You can hear your daughter coughing in her room. She’s been up all night and neither of you has gotten any sleep. This is the third time she’s had bronchitis this year. And, even after the antibiotics, you know she’ll still cough when she plays at the park. What should you do?

Ask her doctor. Nearly 9 million children have asthma, a chronic, inflammatory condition of the bronchial airways that makes airways smaller and causes them to produce extra mucus, making airflow more difficult.

As a parent, what symptoms can you watch for and how early can you tell that asthma is setting in?

Frequent respiratory infections

Children who have asthma often have a weakened immune system, and their lungs cannot handle even the smallest infection. Asthma sufferers frequently find themselves in the doctor’s office, being diagnosed with bronchitis or even pneumonia. If it seems like your child is always fighting off a cold or the flu, or something more serious, it might be time for your doctor to look a little deeper.

Coughing

Coughing is usually the first indicator of asthma. Crying, stress or exertion like exercise exacerbates coughing in asthma sufferers. It can be especially bad at night when your child tries to relax. Nighttime coughing of undiagnosed and untreated asthmatics can greatly disrupt sleep, so your child may complain of fatigue.

Wheezing and chest tightness

As air tries to pass through the tiny passages of a constricted airway, breathing can sound like a high-pitched, whistling sound, commonly referred to as wheezing. This is a terrifying sound because it seems your child is gasping for air, which in a sense, he is.

Aside from the telltale wheezing, children may complain of tightness in their chests, like there is a weight on them when they breathe. Some younger children have described it saying their clothing feels too tight.

Asthma attack or sudden onset

The primary symptom of a full-blown asthma attack is the inability to breathe. If this happens, your child will likely panic. Stress and fear will cause his symptoms to accelerate and worsen. Do all you can to keep him calm, and get him emergency medical attention immediately, through your closest emergency department. Inform your pediatrician as soon as possible.

The cause of a sudden-onset attack can be due to the symptoms of your child’s asthma compounding to become suddenly acute or to a combination of triggers in his environment. Every child’s triggers will vary but common ones include airborne allergens like mold, dust or pollen.

What about babies?

In children that are too young to speak, it\’s still possible to spot early indicators. In addition to shortness of breath, you may notice a softer, shorter cry; rapid, noisy breathing; a sucked-in-looking chest (between the ribs at the front of the neck); and difficulty feeding. A baby who has trouble breathing will have trouble eating and breathing at the same time, and will therefore be a fussy eater.

Every mother has watched the rapid and odd breathing patterns of her newborn. A normal newborn’s respiratory rate is about 40 times per minute. Adults typically breathe between only 12-20 times per minute. So, try not to panic as you watch your baby breathe heavily. He may not be short of breath.

What if it is asthma?

If your child is suffering from asthma, he has not been handed a life sentence of playing indoors with little stimulation for fear of aggravating his condition. Children with asthma, thanks to a wide range of treatment options, can play and be active.

Your child’s doctor will run tests to find out what your child’s triggers are, meaning exactly what environmental factors will cause your child’s respiratory system the most distress. This will help your family keep those triggers to a minimum. For example, some asthma sufferers cannot tolerate fragranced air fresheners, and you can help by tossing your scented sprays.

Next, your child’s doctor will determine what type of medications your child needs to control his condition. There are a variety of medications available, and depending on the severity of the condition, your child may be on a number of treatments to help control his symptoms. Most asthma medications are divided into two categories: anti-inflammatory and bronchodilators.

Anti-inflammatory medications help prevent asthma attacks by reducing swelling of the airways and reducing mucus production. This category of medication includes steroids and corticosteroids, commonly prescribed to asthma sufferers. Bronchodilators relax the muscle bands that tighten around the airways, rapidly opening airways to let more air through. They also help clear mucus from the lungs.

Your child may need a variety of medications, including a fast-acting inhaled medication for sudden-onset symptoms. As with all medications, there are a variety of side effects, and your child’s doctor will help your decide what benefits outweigh which side effects.

Your doctor will also recommend avoiding common triggers, like mold, pollen and ragweed; and helping your child become conscious of his symptoms, slowing down when he feels an attack coming on, learning to be more tuned-in to his own body.

If you notice that your child has only one or two of the symptoms mentioned above, he likely doesn’t have asthma. However, watch for a combination of symptoms, and talk with your doctor.