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If you've been told your child has asthma, or if your child has trouble breathing when running or playing hard, take this simple Kids' Asthma Check.

 

Kids' Asthma Check: For Ages 1-8
Just answer yes or no to these questions.
1. When walking or playing hard with friends, my child has trouble breathing or coughs. Yes__  No__

2. When walking up hills or stairs, my child has trouble breathing or coughs. Yes__  No__

 

3. When running or playing sports, my child has trouble breathing or coughs. Yes__  No__

 

4. Sometimes my child wakes up at night with coughing or trouble breathing. Yes__  No__

 

5. Sometimes my child has trouble taking a deep breath. Yes__  No__

 

6. Sometimes my child makes wheezing sounds. Yes__  No__

 

7. Sometimes my child complains of pain or tightness in the chest. Yes__  No__

 

8. Sometimes my child coughs a lot. Yes__  No__

 

9. Being outdoors or around dust or pets makes my child's breathing worse. Yes__  No__

 

10. It's hard for my child to breathe in cold weather. Yes__  No__

 

11. It's hard for my child to breathe when people smoke or there are strong odors. Yes__  No__

 

12. Colds make my child cough or wheeze. Yes__  No__

 

13. My child went to the doctor's office or emergency room for asthma or trouble breathing this year. Yes__  No__

 

14. My child stayed in the hospital overnight for asthma or trouble breathing this year. Yes__  No__

 

15. I've been told that my child has asthma. Yes__  No__

 

If you answered "no" to number 15, you have completed the Asthma Check. If you answered "yes," please answer questions 16-21.

16. My child uses an asthma inhaler two or more times a week. Yes__  No__

 

17. Sometimes asthma medicine makes my child feel bad. Yes__  No__

 

18. My child only takes medicine when not feeling well. Yes__  No__

 

19. My child can't do some things because of asthma. Yes__  No__

 

20. My child gets scared because of asthma. Yes__  No__

 

21. I worry that asthma affects my child's health or that my child may die from asthma. Yes__  No__

 

 

"Yes" answers to more than one of these questions may indicate that the child has asthma. Further testing is recomended. Print this form and bring it with you to see your family physician.

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