teaching kids to use epi pen/ inhaler

[JJ]

Hi all. My son is nearly 5 and has an epi pen and inhaler for most of his life. He's used to them, knows how they work and, for the most part, considers the package (aka his "medicine bag" a part of his daily routine. Up until now, his medicine bag has been handed off to the adult in charge. Of course, not casually.. he's had only one or two playdates with kids after school without me and his babysitters have been vetted and briefed. In short, we've been really cautious, because we've found that some people just don't get it.

He's getting old enough to carry the epi pen and inhaler on his own. My question (finally!) is, how do you teach a child to inhale the inhaler without the spacer? He's always had the spacer and the few times I've tried to give him the inhaler without it, it's not worked very well. The thing is, if the inhaler doesn't work, he has to use the epi pen. That's no problem, it's seriously easy to use, but I'd rather avoid the fun trips to the ER, especially if they can be avoided.

At the moment, the guideline for giving him the medicine is that he knows he needs it. Ok, ok, that's along with the whole having trouble breathing and/or passing out and/or lips and tongue swelling and/or just general bad reaction guidelines. A lot for a 5 yo, I know, but he's aware of what it feels like to be in distress and knows what it can do. (He's been a good judge of reactions in the past.) And it's starting to really hamper what he can do.

Thanks!

[robinw]

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[JJ]

Robin, thanks. We've needed the epi pen a few times. My son has a friend his age that has used it on himself. It doesn't require great strength. Trust me, I know these things. My son knows these things. He can work the practice epi pen which is easier than the real thing. With the epi pen, my worry is that he'll give it to himself a bit too soon which might happen, but will not be harmful.. but will worry the adults he's with.

Anyway, any advice on the inhaler thing welcome.

Sorry to sound so short, I'm just wanting some help here.

[JJ]

uhhhh... the practice epi pen is harder than the real thing. See that's what previewing gets you!

[robinw]

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[robinw]

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[Tissy]

JJ, you don't say if you're in the UK or USA. Most hospital paediatric clinics will have a liaison nurse, some have one who specialises in asthma. She (or he!) should be able to advise you on the right sort of age to go without the spacer. If he is good at simple instructions/ sequences then he may well be ready. You can break down using the inhaler into simple steps:

Breathe in
Breathe out all the way
Inhaler to lips
Push button and inhale at the same time
Hold breath for count of 5

Your pharmacist/ GP surgery may be able to give you a dummy inhaler to practise with that has the propellant but not the drug, so it makes the right noise.

HTH

[SueW]

I thought JJ was in Switzerland now.

[mears]

Perhaps now he might be able to use a turbohaler instead of inhaler, you don't need to press a button. As Tissy said the liaison nurse can make sure he is inhaling properly.

[suedonim]

JJ, there are a number of 'breath activated' inhalers available now, which don't require any coordination between an in-breath and pushing the button. The only drawback to breath-activated inhalers, IME, is that if a child is extremely breathless they don't take deep enough breathes to trigger the mechanism. It's a trial-and-error process, I think, and the nurse at your GP's Asthma Clinic should be up to speed about them, or the Asthma Campaign people are very good for info. Good luck.

[JJ]

Thanks for all of the information. We're in Switzerland now, as SueW mentioned, so the medical set up is a bit different. His paediatrician is wonderful and up on the latest, but it's always good for me to know what I'm talking about and whatever options I have before I go in. She's one of the good doctors who values parental input... I like to have some, if it's at all possible.

The reason for this latest panic is that we're about to learn how to ski -- so while his asthma is very well managed and he doesn't have many attacks, he hasn't experienced the cold dry air combined with the ubiquitous smokers yet. (Everyone seems to smoke here. Agh!) And I'd really like him to have a chance to do what the other kids get to do. Playdates are becoming a sticking point also, as most of the kids now go sans parent. I always fill the other parent in on everything, but I think my son needs to know how to do it himself, instead of completely relying on someone else. Of course, he will be instructed to ask for help if he needs it! I do think he should know how to use the medicine if he's going to be wearing it.

I think we'll be proactive about it and give him a couple of puffs with the spacer before ski school. (Also playdates with kids who have parents who smoke.) We'll be in to see the doctor soon, anyway, and I'll talk to her about it also.

Just in case anyone is interested: he's been taking montelukast (Singulair) tablets for a couple of years now and they've worked wonders for him. His former paed had heard mixed reviews on the pills, but they do work for my son. My son goes off them once a year, to check to be sure he still needs them, and each time has trouble without them. (They work in a matter of days, so we can plan around the yearly test.)

Thanks again.

[lou33]

My daughter uses an accuhaler, which more or less involves opening it and breathing in. Nothing to push with any force.

[Lara2]

If he can co-ordinate breathing in as he pushes the inhaler then he should be OK without the spacer. You can get very small ones now. My DH uses a breath activated inhaler. Please make sure he can do it all properly( I'm sure you will, or you wouldn't have posted!!) - I only say this because as a primary teacher, I have so many children who come to school with inhalers and spacers and have absolutely no idea how to use them. So, I end up teaching them ( and I only know because of DS1) - which shouldn't be my responsibility - but who could stand by and watch a child take medication inaccurately?

[robinw]

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