How To Help Children And Teenagers
“To know even one life has breathed easier because you have lived.
This is to have succeeded.”
- Ralph Waldo Emerson (1803 – 1882)
This chapter contains breathing exercises and information that can be taught to children. Parents are advised not to rely solely on this chapter but to read the entire book in order to understand the whole concept of reduced breathing. It is recommended that this chapter is used for revision purposes only. For parents, working with their own asthmatic children to correct their breathing can be a challenge, but three case studies appended at the end of this chapter prove that it is a challenge worth the effort.
There are five steps that must be taken to correct a child’s breathing, each of which will be explored in greater detail. The steps are: unblocking the nose, switching from mouth to nasal breathing, knowing what causes asthma, learning to relax the body and learning exercises to reduce the volume of air inhaled.
Unblocking the nose
A child’s nose becomes blocked mainly due to overbreathing. Nasal passages constrict and mucus secretion increases, narrowing the space through which the child breathes. It feels like not enough air is passing through the nose and as a result the child will switch to mouth breathing. This creates a vicious circle because an even greater amount of carbon dioxide is lost. This increased loss of carbon dioxide causes the nasal passages to constrict even further and so the child continues to mouth breathe, possibly for the rest of his or her life. The most important factor in correcting breathing is learning to unblock the nose, a very simple and effective exercise.
The nose unblocking exercise involves holding the breath to temporarily increase carbon dioxide levels in the blood. The increase of carbon dioxide will then open the nasal passages within five minutes.
To perform this exercise, again using our hypothetical little girl called Emily as our example, she should sit down with her back straight, take a small breath in (two seconds) through the nose if possible and a small breath out (three seconds). If she is unable to take a breath in through the nose, a tiny breath in should be taken through the corner of the mouth. The child should then hold her nose with her fingers to stop the air flow and nod her head gently or sway her body until she cannot hold her breath any longer. It is important that Emily holds her nose until she feels a relatively strong need to breathe in.
Once Emily experiences the need to breathe in, she may let go of her nose and breathe gently through it, keeping the mouth closed. Sometimes Emily will take a breath in through the mouth when she lets go of her nose. At other times, she may open her mouth during the exercise. In both situations explain that she should keep her mouth closed. Practise the exercises with her until she is able to do it correctly.
Diagram; Unblocking the nose.
Parents should supervise their child during the exercise and immediately afterwards should listen to the child’s breathing and encourage her to reduce it to retain the increased level of carbon dioxide. The child should continue to do this exercise until the nose is unblocked. If it does not totally unblock, wait for about two minutes and perform the exercise again. It may be necessary to practise five or six times until the nose is unblocked.
Holding the breath traps additional carbon dioxide that has been produced from moving the head or swaying the body. At the start, it is common practice for the child’s nose to become blocked again shortly after doing this exercise. This is because Emily’s underlying breathing has not been changed and the body has not become accustomed to the increased carbon dioxide. After some time and with regular practise of breathing exercises, the child’s body will become accustomed to a higher level of carbon dioxide and the nose will remain unblocked.
If the child is having difficulty unblocking her nose while shaking her head, then she should perform Steps, a process which will be explained later on.
The nose sounds the first warning call when overbreathing occurs by becoming the first part of the respiratory system to constrict. As soon as a child’s nose starts to become blocked they should be assisted to unblock it with the nose unblocking exercise or with Steps.
Switching from mouth to nose breathing
It is important that all children breathe solely through the nose. Children can be helped to understand the importance of breathing through the nose by having the following points explained to them.
The air that we breathe in is not totally clean. It contains a large amount of dirt including germs, smoke and other filthy particles even though we may not be able to see it. The nose contains tiny cleaners, which cleanse this air before it goes into the body. If the air sneaks in through the mouth, dirty air is being sucked in which can make asthma worse, resulting in coughing or wheezing.
Air that sneaks in through the mouth is cold and dry while air that comes in through the nose is warm and moist and is better for the body. Ask the child if she would rather be warm (but not too warm) or very cold. Most will answer that they would rather be warm, so tell them that the inside of the body also likes air to be warm but this only happens by breathing through the nose.
