often associated with allergies) also are more likely to
have asthma.
Treatment of asthma requires a whole life ap-
proach. Prevention of attacks is extremely important,
especially in children with moderate to severe asth-
ma. This requires a multifactorial approach involving
attention to and potential changes in all spheres of a
child’s life, including home and school. Environmen-
tal modification includes elimination of triggers such
as cigarette smoke, pet dander, dust, molds, pollens,
and insects (especially cockroaches). Special care to
avoid colds is also important. Furthermore, some
children require preventive or prophylactic medicine
daily to decrease the number of attacks. These in-
clude anti-inflammatory medications in more severe
cases of asthma, to help decrease inflammation and
swelling of airway lining cells. Once an acute asthma
attack has started, treatment consists of albuterol,
which immediately relaxes the smooth muscle to help
open the airway. Steroids can also increase airway size
by decreasing acute inflammation. Oxygen may also
be needed. Education of patient, family, and other
caregivers in the early recognition of symptoms is key
to successful treatment of an asthmatic attack, and im-
proving baseline lung functioning.
Asthma, like any chronic illness, can have a signif-
icant impact on a child’s psychosocial functioning and
development. Children with asthma exhibit a three-
fold increase in school absences (on average) when
compared to children without asthma. A study by
Fowler from 1992 also suggests a potential link be-
tween asthma and learning disabilities in children
with poor to fair health because of severe asthma with
poorer school performance. Children with asthma
who come from lower income families (household in-
come less than $20,000 per year) were twice as likely
to fail a grade than healthy children from low income
homes in this study.
Children with asthma also exhibit increased emo-
tional vulnerability. They may demonstrate anxiety
regarding their asthma, and feel physically vulnera-
ble as well, sometimes out of proportion to the severi-
ty of their asthma. Anxiety with hyperventilation can
be a trigger for stress-induced asthma attacks. Young
children with moderate to severe asthma may have
great fears and anxieties regarding their health and
fear of death at a very young age. In addition to the
child, parents also develop fear and anxiety in rela-
tion to their child with chronic illness, which also may
be out of proportion to the severity of the child’s asth-
ma. This can lead to increased parental sheltering
and overprotectiveness, giving rise to the vulnerable
child syndrome and feeding the child’s anxiety.
Asthma can also be an isolating illness for school-
age children. Increased school absences take them
away from their friends and peers. Having to leave
the classroom to receive medicines or treatments also
may give the child a sense of being set apart from
peers and therefore different. Furthermore, class-
mates may perceive the child as being ‘‘sick’’ and may
treat him differently as a result, further impairing
bonding with peers.
In conclusion, asthma is a common illness among
children. It affects their physical, psychosocial, and
emotional lives. Effective management involves the
child, family, pediatrician, school personnel, and
when needed, allergy specialists to minimize symp-
toms and allow children with asthma to thrive.See also: CHRONIC ILLNESSBibliography
Bloomberg, G. R. ‘‘Crisis in Asthma Care.’’ Pediatric Clinics of North
America 39 (1992):1225–1241.
Brugman, S. M. ‘‘Asthma in Infants and Small Children.’’ Clinics in
Chest Medicine 16 (1995):637–656.
Fowler, M. G. ‘‘School Functioning of U.S. Children with Asthma.’’
Pediatrics 90 (1992):939–944.
Gern, J. E. ‘‘Childhood Asthma: Older Children and Adolescents.’’
Clinics in Chest Medicine 16 (1995):657–670.
Hoekelman, Robert, Stanford B. Friedman, and Modena E. H. Wil-
son, eds. Primary Pediatric Care, 3rd edition. St. Louis: Mosby,
1997.
Morgan, W. J. ‘‘Risk Factors for Developing Wheezing and Asthma
in Childhood.’’ Pediatric Clinics of North America 39
(1992):1185–1203.
Warner, J. O. ‘‘Third International Pediatric Consensus Statement
on the Management of Childhood Asthma.’’ Pediatric Pul-
monology 25 (1998):1–17.
Ericka V. HayesATTACHMENT
Attachment is a strong emotional tie that children de-
velop with the special people in their lives, particular-
ly parents. Attachment figures provide comfort to
children in times of stress; in so doing, they serve as
a secure base from which children explore the world.
Further, attachment figures serve as a source of plea-
sure and joy for children. Note, however, that parents
also play other important roles in their children’s
lives, including playmate, teacher, and disciplinarian.
The development of attachment follows four
phases in infancy. For the first two to three months,
young infants do not discriminate among the people
who care for them. From three to seven months in-
fants begin to show their preferences for familiar car-
egivers, such as their parents, by reaching for them,
smiling at them, and responding to soothing efforts
by them. By nine months, infants show evidence of
their attachment relationships. They make attempts32 ATTACHMENT