If you’re a parent of a kid with asthma, you know all too well the terrifying experience of seeing your child cough uncontrollably, gasp for air, or even double over and turn shades of purple while you scramble for the inhaler. Pediatric asthma attacks, most common in children ages 4 and under, are not for the faint of heart. And while the number of asthmatic kids who experienced an acute attack last year dropped to 54 percent compared with 62 percent in 2001, one in six of those kids still wound up in the ER, according to the Centers for Disease Control and Prevention.

As far as health conditions go, asthma is pretty mainstream: More than 32 million people in the U.S. have asthma. Of those, 6.2 million are children, making asthma the most common chronic illness for kids. It is the third biggest cause of hospitalization in children, and experts estimate 12.8 million school days are missed every year due to the condition. Characterized by a narrowing or blockage of the airways to the lungs, asthma makes everyday breathing a massive challenge. During an attack, the lining of the lung’s airways become inflamed, and then a layer of mucus coats them, further inhibiting breathing. In response, muscles surrounding the airway begin to constrict, cutting off the air supply.

Although asthma has no cure, it can be kept in check with proper treatment. Here’s what you should know about the condition, and how to help your child.

1. Anyone Can Get Asthma but Some Have Greater Risk

Asthma is found in every population in the U.S. and one in 10 children have it. However, kids are twice as likely to suffer from it than grownups; girls more than boys; Africans Americans more than caucasians; and people in the northeast more than any other region. There also appears to be a familial connection: “If you have allergies or asthma, your child is more likely to develop the condition,” says physician Neeta Ogden, M.D., of the American College of Allergy, Asthma, and Immunology. Living in highly polluted areas, cities with poor air quality, or homes with dust mite problems, can also raise a child’s risk.

2. Asthma is Tough to Diagnose

“Asthma is difficult to diagnose before age five,” says Ann Wu, M.D., a pediatrician and asthma researcher at Harvard Medical School. “While multiple studies show that 50 to 80 percent of children who have asthma develop symptoms before their fifth birthday, they may receive diagnoses such as pneumonia, upper respiratory tract infections, or wheezy bronchitis.” On the other hand, Dr. Wu points out, wheezing and coughs in young children can be caused by conditions other than asthma, so distinguishing between the two is essential.

3. Night Coughing Is a Prime Indicator

While there is no single diagnostic test for asthma, recurring symptoms such as coughing at night are a good indication that your child may have the condition, says Elizabeth Matsui, M.D. a professor of pediatrics, epidemiology, and environmental health sciences at Johns Hopkins University. Other symptoms, according to the Mayo Clinic include:

• Frequent, intermittent coughing,
• A whistling or wheezing sound when exhaling,
• Shortness of breath,
• Chest congestion or tightness,
• Chest pain, particularly in younger children,
• Trouble breathing that may limit play or exercise,
• Fatigue, which can be caused by poor sleep.

4. Triggers Are Everywhere

“One thing that’s very clear and every parent should be aware of is that secondhand smoke exposure increases the risk of wheezing symptoms in kids,” says Dr. Matsui. The American Lung Association offers this list of additional everyday triggers, including:

• Respiratory infections and colds,
• Pollen, mold, animal dander, feather, dust, food and cockroaches
• Indoor and outdoor air pollutants, including ozone and particle pollution,
• Exposure to cold air or sudden temperature change,
• Excitement/stress,
• Exercise.

5. Meds Work Two Ways

Kids with severe asthma generally require a double-prong treatment approach. So-called “rescue medicines,” or short-acting beta agonists like Albuterol, provide quick relief of symptoms during an asthma event by relaxing the bronchial smooth muscle of the airways, says Dr. Wu. Controller medicines, on the other hand, work by decreasing airway inflammation. “Controller medicines are prescribed for children with asthma who have had multiple flares and need to be taken daily whether the child is symptomatic or not,” says Dr. Wu.

6. Consistency Is Key for Treatment

One of the biggest reasons asthmatic kids require ER trips is because of insufficient or improper administration of their medication, according to several studies. In the January 2018 Pediatrics journal, researchers found that combining an in-school treatment schedule with regular tele-checkups by the child’s physician via the school’s nurse program, resulted in cutting the number of ER visit in half over kids without this support.

7. Steroids Are OK for Kids

“One of the biggest misconceptions parents have is that giving their child steroid medication is going to harm them,” says Dr. Ogden. Rest assured, these are not the Barry Bond-building type of ’roids. Usually administered through an inhaler, asthma steroids act as anti-inflammatories, reducing the swelling of a child’s airway, making it easier to breathe. That’s where you come in: According to a study in Respiratory Medicine, parents who monitored and encouraged children to use their inhalers had kids who were significantly more likely to follow through on treatment, thereby lowering their rate of asthma attacks.

8. Bigger Doses Are Not Better

In two important studies published this month in the New England Journal of Medicine, scientists investigated whether providing glucocorticoids in substantially larger doses could have a greater impact in preventing the escalation of asthma attacks in children. The answer: No, but larger doses of the drug do appear to negatively impact a child’s growth.

9. You Can’t Cure It, But You Can Lower the Risk

While medication is an important aid to keep your asthmatic child free from attacks, there are other simple things you can do to reduce the likelihood of an attack. Don’t smoke, and don’t allow guests to smoke in your home. And finally, consider washing your child’s stuffed animals and bedding in very hot water once a week to kill any lingering dust mites.