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The symptoms of asthma vary enormously from child to child.

Your child might get some or all of the following.

• A cough. This is the most common symptom of asthma in children. In many children it's the only one.
• Wheezing. A wheeze is a high-pitched whistling sound in your child's chest. It's the noise of the air vibrating though the air passages of the lungs. It happens when the air passages become narrower.
• Gasping for breath. Because your child's air passages get narrower he or she finds it harder to get air in and out of the lungs. Your child might become breathless.
• A tight feeling in the chest. This happens as the airways swell up. Your child's chest might feel tight and uncomfortable.

If your child has a bad asthma attack, they may not get enough oxygen into their body. This can mean they get blue lips, fingers, toes, tongue or skin. If this happens, it's an emergency. You need to call 911 or get your child to the hospital urgently.

Some children have mild asthma, with only occasional wheezing and coughing. Others might have symptoms on most days and need to take long periods of time off school when their symptoms get very bad. It's also hard to predict how long an asthma attack will last or how severe it will be. Some might last just an hour or so, while others go on for days or even weeks.

When your child gets asthma symptoms it's called an asthma attack. It can be mild or severe.

Mild attacks are common. Your child might start to cough or get a feeling of tightness in the chest. He or she might make a whistling sound when breathing (called a wheez e). When this happens, your child should use his or her quick-relief inhaler. Your child's airways should open, making it easier to breathe.

If your child's medication doesn't help, or his or her symptoms get worse, you should call your doctor.

Sometimes your child's symptoms might get better but then get worse again, often about four to six hours later. This second set of symptoms is called a late reaction.¹ It can be worse than the first attack.

A late reaction happens because your child's airways have become more sensitive to the things that are triggering his or her asthma. Your child might need to keep taking asthma medications for a few days to prevent more attacks. Call your doctor if his or her symptoms seem out of control.

See How can I tell when my child's asthma is getting out of control?

In a severe asthma attack, symptoms get worse quickly. Your child will find it more and more difficult to breathe. You might also notice:²

• It's hard for your child to talk
• Your child's lips or fingernails turn gray or blue
• Your child's nose opens wide to breathe
• Your child's skin is pulled in around the ribs and neck when he or she breathes
• Your child's heartbeat or pulse is very fast
• Your child finds it hard to walk.

If this happens, call 911 or take your child to your doctor or to your nearest emergency room as quickly as you can.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.