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When wildfires struck the West Coast in September 2020, there was a lot for parents to worry about. For parents of children with asthma, though, the danger could be even greater. "There are more than 400 toxins that are present in wildfire smoke. That can activate the immune system in ways that aren't helpful by both causing an inflammatory response and distracting the immune system from fighting infection," says Amy Oro, MD, a pediatrician at Stanford Children's Health. "When smoke enters into the lungs, it causes irritation and muscle spasms of the smooth muscle that is around the small breathing tubes in the lungs. This can lead to difficulty with breathing and wheezing. It's really difficult on the lungs."

With the added concern of COVID-19 and the effect it can have on breathing, many parents feel unsure about how to keep their children protected. The good news is that there are steps parents can take to keep their children as healthy as possible.

Here are tips parents need to know about how to deal with poor air quality when your child has asthma.

Minimize smoke exposure.

Especially when the air quality index reaches dangerous levels, it's best to stay indoors as much as possible. You can find out your area's AQI at AirNow.gov. An under 50 rating is the safest, but between 100-150 is considered unhealthy for sensitive groups, such as children with asthma. "If you're being told to stay indoors, listen. If you can, keep the windows and doors closed," Oro says.

Do your best to filter the air.

According to Oro, a HEPA filter is your best bet to effectively clean pollutants from the air. Many homes are equipped with a built-in HEPA filter in their air conditioning systems, but you can also get a canister filter. Oro says her family (her husband and children all suffer from asthma) also made use of a hack from the New York Times and built their own filter by duct taping a HEPA furnace filter to the front of a box fan. "It was pretty disgusting what we accumulated in the first 20 hours in our fan," she says.

Avoid letting your child play outside or overly exert themselves in open air.

"Unfortunately, cloth masks don't do very much [to protect you from the smoke pollution]," Oro says. "You really need an N95 mask, and most of those have been allocated toward essential workers." To keep at-risk children safer, Oro recommends avoiding brisk exercise outdoors. Instead, set up an indoor obstacle course or challenge your family to jumping jacks periodically to keep everyone moving safely.

Know the difference between smoke exposure and COVID-19.

"COVID-19 can have a lot of the same symptoms—dry cough, sore throat, shortness of breath and chest pain could overlap. But what COVID and other viruses generally cause are fever, chills, vomiting, diarrhea and body aches. Those would tell you it's not just smoke exposure," Oro says. When a child has been exposed to smoke, they often complain of a "scrape" in their throat, burning eyes, cough, shortness of breath, chest pain or wheezing. If the child has asthma, parents should watch for a flare of symptoms, such as coughing, wheezing or a tight sensation in their chest.

Unfortunately, not much is known about long-term exposure to wildfire smoke on a healthy or compromised immune system, but elevated levels of air pollution have been associated with increased COVID-19 rates. That's because whenever there's an issue with your immune system, it distracts your immune system from fighting infections and you have a harder time fighting off viruses. Limiting your exposure to wildfire smoke is your best bet to keep immune systems strong.

Have a plan in place if you think your child is suffering from smoke exposure.

Whatever type of medication your child takes for asthma, make sure you have it on-hand and that your child is keeping up with regular doses. Contact your child's pediatrician, especially if your area has a hazardous air quality—they may want to adjust your child's medication schedule or dosage to prevent an attack. Oro also recommends that, if your child has asthma, it might be helpful to have a stethoscope or even a pulse oximeter at home to help diagnose issues with your pediatrician through telehealth.

Most importantly, don't panic.

In some cases, social distancing and distance learning due to COVID may be helping to keep sensitive groups like children with asthma safer. Oro says wildfires in past years have generally resulted in more ER visits for children, but the most recent fires haven't seen the same results. "A lot of what we've seen is that the smoke really adversely affects adults, especially older adults over 65," Oro says. "Children tend to be really resilient."

This article was sponsored by Stanford Children's Health. Thank you for supporting the brands that support Motherly and mamas.