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
- My child has to take a tablet as well as their preventer inhaler
- My child's preventer tablet can 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 specialist 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 may also find it useful to think about what might happen if your child doesn’t take their medicines – they may:
- Become breathless
- Start wheezing
- Cough at night
- Not feel well enough to play in the park
- Or miss 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 more than they have been prescribed. Reliever inhalers (usually blue) are safe and effective,” says Dr Andy Whittamore, Asthma UK’s in-house GP.
Some relievers can:
- Temporarily increase your child’s heartbeat
- Give them mild muscle shakes.
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 a lot, tell your GP or asthma nurse.
“Remember that if your child needs to use their reliever inhaler three or more times a week, their asthma is not being well managed and they have a higher risk of an asthma attack,” says Dr Andy. “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
- 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 once a year) 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, who has asthma and who has two sons, Gabriel and Beau, who both have asthma too.
Using preventer inhalers may cause a small number of children to have one or more of these side effects, but there are useful things you can do to help prevent them:
- A sore tongue
- A sore throat
- Hoarseness of the voice
- Rarely, a mouth infection called thrush
- For children, a very small chance of reduction in adult height.
You can help prevent these side effects by making sure they:
- Use a spacer
- Use the correct inhaler technique
- 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 their asthma medicine. They use them 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, who has two sons with asthma, Salis, 12, and Sami, 6.
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.
If your child’s preventer inhaler doesn’t seem to be helping with their symptoms, your GP might prescribe Montelukast as an add-on treatment.
“Montelukast is a Leukotriene Receptor Antagonist (LTRA). It comes in tablet form, but is also available as a chewy tablet or as soluble granules,” says Dr Andy Whittamore. “It relaxes the airways in your child’s lungs to make breathing easier and to help prevent asthma attacks. Montelukast is a non-steroid based preventer medicine and will help your child get on top of their asthma symptoms.”
Whenever your child’s GP changes your child’s prescription they should see your child again in four to eight weeks to see if it’s working well.
“If Montelukast doesn’t seem to be helping, or doesn’t suit your child, let your GP or asthma nurse know so you can talk about other ways to help your child’s asthma,” says Dr Andy.
All medicines have potential side effects. The most common side effects of Montelukast are:
- Frequent sore throats
- Frequent infections
“If your child does get any side effects, or you’re worried about anything at all, speak to your GP, asthma nurse or pharmacist as soon as possible,” says Dr Andy Whittamore. “You may find that there are some simple things you can do to help prevent or reduce these side effects. Or your GP may recommend a different medicine instead.”
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 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.
“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,” says Dr Andy Whittamore.
Research shows there’s only 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
- How long they take them for.
For this reason the latest clinical guidelines recommend that all children taking inhaled steroids for asthma have their height and weight checked at least annually.
However, clinically, any reduction in height is described as ‘insignificant’.
If you’re concerned about your child taking steroids, it might help you to remember that:
- Your child will likely need to take fewer steroid tablets overall if they are taking a regular lower dose of steroids in a preventer inhaler to manage their symptoms well and lower your child’s risk of a potentially life-threatening asthma attack
- The risk of your child ending up in hospital is higher if they're not using their preventer inhaler. 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 under 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 steroid 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 temper tantrums.
“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,” says Dr Andy Whittamore.
“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,” says Dr Andy.
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,” says Dr Andy Whittamore.
In the longer-term, giving your child a well-balanced diet with lots of fruit, vegetables and wholegrains is recommended.
“Guidelines recommend that all children taking inhaled steroids for asthma have their height and weight checked at least once a year, but if you think your child is putting on weight, don’t wait for this appointment,” says Dr Andy. “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 soon as possible,” says Dr Andy Whittamore, Asthma UK’s in-house GP.
“They will give you advice and may take a blood test to check your child’s immunity to chickenpox. If your child isn’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,” says Dr Andy.
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 the Asthma UK Helpline on 0300 222 5800 or message them via WhatsApp on 07378 606 728 (Monday-Friday, 9am-5pm).
Your child and asthma steroids
Asthma UK specialist nurse Debby Waddell answers your common concerns about children taking steroids for asthma.
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.
Last updated August 2019
Next review due August 2022