Tell the child that by opening the mouth and breathing through it asthma will enter and slowly eat away at the inside of the body, especially at the airways. The more breathing through the mouth takes place, the more bronchial asthma will nibble at the airways and this will cause an attack. By breathing through the nose, bronchial asthma gets caught in the channels and by the tiny hairs that are in the centre of the nose. This prevents bronchial asthma from getting into the body to nibble at the lungs.
Diagram; Asthma eating the airways.
Finally, check that the child is aware of why she should breathe through the nose and help her to understand how important this really is. Reinforce the importance of breathing through the nose all of the time.
Breathing through the mouth is a bad habit and is common among children with asthma. For the first few weeks of the exercises the child will alternate between mouth breathing and nasal breathing. To make the switch to nasal breathing permanent, parents must play a significant role in observing the child’s breathing and in telling the child when she is breathing through her mouth. This does entail a certain amount of persistence and observation from parents but it will reap untold health benefits for the child. The length of time it takes for the child to make a permanent switch to nasal breathing is dependent on the observations of parents and the attention the child pays to breathing.
If a very young child experiences difficulty learning to breathe through the nose, then it may be helpful for them to suck a dummy. This will cause the mouth to close, which will encourage nose breathing. Although some reports suggest that sucking a dummy is bad for a child’s teeth, these reports are inconclusive. On the other hand, children who mouth breathe have far poorer health and a much higher number of cavities and incidence of gum disease than children who breathe through the nose.1
Knowing what causes asthma
It is important that children understand that big breathing causes asthma. The best way to explain big breathing is by blowing air onto a child’s finger. At first blow a large amount of air with a big, noisy puff onto the finger and explain to her that this is big breathing. Then breathe a tiny amount of air onto the finger and explain that correct breathing means a small amount of air with almost nothing felt on the finger.
Big breathing is the cause of asthma and to make it easy for the child to understand explain that Emily is big breathing if she is breathing with her mouth.
By getting the child to repeat this explanation of what causes her asthma, parents can determine whether Emily understands the relationship between big breathing and her symptoms. Once the child understands and can tell others the difference between big breathing and correct breathing, she can proceed to the next level which is reducing the volume of air inhaled.
Learning to relax the body
It is important that the child remains relaxed throughout the day and especially before, during and after breathing exercises. Tension increases the rate of breathing because it results in a reduced blood flow and a consequent reduction in the amount of oxygen reaching tissues and organs. A child’s asthma symptoms are generally worse following a period of anger, emotion or tension.
To explain relaxation, tell the child to think of jelly on a plate and ask this question: what would the jelly do if the plate was carried across the room? Children usually say that the jelly wobbles but if your child is not sure, explain that jelly is normally soft and wobbly. Make some jelly for tea if you have to! Make it clear that when we are relaxed we are all soft and wobbly too, just like jelly on a plate.
Diagram: Learning to relax.
Demonstrate how to become soft and wobbly by standing up and letting your shoulders fall to the resting position, allowing your arms and body to go soft and limp. Become floppy and sway your body gently and ask your child to copy you. Remember, this is supposed to be fun, and your child will enjoy watching you ‘messing’. Explain that this is relaxation and that when we are relaxed, we breathe less and as a result asthma attacks are reduced.
There is a very simple test that can be applied to determine whether a child like our Emily is relaxed. Lift up her arm; if it is heavy she is relaxed, if it is light the child is helping you to raise her arm. Ask her to become floppy and wobbly like jelly and her arm should become heavy on lifting.
Exercises to reduce the volume of air inhaled
Once Emily has a good understanding of nasal breathing, big breathing and relaxation, she can proceed to the next level of reduced breathing using special exercises. The primary exercise for children is called Steps and Mouse Breathing is the secondary exercise. Mouse Breathing is the name used to describe the process of reduced breathing in children.
The steps exercise helps children to make great progress with their breathing and is also helpful as a measurement of progress if a child is unable to apply the control pause. Steps involves physical activity which will increase carbon dioxide combined with holding the breath which will trap this carbon dioxide.
To perform Steps, children should practise the following. Tell them to take a small breath in (two seconds) followed by a small breath out (three seconds). They should then hold the breath by pinching the nose. It is better if the child holds her nose by raising her hand above the mouth so that the mouth remains visible. This way, if a child like Emily takes a breath in through the mouth, it will be noticeable.
