Asthma affects approximately 10.1% of children living in the United States, and continues to be the most common chronic childhood illness ("Strategies," 2002). Some risk factors that account for this startling percentage of children with asthma include age, heredity, gender, children of young mothers under age twenty, smoking, ethnicity (African American are at greatest risk), previous life threatening attacks, lack of access to medical care, psychological/psychosocial problems, underdiagnosis, and undertreatment (Hockenberry, 2003). The nurse plays a vital part in identifying modifiable and non-modifiable risk factors, and educates both parent and child on effective ways to control unwanted asthmatic attacks through self-care education and participation in asthma management programs.

The responsibility of caring for a child with asthma should be shared equally between the adult caregiver (i.e., parent, relative, or teacher) and child. The overall objective is to avoid or reduce exposure to triggers that tend to precipitate or aggravate asthmatic exacerbations; however, these precautions should not sacrifice the child's normalcy in development and socialization. At present, nurses are given the opportunity to fully enact their roles in terms of case management; client advocacy in both school and health care systems; education of children, parents, teachers, and support for children and families as they learn to master the complexities of managing a chronic illness (Horner, 1999). For the child, there are six themes that need special attention upon initial diagnosis: worries, asthma knowledge, school issues, medications, parental support, and the desire to be normal (Ming & McConnell, 2002). The ability of the nurse to address initial and ongoing parental concerns, as well as those of the child, will foster an effective nurse, parent, and child partnership in managing childhood asthma.

Assessment

A school age girl (7 years-old) is brought in to the emergency department (ED) with the following symptoms: Wheezing and dry cough; prolonged...