Steroid Inhalants

• How to rinse toddler's mouth after using Flovent inhaler
• Worried about using steroids for 2 year old's asthma
• Daughter gets a rash when discontinuing Flovent
• Asthma medications for 2 year old: Flovent vs. Pulmicort

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

Worried about using steroids for 2 year old's asthma

Sept 2008

Hi I have a 2.4 year old son, who has had seasonl asthma. My doctor had intially started steroids, and we have taken him off of them during the summmer..However now we are approaching winter and he is sick and having respiatory stress, so we are back on steroids again... Does any one have any current advice on alternative medicine for a toddler? other than steroids? I question the doc about side affects but of course they say there is none.. I wish there was more help I could get other than these strong medications?? please help! alexandra

I'm sorry your young child is suffering from asthma. I am an adult who has had asthma nearly my whole life -- age 45 now. I can tell you that the medicines today are truly leaps and bounds better than meds years ago. You say your son is on ''steroids'' but what you probably mean is ''inhaled steroids''. Inhaled steroids are quite different -- different chemicals to the kinds of ''steroids'' we hear about in other contexts, different doses (very small) and targeted (to the lungs, where they are needed). It is true that small amounts will likely get in the blood stream -- but it is very small amounts compared to anything people were given a generation ago.

Controlling asthma is very important. If you want to check out non-western options, do so, but be sure that you do not endanger your child in the process. Asthma ''attacks'' are scary, very distressing to the body, and potentially fatal -- they are not to be played with. Myself, I have grown very comfortable taking the medicines and I am very grateful for them as my asthma is completely controlled. Certainly, go for low doses, but make sure it's controlled. asthma sufferer

It is true that inhaled steroids are very well tolerated over long periods of time, but one side effect you should be aware of is the possibility of thrush. Prevention is easy. just have him drink some water afterward to wash any residual medication out of his mouth. anon

Daughter gets a rash when discontinuing Flovent

April 2007

We have a 3.5 yr old daughter with mild asthma who uses a Flovent inhaler morning and night. We have noticed that when we have taken her off of it, she gets a big pimply rash around her mouth. Once she is back on the inhaler, the rash goes away. Is this her body's way of trying to get it out of her system? Why does she only get it when taken off of it?

What are the long term side effects of being on low dose inhaler steriods? A friend of mine who doesn't buy into Western Medicine, thinks we should have our daughter muscle tested for allergies. How can asthma be caused by or affected by allergies? I'd love to hear the perspectives of both Western and alternative medicine followers.

Thanks anon

This is a real pet peeve of mine. Most of the non-western meds people who advocate not treating asthma do not have or know people who have asthma. Asthma is a potentially life-threatening condition, and should be medically treated. Believe me, your doctor will help ensure your child gets by with as little medicine as possible, especially if you articulate that is your goal, but if your child needs a preventative medicine like Flovent he or she should take it. Sometimes people can get by without preventative medicine, and if so, that is great. Other people cannot without the risk of fairly regular bouts of asthma and that is dangerous, destructive, and very restricting of one's life.

Inhaled steroids have none of the side effects of oral steroids that you may have heard about. Very little of the medicine gets into the whole system.

Asthma and allergies are linked, but allergy testing is a bit of a faux science -- skin reactions are not always the same or proportional to how you react otherwise. Allergies can and should certainly be explored as a possible source or trigger of asthma symptoms.

As for the rash -- *ask your doctor* why your child is getting it and what it is. You should not be putting the child on and off the medicine -- it only works if you stay on it, and taking him/her on and off is potentially dangerous.

These really are questions to ask your doctor. If your doctor is not open to your questions, find another, but you really can ask a western medicine doctor about alternative treatments and at the very least the doctor can give a fuller explanation of what asthma is and how and why he or she is treating it in the manner he or she is. Then you can make an informed decision. good grief

ok I could be totally wrong but here's my thought. we use steriods somrtimes to treat rashes, right? like steriod creams. maybe your daughter is reacting to something else but the flovent is masking the reaction. When you take the flovent away the reaction becomes apparent. if it is only around he mouth maybe she is allergic to the mask (latex allergy?). you don't mention if she is taking other inhaled meds.

my daughter is also on inhaled steriod (pulmocort) plus Xopenex as needed (similar to albuterol) and singular which is a pill. she's been on the steriod since she was 10 months old with some breaks when she's not symptomatic and it's not cold season (she's 2 now). I do know that they can get thrush (yeast infection of the mouth) from steriods but this is a white coating on the tongue, not what you're describing. the way you prevent that is to have them drink a few sips of something to wash the med out of the mouth after giving it. anon

Asthma medications for 2 year old: Flovent vs. Pulmicort

Dec 2004

I have a two-year-old son who needs to be on a controller medication for asthma. I'm comparing Flovent (44 mcg inhaler, 2 puffs twice a day) and Pulmicort (.25 mg respule for nebulizer once a day) and wonder if anyone has any experience with these, especially with side effects. The Flovent is easier to use but causes some coughing and hoarseness. It also seems to make him cranky, though it's tough to tell with so many things going on all the time that could also play a role (his doctor says it shouldn't affect his behavior). With the Pulmicort, though, I'm concerned about the possibility of slowed growth, which from what I've read is a bigger risk with that drug (though his doctor assures me the risk is minimal). My son seems to be eating less these days as well (on either drug). My doctor says that I should use whichever works better; the Pulmicort seems to, but marginally.

