is really small, and
2:08 it's much safer to make sure that your child is taking their inhaled corticosteroid regularly
2:13 to reduce their risk of a potentially severe or life-threatening asthma attack.
2:21 Your doctor or nurse will only ever prescribe steroid tablets if they feel that your child really needs them.
2:26 They're a really fast, effective way of taking down the inflammation that's in your child's lungs.
2:35 We know that some people are concerned that their child may gain weight, that
2:39 they've noticed that maybe their child is hungrier when they're taking steroids.
2:42 If you're taking steroids in the short term, this really should pass when the steroids are stopped.
2:48 However, if you're taking inhaled steroids in the long term, it's really important to
2:52 make sure you follow all of the usual advice and make sure the child is eating healthily,
2:57 a well-balanced diet, and at the asthma review, make sure your child's weight is
3:02 monitored by your healthcare professional.
3:08 Some people do tell us that their children have mood swings, difficulty sleeping, or
3:13 they've just noticed differences in their children's behaviour when they’re taking steroids.
3:18 So, to reassure you, the side effects will only be very short term and will only last for as long as you’re taking the tablets.
3:24 If your child is taking steroids in the longer term, please bear in mind that most of these children don't experience side effects.
3:31 And please remember that you can call our helpline to speak to one of our friendly asthma nurse specialists.
If you have any other questions or concerns about your child’s asthma medicines, you can call our Helpline and speak to a respiratory nurse specialist on 0300 222 5800 (Monday-Friday, 9am - 5pm). Or you can WhatsApp them on 07378 606 728.
Last updated July 2021
Next review due July 2024