Encourage her to walk as many steps as she can until she needs to breathe in again. Count aloud every five or ten steps to motivate the child to take as many steps as possible.
When the child recommences breathing, it must be only through the nose and breathing must be calmed immediately. If the child’s shoulders rise and become tense, point it out and ask her to let her shoulders drop to the resting position.
Usually the first breath after completing Steps will be bigger than normal. Make sure the child then reduces or suppresses the second and third breaths. It is important that Emily relaxes and becomes as soft as jelly because the more she relaxes, the quicker the recovery of breathing will be.
Count each step aloud and record the number so that progress can be evaluated and compare each day’s steps with the previous few days. Steps can be used as a measurement tool if the child is unable to do the control pause correctly, and she should be encouraged to increase the number of steps she takes over time. The goal is for children to be able to walk a hundred steps without having to take a breath. This might sound like a tough standard but it is very feasible. Steps should be done walking but not running, but fast walking is fine.
If Emily becomes stressed or pushes too hard, it will take a number of breaths to calm her breathing. When this occurs, reduce the number of steps that she takes.
Diagram; Doing Steps. (illustration)
Steps can be interspersed with reduced breathing called Mouse Breathing and the sequence this should follow is explained later in this chapter.
This exercise requires concentration in order to be practised correctly so the child should be taken to a quiet place where there will be no distractions. With this exercise the child sits down, adopts the correct posture with the back straight and the head looking forward.
Emily should be encouraged to relax her shoulders, allowing them to fall to their natural position. Raised or tense shoulders increase the volume of the chest cavity and so increase the volume of air that is inhaled. Tension increases breathing while relaxation decreases breathing. Therefore it’s especially important to relax the muscles involved in respiration.
The child should place a finger under the nose in a horizontal position so that the air flowing through the nostrils can be monitored. The finger should be placed just above the top lip, close enough to the nostrils to feel the air flow, but not so close that the flow will be blocked.
Encourage the child to pretend that she is a little white mouse and that there is a big hungry cat waiting outside the door listening for any sound that the mouse makes. Explain that the cat has excellent hearing and will know that there is a mouse present if it hears the mouse breathing. The child will instinctively reduce her breathing to avoid being captured by the cat.
Diagram; Cat and mouse.
The aim of this exercise is to reduce the volume of air exhaled onto the finger. The greater the amount of warm air felt on the out breath, the greater breathing is. Encourage the child to concentrate on reducing the amount of warm air felt on the finger.
With this exercise, when the depth of breathing is reduced, the breathing rate (number of breaths taken per minute) may increase. This is completely normal. Do not be concerned with the number of breaths per minute as this will change according to the volume and the aim is to reduce this volume.
Diagram; Finger under nose.
The aim of all breathing exercises is to condition the body to accept a higher level of carbon dioxide. There are two main ways to do this: by reducing the breathing by monitoring the air-flow with mouse breathing and by reducing breathing through physical activity, Steps and outdoor exercise.
Exercises are best performed in blocks of twenty minutes, two to three times per day. Spending less time than this only temporarily increases the carbon dioxide.
A commonly practised sequence of exercises for most children is detailed below and exercise sheets especially for children to record the amount of steps are included at the back of this book.
Exercises should be completed in the order set out below, with intermittent breaks.
CP Steps Steps Steps CP Steps Steps Steps Mouse Breathing
3-5 min CP
A relatively smooth session with no breaks will take about twenty minutes. This should be practised twice a day for two to three months, preferably before breakfast and before dinner. All exercises are better practised before meals as food intake decreases the number of steps that can be taken and may lead to cramps. Times do not have to be exact but should be as close as possible to those set out above.
A rest should also be taken after every set of exercises in order to avoid overdoing them as this can result in a headache. If a child does experience distress, then stop the exercises and concentrate on relaxation. Exercises can be resumed later that day or the following day with special observation on applying the correct intensity of exercises.
