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Diagnosis in children

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Initial Clinical Assessment:

  • focus the initial assessment in children suspected of having asthma on:
    • presence of key features in history and examination
    • careful consideration of alternative diagnoses

Clinical features that increase the probability of asthma

  • more than one of the following symptoms
    • wheeze, cough, difficulty breathing, chest tightness - particularly if these are frequent and recurrent; are worse at night and in the early morning; occur in response to, or are worse after, exercise or other triggers, such as exposure to pets; cold or damp air, or with emotions or laughter; or occur apart from colds
    • personal history of atopic disorder
    • family history of atopic disorder and/or asthma
    • widespread wheeze heard on auscultation
    • history of improvement in symptoms or lung function in response to adequate therapy


Clinical features that lower the probability of asthma

  • symptoms with colds only, with no interval symptoms
  • isolated cough in the absence of wheeze or difficulty breathing
  • history of moist cough
  • prominent dizziness, light-headedness, peripheral tingling
  • repeatedly normal physical examination of chest when symptomatic
  • normal peak expiratory flow (PEF) or spirometry when symptomatic
  • no response to a trial of asthma therapy
  • clinical features pointing to alternative diagnosis

With a thorough history and examination, a child can usually be classed into one of three groups:

  • high probability - diagnosis of asthma likely
  • low probability - diagnosis other than asthma likely
  • intermediate probability - diagnosis uncertain


  • (1) BTS/SIGN (May 2008). British Guideline on the Management of Asthma

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