A worsening of your child’s asthma caused by exposure to one of their triggers. These vary between children but the most common ones are coughs and colds, cold weather, cigarette smoke, pet fur or feathers and pollen.

Over the next few days, your child will need to be regularly given a blue (salbutamol) reliever inhaler.

Dose of blue (salbutamol) reliever inhaler via Spacer:

Today ....... puffs, ....... hourly for first ....... day(s)

Then ....... puffs, ....... hourly for next ....... day(s)

Then ....... puffs, ....... hourly until symptoms improve

after which your child should be back to normal and you should be able to stop the blue inhaler.

In the event that your child has been started on steroid tablets, these should be continued once daily (usual treatment course is 3 days).

If your child becomes increasingly breathless despite following the plan above, you should follow the instructions outlined in the table below.

You should continue your child’s normal preventer treatment(s) during an acute exacerbation of asthma.

At the start of cold symptoms (such as runny nose), begin your child on blue (salbutamol) reliever inhaler 2 puffs 4 hourly (including through the night).

If your child is:

  • Too breathless to talk / eat or drink
  • Has blue lips
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite 10 puffs blue (salbutamol) inhaler every 4 hours
  • Confused and drowsy






Ring 999 for immediate help.

Give 10 puffs of blue (salbutamol) reliever inhaler every 10 minutes until ambulance arrives.

Keep child in upright position and reassure them.

If your child is:

  • Wheezing and breathless and blue (salbutamol) reliever inhaler 2-5 puffs is not lasting 4 hours
  • Having a cough or wheeze/tight chest during the day and night
  • Too breathless to run / play / do normal activities






Immediately contact your GP and make an appointment for your child to be seen that day face to face.

Increase blue (salbutamol) reliever inhaler 6-10 puffs every 4 hours

If your child starts to cough, wheeze or has a tight chest but can continue day to day activities







Give 2-5 puffs blue (salbutamol) reliever inhaler every 4 hours until symptoms improve.

Choose appropriate sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath).


  1. Shake the inhaler well and remove cap.
  2. Fit the inhaler into the opening at the end of the spacer.
  3. Place mask over the child’s face or mouthpiece in their mouth ensuring a good seal
  4. Press the inhaler once and allow the child to take
  5. slow breaths between each dose 5 Remove the inhaler and shake between every puff. Wait 1 minute between puffs.

Repeat steps 1 – 5 for subsequent doses
Plastic spacers should be washed before 1st use and every month as per manufacturer’s guidelines

For videos on using your child’s inhaler and spacer correctly see goo.gl/235DQf

If your child has been discharged from hospital, you should arrange for them to be seen in the next 48 hours by your GP or GP practice nurse.

NHS 111 Wales

Website: NHS 111 Wales

NHS 111 Wales (Option 2) telephone service is available 24/7 and can be used for urgent mental health advice and support.

 

Meic

Website: www.meiccymru.org

Meic is the helpline service for children and young people up to the age of 25 in Wales. Chat online, freephone 080880 23456, or text 84001.

 

 

C.A.L.L. Community Advice Listening Line

Website: www.callhelpline.org.uk

Provides a confidential mental health listening and emotional support line which is open 24/7. Call 0800 132 737 or text ‘help’ to 81066.

 

 

Shout

Website: www.giveusashout.org

Text ‘shout’ to 85258 anytime, day or night.

 

 

Childline

Website: www.childline.org.uk

If you’re under 19 you can confidentially call, chat online or email about any problem big or small.

 

 

Samaritans

Website: www.samaritans.org/wales/samaritans-cymru/

Call 116 123 free, anytime, day or night.

 

 

Papyrus

Website: www.papyrus-uk.org

Are you, or is a young person you know, not coping with life? For confidential suicide prevention advice contact HOPELINEUK. We are open 9am–midnight every day.

 

 

Campaign Against Living Miserably (CALM) for men

Website: www.thecalmzone.net

Need help? Call our helpline 5pm-midnight, 365 days a year on 0800 58 58 58.

 

 

DAN 24/7 - Wales Drug and Alcohol Helpline

Website: www.dan247.org.uk/

Freephone 0808 808 2234, or text DAN to 81066.

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  • Try to stay calm.
  • Tell them you are there for them and that you are not upset or angry.
  • Tell them you are pleased they have told you they are having thoughts of harming themselves and that you are able to help them through this time.
  • Listen to what they are saying even if they are venting anger or other negative emotions at you.
  • Listen without interrupting.
  • Validate their thoughts and feelings – they are real and important.
  • Try to be emotionally available and present for your child.
  • Once things appear to be settling please encourage your child to relax as the day/ evening progresses and make some suggestions for things you can do together to distract them from their thoughts (see below for some ideas).
  • Try to proactively manage any potential conflicts or arguments within your immediate environment.
  • Be mindful of excessive use of mobile devices but that young people really need to feel connected to others at times of distress.

If you are concerned that your child/ young person is at risk of harming themselves, please ensure the following:

  • All medications (prescribed/ over the counter/ vitamins) are removed and/ or locked in a strong lockable medical box or locked cupboard.  Medication needs to be stored in this way in all houses where the young person stays, including grandparents, foster carers, step parents and residential homes.
  • All sharp objects, such as knives and razor blades, to be removed and/ or stored securely.
  • Ensure the young person has not got a stock of medication or sharp objects in their room or amongst their property.
  • Other environmental risks in your home should be considered, e.g. removing ropes, ties, dressing gown ties.
  • Do not allow your child/ young person to go out alone or with friends during times of distress and when they are voicing thoughts of self-harm or suicide.
  • Monitor your child/ young person’s mood and behaviour closely.
  • Increase your presence and supervision of your child at home, if needed remaining awake or checking on them during the night.
  • Ask them about thoughts of self-harm and suicide.
  • ​​​​Look out for any warning signs in your child/ young person that they might be struggling.

  • Distract yourself - watch a film or TV programme, play a computer game that absorbs your mind, or read a book you’re really interested in
  • Get creative – drawing, mindful colouring, taking photos, listening to music, singing
  • Get moving – walk, run, dance, do an exercise or yoga video
  • Comfort yourself – have bubble bath or shower, eat something you like, stroke a pet, cuddle up tightly in a blanket, rock/ hug yourself, spray a favourite perfume

 

Alternatives to self-harm when the urge to harm is very strong:

  • Hold ice in your hand for as long as you can
  • Step under a cold shower briefly
  • Run your hands under cold water
  • Snap an elastic band against your wrist
  • Hit a cushion against the wall or bed
  • Punch a punch bag or pillow
  • Go for a fast paced walk or run up and down the stairs several times
  • Tear or scrunch up paper

Improving the physical and emotional health and wellbeing of expectant mothers, infants, children and young people throughout Aneurin Bevan University Health Board Area.

(N.B: The Family and Therapies team at ABUHB is NOT responsible for the content on the webpage links that we refer to in our resource sections and linked information to external sites. All information was accurate and appropriate at the time the webpage was created.)

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