A rest is taken before each control pause to ensure it is measured accurately. A control pause that is taken directly after reduced breathing will be lower than after a rest. If the child is unable to perform a CP or reduced breathing then replace both with an extra set of Steps. (Steps can be also used as a measurement of progress.) Every two steps constitute one second of the control pause. When the child is able to perform a hundred steps, her control pause is estimated to be fifty seconds. In practice, a child may be able to perform a hundred steps but may only have a control pause of twenty seconds. In this situation, Steps is the more accurate guide of progress.
Everyone knows children can have a short attention span so if the child becomes bored with doing exercises, then Steps can be replaced with breath-holding while playing hopscotch, squats, jumping jacks or swimming (in the case of swimming, aim to increase the amount of strokes or time spent under water between each breath).
Diagram: The jumps.
Remember, the aim of these exercises is to eliminate asthma symptoms by switching to nasal breathing and normalising the carbon dioxide levels. This should always be kept in mind when practising exercises and monitoring the progress which has been made.
How to stop an asthma attack
If a child is experiencing difficulty breathing, it is better to refrain from doing Steps as it can cause a large inhalation on completion, which can exacerbate an attack. In this instance it is safer for the child to perform Mouse Breathing to control the asthma attack and to continue with Steps only when her breathing has calmed.
As soon as the first signs of an attack appear a blocked nose, wheezing, coughing or tightening of the airways the child should practise the exercise below. If the child is unable to obtain relief within five minutes, then her reliever medication should be administered. If she experiences a severe attack, medication should be given or medical assistance sought immediately.
However, the following exercise can prove very effective in stopping an attack when applied during the early stages.
Sit the child in an upright position. If Emily is lying down in bed make her get up and sit instead. If the room is stuffy, open the window to let in fresh air.
At the first signs of an attack, encourage the child to resist the urge to take big breaths. It is important to focus on remaining calm and it may also help to have Emily repeat to herself, over and over again, the words “relax and remain calm”.
It is important that Emily does not reduce her breathing too much as this may lead to an increase in breathing which will exacerbate the attack.
An asthma attack can be a frightening experience and a child will naturally become tense as anxiety and panic set in. The struggle to breathe can also create both mental and emotional stress and a vicious circle is activated because the asthma attack increases stress levels which in turn leads to increased hyperventilation.
A very useful exercise as a parent is to gently massage the shoulders of the child. This is not difficult to accomplish and anyone can do it. Gentle pressure should be applied by massaging the muscles located in the chest, shoulder and neck region while repeating the words “relax and breathe less” to the child.
Increased tension brought about by the attack will only result in making it worse. A massage can offer comfort to a child because it has a very calming and reassuring effect, helping Emily to come out of the discomfort being experienced as a result of the asthma attack.
This might be construed as a provocative statement but, in some cases, children have been known to start an asthma attack in order to get attention from their parents. They subconsciously know that their tantrum or anger will cause deep breathing and lead to an attack. It is important to remember that an asthma attack is always serious regardless of how it started. At the first signs of an attack a blocked nose- help the child to breathe like a little mouse and to perform nose unblocking exercise. If the attack is not under control within a few minutes, then whatever medication has been prescribed should be taken. Don’t prolong the attack or have your child experience unnecessary discomfort by delaying the taking of reliever medication. After she has taken this medication, ask her to remain as soft as jelly and to breathe as gently as possible. If reliever medication is not working correctly within five to ten minutes, seek medical attention immediately.
Parents’ behaviour during an asthma attack
An asthma attack can be best compared to trying to breathe while a pillow is pressed down on your face. This greatly restricts breathing and creates anxiety, stress, uncertainty, fear and panic, especially for a child. If a child is suffering an asthma attack sit her down and help her to relax in a cool environment.
As parents, try not to be visibly upset, to cry or to panic in front of the child. This can be a very difficult thing to do but remaining calm will help reduce the anxiety being experienced by the child. Instilling a sense of fear and panic in the child will exacerbate the attack and can cause a lot of harm. Likewise, do not encourage the child to pay too much attention to their condition. Repeating phrases like “poor David has asthma” or “you’re so unfortunate to have asthma” leads to the child thinking negatively about her own condition and will result in a deterioration of the child’s asthma in the long term.
On a more positive note, parents often experience great peace of mind when they begin to observe an improvement in their child’s condition using the exercises outlined and when the child realizes that it’s possible to have some control over her condition. This will lead to the parents offering greater encouragement to the child to continue with the breathing exercises and to implement other lifestyle changes.
