Managing Inhalers for Young Children

• How to manage the inhaler in kindergarten?
• How to rinse toddler's mouth after using Flovent inhaler

How to manage the inhaler in kindergarten?

Oct 2012

What have you wise BPNers done to assist or advocate for your child with asthma? I thought my 5-year-old kid would be pretty good at taking inhaler when needed (e.g. on the playground), but now I'm not so sure, and I want to make sure the school adults are keeping a better eye.

Here are some things I'd ideally like to have happen. Let me know if you've managed to accomplish any of these things (if so, how?) or if you have other ideas for how to make this work. I'm feeling confused and a little anxious. We're at a Berkeley Public School, btw. We can get a Dr.'s note to for child to 'self-carry'.

- ideally when on playground, would like inhaler to be nearby (not locked in office, not in backpack in the classroom), want child to not have to 'go far' to get it if needed, especially if having an urgent attack (rare, but has happened), but also if just having mild wheezing

- child could possibly carry backpack with inhaler during recess, but would rather not have that be solution - can restrict movement & ability to play fully ...

- ideally when on playground, would like the adults in charge to check in with child once or twice to see if inhaler is needed (child will know 'yes' or 'no', but might not make the effort to do on own without an adult asking)

- whenever inhaler is used, would like an adult to mark how many puffs (on inhaler), so I can keep track of those darn puffs (ug)

- trying to avoid giving inhaler regularly before recess, since only needed 25% - 50% of the time or less

There are times when I know it will be needed on a schedule - I'm less worried about that since I can more clearly communicate that with teachers, etc. But it's sometimes needed on the playground, when any variety of staff or parent volunteers are watching the kids. That's what seems complicated to me.

Hope I'm giving enough info. Would love experience or advice.

anxious about asthma

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It seems like a tracking device like this might help with part of your query. http://asthmapolis.com/ Hope this helps

Not sure which school district you're in, but I'll assume they all basically have the same policy. No self-medication is allowed...at all. My son also had mild asthma, and the policy at public school is that only the nurse is allowed to administer it. You have to have a form filled out by your pediatrician. We were able to give an extra inhaler to his after school program without hassle. I wish it were easier... asthma mom

I can't help you with the school logistics, but it sounds like you might need to talk with your daughter's doctor about whether her asthma is adequately controlled. If she needs her inhaler 25-50% of the time with physical activity, it likely isn't. True exercise induced asthma is pretty rare in a 5 year old. Far more common is poor asthma control that causes them to have symptoms with exercise. If you get her asthma well under control then she should only need her inhaler once or twice a week, which would make the school recess issue a lot easier.
official ''asthma champion'' in pediatrics

I can't speak to most of your questions, but regarding how to make it possible for your son to carry his inhaler around: cargo pants! My partner has asthma and has to work out on job sites a lot. He keeps his inhaler in the large pocket of cargo pants. Works perfectly. Your son might get sick of wearing them, but... they're better than a backpack. Anon

How to rinse toddler's mouth after using Flovent inhaler

March 2011

My almost 2-year-old has asthma and we've just started giving her Flovent inhaled steroid (in addition to albuterol). They recommend that the mouth be rinsed out after each use to avoid fungal infection.

Ummmmm, anyone have success with rinsing a toddler's mouth? They don't know how to spit yet - just swallow. I'm grossed out by whatever might cause fungal infection being ingested. I do brush her teeth after, but that also doesn't seem like it would have the same effect as rinsing.

Not planning on giving Flovent for months at a time - just weeks at a time when she has a cold. Not sure if that makes a difference for chances of fungal infection.

Anyway, mostly wondering if there's a way to do the rinsing that you all have figured out. (I already asked my ped - she couldn't help.) If not, anyone know of studies showing effects of very young children swallowing this stuff?? help!

