What are discharge instructions?

Discharge instructions are information about how to take care of your child after getting medical care in the emergency department ("ED").

What should I know?

Your child was seen in the ED for an asthma "attack." This is when asthma symptoms get worse, leading to coughing, wheezing, or trouble breathing. Many things can cause asthma to get worse, like a cold, allergies, or cold weather.

It is important to follow up with your child's regular doctor. You should also help your child take their asthma medicines as instructed.

The doctor might have given your child an asthma action plan or a peak flow meter. These can help you and your child manage their asthma.

How do I care for my child at home?

Ask the doctor or nurse what you should do when you go home. Make sure you understand exactly how to care for your child. Ask questions if there is anything you do not understand.

You should also do the following:

• Call your child's regular doctor and tell them your child was in the ED. Make a follow-up appointment.

• Follow your child's asthma action plan, if they have one. Help your child use their "peak flow meter," if the doctor suggested using one. This is a device older children can use at home to help see how well their lungs are working.

• Know how and when to give your child their asthma medicines. They might have:

  • Quick-relief medicines – These open the airway quickly to stop symptoms of an asthma attack in 5 to 15 minutes. Everyone with asthma should have a quick-relief inhaler to use during an asthma attack. Carry it with you at all times. Make sure all caregivers always have 1 with them.

    Most people rarely need their quick-relief medicines. But some might need them 1 or 2 times a week. When asthma symptoms get worse, more doses might be needed.

  • Long-term controller medicines – These reduce swelling in the long term to help prevent asthma symptoms from happening. Your child should take them every day, even when they feel well.

  • Steroids that come as pills or liquid – These are given during an asthma attack and for a few days after to help get your child's asthma back under control.

• Do not smoke. Do not let others smoke near your child or in the car with your child. Smoke can stay on clothes and furniture and cause breathing problems.

• Lower your child's risk of getting sick. In children, viral infections are the most common asthma "trigger." Examples include a cold, the flu, and COVID-19. Wash your child's hands often, and keep them away from people who are sick.

• Learn what other things trigger your child's asthma, and help them try to avoid those things. Common triggers include allergens (such as dust, pollen, or pet hair) and scents from cleaning products, detergents, or perfumes. Exercise can also trigger asthma, but your child should not avoid it, unless they are sick or getting over a flare. Exercise is important for staying healthy.

• Know if your child needs an extra dose of their quick-relief inhaler before they exercise.

When should I get emergency help?

• Call for emergency help right away (in the US and Canada, call 9-1-1) if:

  • Your child's skin, nails, lips, or area around their eyes are blue or gray.

  • Your child passes out, seems very sleepy, or is less alert than normal.

  • Your child has so much trouble breathing they can only say 1 or 2 words at a time.

  • Your child needs to sit upright to breathe, or cannot lie down.

  Give your child their quick-relief medicine while you wait for the ambulance.

• Return to the ED if:

  • Your child has trouble breathing when talking or sitting still.

  • Your child's symptoms do not get better or get worse after giving their quick-relief medicine.

  • Your child is having trouble breathing, and the skin and muscles around their ribs are pulling in with each breath (called "retractions").

When should I call the doctor?

Call for advice if:

• Your child's wheezing returns but is not severe, they can talk in full sentences, they are comfortable sitting, and:

  • Their symptoms do not improve within 20 to 30 minutes of using their quick-relief inhaler.

  • You have to give the quick-relief medicine more often than every 4 hours.

  • Their wheezing lasts more than 24 hours.

  • They have coughing, wheezing, or trouble breathing at night.

• Your child needs to use their quick-relief medicine more than 2 times a week for symptoms. But you do not need to call for advice if the doctor told you to give your child this medicine more often, such as before exercising or for a few days after an asthma attack.

• Your child cannot do their normal activities because of their asthma symptoms.

• Your child has new or worsening symptoms.