Knowing what causes asthma
People often have a number of questions about asthma and one of those most frequently asked is this: how does a baby develop asthma when many of the conditions responsible for causing overbreathing do not apply?
Children often develop asthma at a very early age, in some cases as young as three months old. Professor Buteyko believes that deep breathing exercises taught to expectant mothers during pregnancy is the main contributory factor. The deep breathing carried out by the expectant mother lowers the levels of carbon dioxide in her body and this, in turn, lowers the level of carbon dioxide for her embryo.
When the baby is born, he or she may receive a slap on the bottom, causing the baby to start breathing with a deep first breath. A life of overbreathing begins at that crucial first moment of life. Although it has not been proved that excessive breathing by mothers may be passed to the child, it is a theory that does merit consideration.
It is a mother’s instinct to protect her newborn baby and it is quite common, due to good intentions, to ensure a baby is kept excessively warm. Some mothers have even recalled beads of sweat on their baby’s forehead as a result of their efforts to keep them warm on a cold Winter night. The truth is that babies have a very high metabolism, which generates much more energy than an adult and means they can tolerate cooler temperatures. A practice performed by a number of older nurses involves stripping children naked and leaving them for a number of hours lying without any covers. In this situation the nurse understands the benefits of a cool environment to the child, even though he or she may not know exactly why. Very warm temperatures and excess synthetic clothing increase breathing while cool temperatures reduce it.
It is also interesting to note that babies who are breast fed for at least the first four months of life are substantially less likely to develop asthma than those who are fed on milk formulas. 2, 3, 4, 5
Formula is processed and can also contain traces of aluminium from the can. It is not an ideal substitute for the milk that nature intended babies to drink. Breast milk has been refined by nature throughout evolution and contains the perfect mix of protein and nutrients for the healthy development of a newborn. Increased protein levels and traces of aluminium (which are toxic) will lead to an increase in breathing. Many parents have observed the onset of asthma and eczema in their child soon after making the switch from breast milk to mass-produced processed formulas.
It has often been observed at clinics that a child’s breathing exactly mirrors that of the parents. Both respiratory rates and other traits, such as sighing, can function in synchronisation. Without doubt, the breathing of parents in part influences the overbreathing of a child.
If the child’s father walks around the house with his mouth open puffing and panting and being unobservant of his breathing, then the child will do likewise. Often, it is the behaviour of parents that slows down the progress of children. Correct breathing is a family affair and it is beneficial for the health of all family members, even if they do not have asthma. Teaching the child to do one thing while everyone else in the family continues with their bad habits and unhealthy lifestyles will not help the child. Children learn best through example. This is very important for parents who wish to help a child with asthma. In fact, the child is unlikely to make progress unless the parents also adopt reduced breathing as a way of life.
Another negative influence on the child’s progress can be the attitude of the parents. On commencing breathing exercises, it is important that both parents display a positive attitude towards correcting the child’s breathing. The simple fact is that unless a child receives encouragement to adopt nasal breathing and practise Steps, the child will not understand the importance of breathing correctly and as a result will not pay any attention to it. A sceptical parent would be far better off keeping their opinions quiet rather than making negative comments about breath retraining. The child’s progress within just a number of weeks will be enough to discount their initial scepticism.
In order to be aware of a child’s breathing pattern it is important to understand what factors may cause a child to overbreathe and these factors should then be eliminated. Parents should monitor a child’s condition by observation and by measuring their CP during the day and after various activities (if the child is unable to understand the concept of reduced breathing, then measure the number of steps they can walk).
This detective work will provide some insight into what is causing the overbreathing and therefore the symptoms. Many children become so focused on certain activities that they are completely oblivious of the fact that their mouths are open or that they are big breathing. It takes time for a child to make the switch but when she does, mouth breathing will feel peculiar and strange and she will naturally revert to nasal breathing.
While the child is outdoors, there may be times when there is a quantity of dust, exhaust fumes from cars or any other agent in the air. To avoid inhaling these particles, the child should be told that if they ever see or smell dirty air, she should hold her breath and walk away. If she is unable to walk away, encourage her to reduce their breathing. Both of these practices will greatly reduce the amount of dirty air that enters the airways.
