DS is refusing to use his inhalers

[greenbananas]

I'm just having a moan really, but any suggestions very gratefully received!

DS is 3 and has only mild and intermittent asthma, but the last few nights have been awful. We co-sleep, so I know exactly how much he is tossing and turning in the night! He coughs, wheezes, clutches his throat in his sleep and rolls around in the bed (kicking me quite a lot in the process).

He has a blue Ventolin inhaler and a brown preventer inhaler. He is supposed to use both each morning and night but is completely refusing to use them at all. I didn't worry too much when he wasn't doing much wheezing, but now I am starting to be a bit concerned.

I know (from these boards) that uncontrolled asthma puts him at greater risk of having a serious allergic reaction if he comes into contact with foods he is allergic to. I've made a star chart to try and encourage him to use his inhalers, and he loves the chart but is still refusing to use the inhalers. He says they feel 'furry' (whatever that means) and that he doesn't need them.

Does anybody else's child feel like this about their inhalers?

[eragon]

check to see if he has a thrush infection from the inhalers, (the gp might give him a prescription for a orange tasting gel to eat)

give him a drink straight away after giving him his inhalers.

You have to be firm. you are the grown up and he MUST take his inhalers.

ditch the star chart if he 'loves them' but is not complying. this room for his avoidance shouldnt be there really.

of course he is wheezing if he has stopped his preventors, they shouldnt be missed!

good luck!

[greenbananas]

Thanks eragon. I'm fairly sure he doesn't have a thrush infection (he's had that before, so I know what to look for). I'll try giving him a drink straight afterwards.

The star chart worked really well on Saturday (when I made it) and on Sunday morning, but by Sunday night, although he really wanted a star, he still couldn't bring himself to do his inhalers by himself. I have ended up forcibly holding the spacer over his face while he cries, which must be absoutely horrible for him. The star chart is still on the wall, because he is still looking at it and saying "I will get a star if I do this by myself", but he knows he will only get a star if he does the inhalers without wriggling and crying.

It's only in the past week that he has started wheezing so badly in his sleep, and he hasn't been using the preventer for many months now - I thought he didn't need it any more . We have had a couple of slightly better nights, but I know it will take some time for the preventers to start working again.

[giraffesCantDonateBoneMarrow]

what make is the salbutamol, some makes taste vile.

I would do no negotiations, dont accept no. no tv, no games, no outings, until takes it. Not a big deal though, no shouting, tension. Infact its even a bit dull, no drama. It needs to become like teeth brushing, just slot in to being part of the routine.

You could also see asthma nurse to chat? Do you know anyone else with asthma? Can you meet them casually and they have to talk inhaler - dont mention it just let him observe them take it so it is seen as normal.

[greenbananas]

Ah well, brushing teeth is a similar story We have a battle about it every single night and I usually end up holding him down. Threats and promises don't work, and if I just sit patiently and wait for him to comply he has been known to stare at me for an hour and a half rather than voluntarily put a toothbrush in his mouth. When I brush them he screams like the world is ending.

DS is not normally a disobedient child. Teeth and inhalers are the only things we have this issue with. Perhaps there really is something wrong in his mouth.

The brown inhaler is labelled Clenil Modulite - is that one of the disgusting ones?

[greenbananas]

(the hour and a half waiting for toothbrushing was in bed, after I had said I would brush them anyway if he didn't do them himself before he went to sleep)

[weblette]

At that age we found that having a toy ds could give the inhaler to - through the spacer obviously - helped, as did letting him decorate the spacer with stickers.

What spacer does he have?

[freefrommum]

It's the blue salbutamol inhaler that can taste particularly yucky according to DH (he will only use Ventolin as he says the generic ones are disgusting). Just wanted to point out that you really shouldn't have stopped the brown preventer inhaler without medical advice as it's a steroid and must be weaned off gradually (you should have been given a leaflet/card about this when the preventer was prescribed) plus I'm pretty sure no doctor would recommend stopping it anyway especially in a child with severe allergies. The preventer needs to be taken every day for 6 weeks to really start working properly. This really is non-negotiable and must become a normal part of your child's daily routine even if that means following through on some harsh sanctions like taking away favourite toys/DVDs etc until he accepts taking the inhalers. I don't want to sound harsh but this could be life-threatening. Asthma can be deadly anyway plus, as you said, poorly managed asthma increases the likelihood of a severe allergic reaction.

I would definitely consider the oral thrush senario again too as this can make the mouth incredibly sore and doesn't always manifest itself in the textbook way eg you don't always get the white tongue, sometimes it can just look red and very smooth. Might be worth getting some Daktarin oral gel to see if this helps at all. Good luck, I really hope you get this sorted asap.

