Asthma Action Plan, Pediatric

An asthma action plan helps you understand how to manage your child's asthma and what to do when he or she has an asthma attack. The action plan is a color-coded plan that lists the symptoms that indicate whether or not your child's condition is under control and what actions to take.

If your child has symptoms in the green zone, he or she is doing well.
If your child has symptoms in the yellow zone, he or she is having problems.
If your child has symptoms in the red zone, he or she needs medical care right away.

Follow the plan that you and your child's health care provider develop. Review the plan with your child's health care provider at each visit.

Provide the information to your child's school. You and your child's health care provider need to sign the school permission slip.

What triggers your child's asthma?

Knowing the things that can trigger an asthma attack or make your child's asthma symptoms worse is very important. Talk to your child's health care provider about your child's asthma triggers and how to avoid them. Record your child's known asthma triggers here: _______________

What is your child's personal best peak flow reading?

If your child uses a peak flow meter, determine his or her personal best reading. Record it here: _______________

Green zone

This zone means that your child's asthma is under control. Your child may not have any symptoms while he or she is in the green zone. This means that your child:

Has no coughing or wheezing, even while he or she is working or playing.
Sleeps through the night.
Is breathing well.
Has a peak flow reading that is above __________ (80% of his or her personal best or greater).

If your child is in the green zone, continue to manage his or her asthma as directed.

Your child should take these medicines every day:
- Controller medicine and dosage: _______________
- Controller medicine and dosage: _______________
- Controller medicine and dosage: _______________
- Controller medicine and dosage: _______________
Before exercise, your child should use this reliever or rescue medicine: _______________

Call your child's health care provider if your child is using a reliever or rescue medicine more than 2–3 times a week.

Yellow zone

Symptoms in this zone mean that your child's condition may be getting worse. Your child may have symptoms that interfere with exercise, are noticeably worse after exposure to triggers, or are worse at the first sign of a cold (upper respiratory infection). These may include:

Waking from sleep.
Coughing, especially at night or first thing in the morning.
Mild wheezing.
Chest tightness.
A peak flow reading that is __________ to __________ (50–79% of his or her personal best).

If your child has any of these symptoms:

Add the following medicine to the ones that your child uses daily:
- Reliever or rescue medicine and dosage: _______________
- Additional medicine and dosage: _______________

Call your child's health care provider if:

Your child remains in the yellow zone for __________ hours.
Your child is using a reliever or rescue medicine more than 2–3 times a week.

Red zone

Symptoms in this zone mean that your child needs medical help right away. Your child will appear distressed and will have symptoms at rest that restrict activity. Your child is in the red zone if:

He or she is breathing hard and quickly.
His or her nose opens wide, ribs show, and neck muscles become visible when he or she breathes in.
His or her lips, fingers, or toes are a bluish color.
He or she has trouble speaking in full sentences.
His or her peak flow reading is less than __________ (less than 50% of his or her personal best).
His or her symptoms do not improve within 15–20 minutes after using a reliever or rescue medicine (bronchodilator).

If your child has any of these symptoms:

These symptoms represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).
Have your child use his or her reliever or rescue medicine.
- Start a nebulizer treatment or give 2–4 puffs from a metered-dose inhaler with a spacer.
- Repeat this step every 15–20 minutes until help arrives.

Where to find more information

You can find more information about asthma in children from:

Centers for Disease Control and Prevention: www.cdc.gov
American Lung Association: www.lung.org

School permission slip

Date: __________

Student may use a reliever or rescue medicine (bronchodilator) at school.

Parent signature: __________________________

Health care provider signature: __________________________

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.