Children should be encouraged to play outside and to do as much physical activity as possible while they are out in the fresh air. If a child is symptomatic, then physical activity is not encouraged because it will lead to overbreathing. Years ago, children played outdoors, ate less generally and not nearly the amount of junk food eaten today. Houses were cooler and fresh air often ran throughout them in the form of draughts. It can be argued that children were much healthier in those days; the incidence of asthma was certainly much lower.
Sequence of training
When teaching a child, a step-by-step approach is often best, enabling the child like our imaginary little girl, Emily, to move onto different levels as her knowledge improves. The following is a typical scenario of a young child commencing breath retraining.
The first week is spent teaching Emily the reasons why it is so important to breathe through the nose and the child is taught to use only this way of breathing for every event and situation. If the child is at school, then it is helpful to explain to the teacher exactly what is happening and ask them to be observant of Emily’s breathing. At any time, if she is observed breathing through the mouth, then she should be reminded of the reasons why it is not good to breathe this way.
By positive reinforcement, it can be explained that asthma will improve dramatically with continued nasal breathing, or by negative reinforcement that dirty germs and filthy air will enter their airways and eat away at the lungs. The child should be asked at regular times throughout the day why is it so important to breathe through the nose and not through the mouth.
When Emily understands the importance of nasal breathing and breathes through the nose for most of the day and night, then it is onto the next stage of teaching, and Steps and the importance of being relaxed are introduced. Initially these are practised without the control pause and mouse breathing. Steps is to be practised two to three times each day. When the child is competent in doing Steps, the control pause and mouse breathing can be introduced.
If a child is having difficulty in applying exercises, training should not be abandoned. A softly, softly approach generally produces good results.
All children should be taught the importance of reduced breathing and breathing through the nose. Instead, the typical approach is to administer potent chemicals to the child often from a very early age. It is sad to hear of young children being treated with nebulisers and large doses of steroids on a regular basis. If these children had been taught how to breathe correctly, their symptoms and attacks would be greatly reduced or eliminated entirely. The amount of suffering and medication that each child would be exposed to therefore would be significantly less.
It is common for children to experience a relapse in the first six months. This can be part of the cleansing reaction, as symptoms may get a little worse before they get better. During this reaction, a lot of mucus clears from the lower airways and can result in coughing or wheezing. At other times, the relapse is due to the child becoming relaxed about their breathing, missing steps or reverting to mouth breathing for a few days. When a relapse occurs and the child is wheezy or coughing, then do not do the Steps exercise as it can cause the child to take big breaths on completion. Instead, perform mouse breathing while having a medium air shortage. Generally, the relapse is for two to three days only and afterwards the child will continue where they left off in relation to their control pause, Steps and asthma.
It is always helpful to remember that the very factors that caused big breathing are still present. For example, if the child continues to eat a lot of junk food, drinks no pure water, performs no exercise and remains in very warm clothing or stuffy rooms, then big breathing will ensue.
To demonstrate what can be achieved, case studies have been compiled on three children Robert, Clara and Lorcan who attended workshops with their parents. [These case studies have been compiled from conversations with the parents of the children and have been included with their permission. Surnames are not disclosed to protect their confidentiality.]
Robert is a five-year-old child from Mayo who first attended the Galway Asthma Care Clinic with his mother on March 25th, 2003. Robert had mild to moderate asthma requiring two to three puffs of Ventolin per day. In addition to his asthma, he had chronic tiredness, irritability, lack of energy and frequent headaches. He was taught the very basics of the programme and his mum was asked to participate in the observation and application of Robert’s exercises.
Robert’s task was to practise reduced breathing and Steps every day. Each month he was set the task of completing an extra ten steps. Soon he could do seventy steps quite easily and on a number of occasions reached one hundred. On follow up, his mother was overjoyed with the improvement in Robert’s condition. Not only had his asthma improved so dramatically that he had no symptoms and no requirement for medication, but he also had far more energy and no headaches. He could now enjoy the same activities as other children his age.
Nine-year-old Clara lives in Dublin and was diagnosed with asthma at the age of four. On March 2nd, 2003, Clara attended an Asthma Care workshop accompanied by her mother and grandmother. Here is Clara’s history prior to that date.