I would like to know what other parents have found when using these drugs, and maybe just get some moral support as well.

On a side note, the spacer he uses with the inhaler develops a film on it, even though I wash it according to the directions. These directions clearly say not to wipe it with a cloth. Any suggestions on removing the film? I used an old toothbrush, but I'm not sure that's a great idea, I guess because I'm not sure why one shouldn't wipe the thing with a cloth. Ellen

If the drugs both work well, then choose the one you prefer, and follow the Dr's instructions. If your child likes using one better than the other, let him choose! The positives of being able to breathe should more than outweigh the alleged delay in growth or hoarseness, etc. You may want to hook up with the American Lung Association, or have your Dr. refer you to a specialist to be sure you understand as much as possible, if this is to be a chronic condition. There are also on-line groups for parents of kids with asthma, that are really useful. As for using cloth on the spacer --- the problem may be that inhaling lint from cloth is an irritant. The film is likely not to affect the efficacy of the spacer, but again you might want to talk with an expert. Breathless in Berkeley

Both of my children (5 years old and 21 months) have been on both Flovent and Pulmicort. My understanding of Flovent is that it has been known to articifically suspend growth, meaning that the child may not have normal growth while taking the medication but will catch up in later years. However, my son seems to have normal growth spurts; and his height and weight have been well within expectations. So I don't know how that compares with Pulmicort. I have not seen a difference in hyperactivity. One of my son's daycare teachers used to claim to notice that Albuterol would cause my son to be more hyper (and other parents have said the same thing) and she'd beg to be allowed to wait until after his naps to give it to him, but I merely noticed that at home, giving it to him would allow him to sleep better. And I never noticed either Flovent or Pulmicort making him more hyper.

My preference has been Flovent, because it is formulated to use with an inhaler. I much prefer the few minutes it takes to do a puff or two (or six) with an inhaler over 10 to 20 minutes with a nebulizer. However, our allergists have really pushed Pulmicort, because they say it is more effective, with fewer side effects. That said, I have been forced to use Pulmicort for my daughter, because Flovent has given her vaginal yeast infections. (Her pediatrician says that means she isn't effeciently inhaling the Flovent; regardless, we just can't use Flovent for her.) My daughter's growth has seemed to be regular on Pulmicort. Both drugs seem to be equally effective; once my kids have been on them, their instances of asthma attacks dramatically lessened--which is the whole point. I know that there's an ongoing debate about steroids, but I've heard horror stories about asthma attacks, including death and emergency hospital visits. Before we had my son on a preventive, we had some pretty dicey nights where he just couldn't get a breath, and we were forced to use our emergency Prednisone. I never want to go through that again, and with the Flovent/Pulmicort, I haven't had to. As far as cleaning the spacer, the instructions that came with ours (and we have three) all said you could take them completely apart. I am particularly diligent about washing the face mask in a detergent solution. I rinse out the other parts and wash them thoroughly in hot soapy water every couple of days. I take the thing apart and use a Dobie (a mild sponge/scrubber made by 3M) to get into the spacer. It doesn't get scratched, but as it dries, it does appear to have a residue. I also make sure to wipe my son's face with a wet paper towel and have him either rinse out his mouth or brush his teeth afterward to avoid a yeast infection or eczema outbreak. Please feel free to continue this discussion by email. Gwynne

I have used both flovent and pulmicort myself with no side affects. My son has used flovent, both with an inhaler and in a nebulizer. Both Pulmicort and Flovent are pretty ''old'' asthma drugs, meaning the info about side affects is pretty reliable. My doc actually had me use pulmicort over the flovent when I was pregnant, b/c it is ''older''.

I'm wondering if the p. works better because you are using the nebulizer. The nebulizer often works better because it gradually affects the lungs and allows the child to settle down. If you want to try, I'm pretty sure it is possible to get your doc to prescribe flovent for the nebulizer-- then you'd have the option of taking one med two ways for your convenience. Just some added advice, do you have an asthma/allergy specialist for your son? This might help w/ a lot of unanswered questions. Jim Nichols is supposed to be the best in the berk area-- and we use Dr David Denmead-- he's in pleasanton but worth the trip. Totally changed my and my son's lives. hope this helps. Rebecca