Asthma Action Plan, Pediatric
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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.
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: _______________
If your child uses a peak flow meter, determine his or her personal best reading. Record it here: _______________
Call your child's health care provider if your child is using a reliever or rescue medicine more than 2–3 times a week.
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.
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