[EyeoftheStorm]

DS1 has clenil modulite and says it tastes horrible. He's 7 so we can get over it by doing that one first and green one second. Does he have a spacer? They stop the cold rush on the tongue.

Have you tried love-bombing all his toys who use the inhaler? DS was small when he started on them regularly and all his bed time toys got used to having a (pretend) puff.

I just wondered why he needed to do the inhalers by himself. Even at 7 I do it for DS just to make sure he's getting a proper puff.

[greenbananas]

Thanks all. I am feeling so stupid for not giving DS his inhalers when his symptoms disappeared. We have never been given much medical advice about asthma, but perhaps I really should have known better .

I took DS to see the nurse at our local GP surgery this afternoon (about repeat prescription for inhalers) and did an imitation of his breathing during the night. She said it didn't sound much like asthma, and that DS only needs to use the preventer inhaler if he has to use the blue Ventolin inhaler more than 2-3 times each week (he doesn't). So now I am really confused!!

Thank you eyeofthestorm for that excellent advice about using toys. DS gave one of his toys the inhalers this morning and then took them himself with no arguing at all - however, he still refused to have his teeth brushed and I ended up holding him down again (he says it really hurts, and would hurt his teddy too, so I have made him a dentist appointment to see if there is anything wrong in his mouth).

I will carry on using the preventer inhaler with DS, despite what the nurse said today, although I am uncomfortable about dosing him up with steroids if there is a chance he doesn't need them. Oh it is so confusing and I just want to do the right thing for DS. Thank you again for all your responses.

[greenbananas]

weblette I mean't to say thanks to you to about the great advice re giving inhalers to toys

[freefrommum]

Don't beat yourself up it's not your fault you've had rubbish advice from the medical profession. Just to reassure you, if it's Clenil 50 your DS is on then it's a very low dose steroid & perfectly safe to use long term. I also think that the advice about only needing the preventer if they need the reliever more than 3 times a week is a load of rubbish and def not what our specialist said.

[greenbananas]

Thanks freefrommum you have made me feel better That's very reassuring about the Clenil being only a low dose of steroid.

[weblette]

No worries, I think that now ds is 8 and still needing inhalers, if you can start some good habits early on it helps.

I'd also push for a proper review, why are you being told not to use preventers when everything he displays suggests that's what he needs. Good luck!

[weblette]

Also, is the nurse your surgery's designated asthma nurse? Ours is amazing and knows far more than the GPs.

[3littlefrogs]

I am horrified at the advice the nurse gave you! Is she trained in asthma management?

I work in general practice and I am afraid standards vary enormously regarding the training and qualifications of clinical staff in different practices.

Ds2 had very bad asthma when he was little, and I am afraid bribery was often the only way. He did often get a sore mouth/throat with the preventer, and had to always have a good rinse and drink of water afterwards.

He rarely needed his reliever though, if he was taking his preventer correctly. I never, ever stopped his preventer - the whole point is to use it enough that the reliever is not needed.

I hope you manage to get it sorted.

[TruthSweet]

We have done the stickers on the spacer and also swapped the large slim spacer for a small one with a teddy on it (it also has a shaped face mask so doesn't need to be squashed on their face).

Also, using the spacer as a toy (supervised of course) on dolls, teddies helped. As did a face mask from an ambulance trip when DD1 had a bad asthma attack (we are possibly the only family who have multiple face masks with air bag things attached as toys - DDs use it in their Drs kit).

DD1 can now dispense her own inhalers (and has done since 5y) and DD3 asks for her 'haler when she is tight chested or wheezy (she is 2.6y). Nebulisers aren't terribly popular with DD3 but they do taste horrid!

[greenbananas]

There is no dedicated asthma nurse at our GP surgery. The nurse we saw was lovely, but from what you are all saying she did not give me very good advice I suppose it's not surprising that standards vary so much from practice to practice - I also found this when I first realised that DS had food allergies...

DS gave his toy the preventer inhaler again last night but resisted taking it himself. Ah well, I will keep working on it. Hopefully, it will only take a few days now for him to realise there is no point arguing about this.

[giraffesCantDonateBoneMarrow]

asthma uk have amazing nurses highly reccomend phoning them even just for a chat.

[FileyFilly]

What kind of spacer is he using? DD refuses the big Volumatic one, but we use the Aerochamber now and she accepts it fine. Its a lot smaller and I thin its less frightening for her.

[Frannydean]

If you are still having trouble getting her to use the spacer try a home nebuliser machine as she will recieve lots more medication and the doses are higher just be aware of fast heart rate and hyperactivity. Hope this helps. :)

[greenbananas]

Wow, a thread I started last year!

Thanks Frannydean.

These days, DS does both inhalers every night without complaining (which is great because he really does need them now).

He also brushes his teeth - still hates doing that but gave up arguing a long time ago!