Hi -- oh, now you've given me something new to worry about. My daughter also has asthma and takes Flovent when she has a cold -- and I've never worried too much about rinsing her mouth afterward. She usually drinks or nurses afterwards, and so far so good -- we've had no problems. All the best. liz

Hi, my son started using an asthma inhaler a few months before he turned 2 as well and we ran into the same problem. We never did figure out how to get him to spit (although now he kind of gets it and will *sometimes* spit), so we settled on having him rinse and swallow. I informed out ped of this and he did not seem concerned. We haven't had any problems like fungal infection. I think if you are brushing his teeth afterwards, that is more than sufficient. Kristina

--don't know how to teach a toddler to rinse and spit

I think a child this age can learn to spit. In fact, you may end up asking us next time how to get her to STOP spitting! I'd teach her by starting separate and apart from the inhaler use. Just take a glass of water (maybe add a drop of food coloring?) and make it a game. Put a paper towel in the sink. You take some of the water in your mouth, swish it around and spit on the paper towel. Laugh. Then let her try. Or make it ''rain'' on the grass outside. Once she's comfortable spitting for fun, I think she'll be able to do it after the inhaler. As as I said, good luck getting her to stop!

BTW, if she does swallow what she rinses with, I don't think it will hurt her. After all, it's nothing other than what she's inhaled, plus saliva and water. The doctor presumably just doesn't want that stuff sitting in her mouth. But her stomach can deal with it, I assume. Spitting mama (part llama)

Hi, my daughter was diagnosed with asthma when she was 10 months old and she is almost 6 now, so here's what I know from both personal and professional experience. You're right that it's not realistic to expect a toddler to be able to rinse after a treatment. However, brushing - even just with water should be totally adequate. The inhaled steriods leave a small residue in the mouth which can cause an imbalance in the natural flora of the mouth the result of the imbalance is thrush (oral yeast). Its not poisonous or even chemical, it's just annoying and can cause a sore throat. It generally takes a fair amount of build up over a long period of time with no rinsng to cause any thrush. If it does develop, it's visible on the tongue as a white, patchy coating. as long as you are brushing her teeth and tongue afterward, I'd be surprised if you every see any. It's fine for her to have a drink afterward too. the amount in her mouth is very small and her stomach acid can take care of it easily.

The second, more important, point I'd like to make is this. You mentioned that you are only planning to give Flovent when she has a cold. But the Flovent is preventative. It is not for symptom treatment. Her symptoms will not get better without a rescue medication, like Albuterol. The Flovent PREVENTS her symptoms from getting worse AND it is not effective unless you give it for at least 3 weeks straight. It is really important to control her asthma and to prevent it whenever possible so that her lungs can develop normally, otherwise she may have to deal with this for the rest of her life. If her asthma is well controlled while she is growing, there is a good chance it will disappear in her teenage years. The younger she is, the more important this is.

My daughter takes Singular as her maintenance (prevention) medication. her trigger is also colds so her asthma is worst in the winter. She gets Singular EVERY day from the first sign of a cold in the fall until cold season is over in April - whether or not she has symptoms. In the summer she gets a break. When she's symptomatic, usually at the tail-end of a cold, she gets Xopenex (regular Albuterol does nothing for her so we are forced to use the more expensive drug) in addition to her maintenance med.

If you are only planning to give your daughter Flovent when she is symptomatic, don't bother. but do try to find a maintenance medication that you will do consistently, as directed, otherwise you are really doing her a disservice. Asthma is very common, but also potentially very dangerous. The first patient I ever had that died under my care did so after a severe asthma attack left her mostly brain dead, she was in her early 30's.

Thank you for seeking more information, please do not make decisions about your daughters meds without talking with your pediatrician, if you feel uncomfortable being totally frank with him or her, find another one who can really be clear with you and listen to you. I. Clark RN

I had the same question about a year ago, when my daughter was 1.5. ''Rinsing'' is obviously out of the question, but we just make sure she takes a couple of sips of water after each puff. I don't think there's much of a risk to the body from swallowing water after the puffs. The risk is just that the Flovent can throw off the bacteria in the mouth, which can then pave the way for fungi to move in...in the mouth and in the genital area. (Not much different from antibiotics, if you think about it.) My daughter has had a couple of yeast infections, presumably from when we were less than vigilant about making her drink water after the inhaler and it was awful for her. Nothing a little Lotrimin didn't take care of, but still really unpleasant and we would do ANYTHING to avoid that again. Hope this helps! Asthma Mom

Do the best you can, and don't worry too much. I used a Flovent inhaler for years, and rarely rinsed. I sometimes would have a sip or two of water. Often I did nothing. In over ten years I never had a fungal problem. No Fungus Amongus