[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › The child with asthma: monitoring an attack and the written action plan # The child with asthma: monitoring an attack and the written action plan - Safe practice During an attack the nurse watches breathing before and after each dose; at home a written action plan tells the family what to do in each zone. Updated Nov 13, 2026 ## Key points - Attack signs: fast breathing, wheeze, cough, chest tightness, indrawing; cough at night may be the only symptom. - Emergency signs: great difficulty breathing, blue lips or face, severe anxiety, decreased alertness or drowsiness. - Reassess after each dose: breathing rate, signs of distress, how the child looks and feels. No improvement after the cycles means referral. - Action plan zones (CDC): green above 80 % of best peak flow; yellow about 50 to 75 %; red below 50 % or reliever not helping. - Controller medicines are taken every day even without symptoms; relievers are for symptoms and attacks. ## What it is Asthma is the most common chronic disease of childhood. In an attack the nurse gives the prescribed quick-relief medicine with a spacer, gives oxygen if the child is in distress, and reassesses after each dose to decide whether the child improves or needs referral. Between attacks, nursing work is teaching: the difference between controller and reliever medicines, inhaler technique, triggers, peak flow in older children and the written asthma action plan, which also goes to the school. ## What it requires - A written action plan for every child, made with the health team. - Correct inhaler technique with a spacer (see the inhaler page). - Trigger control: tobacco smoke, dust, mould, pollen, animal dander, colds, cold weather. - School staff hold a copy of the plan and know how to handle symptoms during exercise. ## How it is applied (and why) - Count respiratory rate, look for indrawing, listen for wheeze and measure SpO2 — this is the baseline for every decision. - Sit the child up and keep the child calm with the caregiver close — sitting up allows full chest expansion. - Give oxygen per protocol if there are signs of respiratory distress — AIEPI asks for oxygen during treatment cycles. - Give the prescribed reliever with a spacer, one puff at a time — the spacer is how a child receives the dose. - Reassess after each dose and record the response — improvement or no improvement decides the next step. - If the child does not improve after the treatment cycles, refer or escalate now — the attack is not responding. - Teach controller versus reliever, the inhaler technique and the triggers at home — daily controllers and trigger avoidance prevent symptoms. - In children aged 5 or over, teach peak flow and the zones of the action plan — readings drop when the airways narrow. - Give the family and school a copy of the plan and arrange follow-up — a plan only works if those around the child have it. ## In nursing practice - Children under 5 may not use a peak flow meter reliably; symptoms guide the plan. - Drowsiness, confusion or decreased alertness during an attack are emergency signs, not signs of calm. - Asthma does not stop a child from exercising when it is well controlled. - Contact the health team when peak flow keeps falling or symptoms become more frequent despite following the plan. ## Common mistakes - Giving the reliever without measuring breathing before and after. - Using the inhaler without a spacer in a young child. - Stopping the controller when the child feels well. - Sending the child home without a written plan, or without giving a copy to the school. ## Test yourself Think of the answer, then tap the question to see it. ## What does the nurse check after each dose of reliever during an attack? Respiratory rate, signs of respiratory distress, oxygen saturation and how the child looks and feels. ## What does the red zone of an asthma action plan mean? A medical alert: great difficulty breathing, reliever not helping, or peak flow below half of the child's best; get medical help. ## What is the difference between controller and reliever medicines? Controllers are taken every day to prevent symptoms, even when well; relievers act fast during symptoms or an attack. ## Why does the school need a copy of the action plan? So that staff recognise symptoms, give the reliever as agreed and know when to call for help. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/the-child-with-asthma-monitoring-an-attack-and-the-written-action-plan/) ## Elsewhere in DurgiPedia - [Vital signs in children: how they change with age](https://durgical.com/en/clinical-exam/vital-signs-in-children-how-they-change-with-age/) ## Connections ## Related 2 - [Inhalers with spacer and mask, and nebulisers, in children](https://durgical.com/en/nursing/inhalers-with-spacer-and-mask-and-nebulisers-in-children/) - [Pulse oximetry at the bedside: placement and pitfalls](https://durgical.com/en/nursing/pulse-oximetry-at-the-bedside-placement-and-pitfalls/) ## Related conditions 1 - [Asthma](https://durgical.com/en/conditions/asthma/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Asthma in children](https://medlineplus.gov/ency/article/000990.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Living with Asthma (asthma action plan)](https://www.cdc.gov/asthma/actionplan.html) (Centers for Disease Control and Prevention, 2024); [Asthma (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/asthma) (World Health Organization, 2025); [Cuadro de procedimientos AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia)](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/cuadro-procedimientos-atencion-integrada-enfermedades-prevalentes-infancia.pdf) (Ministerio de Salud y Protección Social de Colombia, 2016). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. 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