Version July 2025
Please read the Disclaimer at the end of this page.
What are discharge instructions? —
Discharge instructions are information about how to take care of your child after getting medical care in the emergency department ("ED").
What should I know? —
Your child was seen in the ED for breathing problems. The doctors gave your child a metered dose inhaler ("MDI") to help them breathe more easily. The MDI releases medicine when you press down on the top of the canister.
It is important to use your child's MDI exactly as instructed.
How do I care for my child at home? —
Ask the doctor or nurse what you should do when you go home. Make sure you understand exactly what you need to do to care for your child. Ask questions if there is anything you do not understand.
You should also do the following:
●Call your child's regular doctor and tell them your child was in the ED. Make a follow-up appointment if you were told to.
●Every inhaler might be a little different. Follow the instructions from the doctor about how often to use it.
●The first time your child uses an inhaler, you need to get it ready. This is called "priming." To do this:
•Take the cap off the mouthpiece.
•Shake the inhaler for 5 seconds (figure 1).
•Press down on the canister to spray the medicine into the air (away from your child's face).
•Repeat these steps 3 more times.
If your child doesn't use their inhaler every day, check when it needs to be primed again. Most need to be primed if they haven't been used for more than 1 or 2 weeks. This means following the steps above before your child uses the inhaler again.
After the inhaler is ready, your child can use it as prescribed.
●Almost all children with breathing problems use an inhaler with a "spacer." A spacer is a device that attaches to the inhaler's mouthpiece. Pressing down on the canister causes the puff of medicine to spray into the spacer, then the person breathes it in. Some spacers also come with a face mask.
●In general, to use your child's MDI:
•Shake the inhaler for 5 seconds.
•Take the cap off the inhaler mouthpiece and the spacer. Put the inhaler in the spacer. If the spacer has a valve, it should face upward.
•Hold the inhaler upright with 1 finger on the top of the canister and your thumb on the bottom of the inhaler, and your other hand holding the spacer.
•Have your child sit or stand up straight and slightly tilt their chin up. Then, have them breathe out normally until their lungs feel empty.
•Have your child close their lips around the mouthpiece of the spacer (picture 1). If the spacer has a face mask, hold the face mask snugly over your child's mouth and nose.
•Press down on the canister once.
•Have your child take a deep, slow breath in, then hold it for 5 to 10 seconds. Have them let the breath out, then breathe in deeply and slowly and hold their breath again. If a mask is used, have them breathe in and out normally for 10 seconds instead of taking a deep breath and holding it.
•If your child needs 2 puffs of the inhaler, wait 15 to 30 seconds in between. Hold the inhaler and spacer away from their mouth while you wait. Shake the inhaler again before the second puff. Then, follow the same steps above.
•Remove the inhaler from the spacer and put the cap back on the mouthpiece, or leave the inhaler in the spacer for the next use.
•If the inhaler is a steroid medicine (also called a "glucocorticoid" or "corticosteroid"), have your child rinse out their mouth, gargle, and spit out the water or brush their teeth.
●If your child uses their inhaler every day, clean it at least once a week. If they don't use the inhaler every day, you can clean it less often. To know when you need to clean it, look inside the mouthpiece. Clean the inhaler when you see powder in or around the hole.
To clean an inhaler:
•Remove the canister and cap from the mouthpiece. Do not wash the canister or put the canister under water.
•Run warm water through the mouthpiece for 30 to 60 seconds.
•Shake the water off the mouthpiece. Let air dry completely, and then replace the cover.
●If your child uses the spacer each day, clean it every 1 to 2 weeks. First, remove the inhaler from the spacer. Wash the spacer with warm water and dishwashing soap, but do not rinse it. Then, let it air dry. Leaving the spacer a little soapy after cleaning actually helps it work better.
If your child uses an InspirEase chamber every day, replace the bag every 1 to 2 weeks or right away if there is a hole in the bag. Clean the mouthpiece in warm running water, and let it air dry. Do not wash the bag.
If your child uses a cardboard chamber every day, replace it every week or if it gets wet or damaged. Do not wash the bag.
●Keep track of how many doses are in your child's inhaler. There might be a counter on the side of the inhaler, or you might have to write this down.
When should I get emergency help?
●Call for emergency help right away (in the US and Canada, call 9-1-1) if your child has severe symptoms like:
•They have so much trouble breathing they cannot talk.
•The skin and muscles around their ribs are pulling in with each breath (called "retractions").
•Their lips or fingernails turn gray or blue.
•They are very drowsy or not responding normally.
●Return to the ED if:
•Your child has breathing problems, and their symptoms do not improve, or get worse, after using a quick-relief medicine.
When should I call the doctor? —
Call for advice if:
●Your child needs to use their quick-relief medicine more than 2 times a week.
●Your child cannot do their normal activities because of their breathing problems.
●You have any questions about your child's medicines.
●You child has new or worsening symptoms.
Patient education: Asthma in children (The Basics)
Patient education: Medicines for asthma (The Basics)
Patient education: Avoiding asthma triggers (The Basics)
Patient education: Exercise-induced asthma (The Basics)
Patient education: Asthma action plan for children (The Basics)
Patient education: Asthma symptoms and diagnosis in children (Beyond the Basics)
Patient education: Asthma treatment in children (Beyond the Basics)
Patient education: Asthma inhaler techniques in children (Beyond the Basics)
Patient education: Trigger avoidance in asthma (Beyond the Basics)
Patient education: Exercise-induced asthma (Beyond the Basics)