She did not suffer from wheezing or coughing. Her main problem was recurrent chest infections, which she often had on a monthly basis prior to March 2003. Each time, a course of antibiotics would be prescribed.
Consistently, Clara looked pale and had black bags under her eyes which is a typical feature of many asthmatics. Her peak flow reading averaged 250 and her personal best was 275. Her daily medication requirement was four puffs of Seretide 125 to control her wheezing and Nasocort for unblocking her nose. She took Ventolin as prescribed by her doctor whenever she had a chest infection.
Clara’s grandmother, who looked after her for much of the day, was present at the workshop. She assisted Clara in her practice of steps each day and in applying other recommendations as part of the programme.
Here is a synopsis of her progress: March 2nd, eighteen steps; April 2nd, fifty steps; May 2nd, fifty-five steps; June 2nd, eighty steps and a CP of forty-two seconds; July 2nd, eighty-six steps and a CP of fifty-one seconds, and August 2nd, a CP of one minute and fifteen seconds.
Clara’s doctor changed her medication from Seretide and reduced her dosage to two puffs of 125 mg Flixotide a day. She did experience a temporary relapse and had a chest infection during the first week of June. An antibiotic was required for this and three puffs of Ventolin were taken during one day.
She recovered from her chest infection quickly and her peak flow reverted to between 290 and 310. Her grandmother calls the clinic frequently to ask questions and also to report on her progress. Clara continues to make excellent progress in recovering from her asthma and also looks far better; she has a healthier colour, feels better and knows herself how well she is doing. For the month of July 2002, Clara had three courses of antibiotics. She did not require any during July 2003.
At the time of writing (December 2003), Clara has had only one chest infection since March. Her peak flow readings now average 350 and her medication intake has been substantially decreased by her GP.
Lorcan is aged ten and from Dublin. Lorcan attended a workshop in October 2002. His condition was continuously moderate, requiring daily preventer and reliever medication. His intake was two puffs of Flixotide per day and Ventolin when needed. Even with this preventative dose, Lorcan was unable to enjoy many of the activities children of his age take for granted. His mum explained that not alone was he having difficulty playing football, but that even standing at the side of a football pitch to watch a game on a windy day would be enough to start an attack.
In addition to asthma, he also suffered regular headaches and occasional tummy upsets. These are common symptoms of hyperventilation and are often present in many people with asthma. However, most people don’t relate one to the other.
Lorcan practised steps each day and also applied other aspects of the breathing programme. Shortly afterwards, he was able to play football with his local team. Over the course of six months, his doctor reduced his Flixotide intake.
Lorcan is now totally free from all medication and symptoms, and his mother says the peace of mind she enjoys from this improvement is wonderful. She reported that Lorcan had taken part in a sailing trip around the Cork coast. She said he did the same trip previously but was plagued with symptoms. The second time, he participated in this voyage totally free from symptoms and entirely free from the need for medication. He still carries his reliever inhaler as advised, and will continue to do so for a year or so in the unlikely event that he may require it.
Summary of breathing exercises for children
Reduced air flow
• Set time aside to do exercise with no distractions.
• Sit down and adopt the correct posture.
• Relax and become as soft and wobbly as jelly. Ask the child to pretend she is very wobbly just like jelly on a plate.
• Place a finger under the nose without blocking the air flow [Mouse Breathing].
• Concentrate on reducing the amount of air flow that is blown onto the finger by monitoring the temperature of air flow onto the finger.
• Reduce movement of chest and tummy.
• Observe breathing throughout the day.
Summary of Steps
• Take a small breath in (two seconds) and a small breath out (three seconds).
• Hold the breath and walk as many steps as possible until there is a strong desire to breathe in again.
• After completion of steps relax like jelly and breathe like a little mouse.
• Count aloud each step and record the number so that progress can be monitored.
Other important points to remember are: young children should only sleep on their tummies and never on their backs; children should never eat before going to bed; the amount of junk food eaten should be reduced and a healthy lifestyle encouraged; children should only eat when hungry, and excessive clothing and temperatures should be avoided. Playing outdoors in the fresh air as much as possible during the day is beneficial while breathing through the nose all day.