Is the air safe for your child today? Reading the AQI in Rewari

From the middle of October, two questions arrive in the clinic almost every day. Is it safe to send him to school? Should she still play outside? Both are reasonable, and both are hard to answer with the numbers most people are looking at.

This is an attempt to make the air quality index useful rather than alarming.

What the AQI is actually telling you

The air quality index is a single number, from 0 upwards, that compresses several pollutants into one scale. In India it reports the worst of them on that day. Through October and November in north Haryana, that is almost always PM2.5 — particles smaller than 2.5 microns, fine enough to travel past the nose and throat and reach the smallest airways.

The bands used in India are:

• 0–50, Good. No action needed.
• 51–100, Satisfactory. Minor breathing discomfort possible in sensitive people.
• 101–200, Moderate. Breathing discomfort for people with asthma, and for children and older people.
• 201–300, Poor. Breathing discomfort for most people on prolonged exposure.
• 301–400, Very poor. Respiratory illness on prolonged exposure.
• 401–500, Severe. Affects healthy people; serious impact on those with existing disease.

Two things are worth knowing about the number itself. It is a 24-hour average, so a reading of 180 can hide a morning spike well above 300. And it comes from a monitoring station that may be some distance away — the air beside a construction site or a burning pile is worse than the figure suggests.

Why children are affected first

This is not sentiment. There are physical reasons a child gets more pollution into a smaller lung.

They breathe faster. A young child's respiratory rate is substantially higher than an adult's, so more air — and more of what is in it — passes through each hour.

They breathe more for their size. Relative to body weight, a child takes in considerably more air than an adult, which means a higher dose of the same pollution.

They are shorter. Vehicle exhaust and resuspended road dust are densest close to the ground, which is exactly where a child's face is.

They are outside more, and exerting themselves. Running means mouth breathing, which bypasses the nose's filtering, and it means much greater airflow.

Their lungs are still growing. Lung development continues into the late teens. Sustained exposure during those years is associated with lower lung function reached in adulthood — a loss that is not made up later.

The thresholds I would act on

There is no single safe number, and the honest position is that the risk rises continuously rather than switching on at a line. But families need something practical, so:

Below 100. Normal routine. Outdoor play and sport are fine.

100–200. Fine for most children. A child with asthma should have their reliever inhaler with them and should avoid prolonged hard exercise outdoors — a cricket match, not a walk to the shop.

200–300. Shorten outdoor sport. Move PE indoors if the school will. Keep windows closed in the early morning and after sunset, when the inversion is strongest. A child with asthma should be on their preventer inhaler every single day through this period.

Above 300. Outdoor exercise is not worth it. School is still usually the right call — the alternative is often a home with a cooking fire or mosquito coil burning, which can be worse. Ask whether the school is keeping children indoors.

Above 400. Keep children in as far as is practical, run a purifier in the room they sleep in if you have one, and have a low threshold for seeking help if breathing changes.

What to watch for in your own child

The AQI describes the air. These describe your child, and they matter more.

• Coughing at night, or on waking
• A whistling sound from the chest, especially breathing out
• Stopping during play to catch breath, when they did not before
• Needing a reliever inhaler more than twice a week
• Complaining of chest tightness
• Unusual tiredness, or irritability from broken sleep

Any of these appearing or worsening through the season means the treatment needs reviewing, not that the child needs to stay indoors until February. A child coughing at night goes into this in more detail, including how viral wheeze is told apart from asthma.

Go to a hospital the same day if your child is struggling to breathe, sucking in at the ribs or neck with each breath, too breathless to speak or feed normally, or if their lips look blue or grey.

What actually helps

A daily preventer inhaler, through the whole season. This is the single most effective thing available, and the most commonly abandoned. A preventer works by reducing inflammation over days and weeks; it cannot be taken reactively when symptoms appear. If it was stopped over the summer because the child was well, restart it now — before the symptoms, not after.

Correct inhaler technique, with a spacer. A correctly prescribed inhaler used wrongly delivers almost nothing to the lungs. For children a spacer is not optional, with a mask for the youngest. Five reasons your inhaler has stopped working covers the specific mistakes.

Timing. Pollution is typically worst in the early morning and again after sunset, when cold air traps everything near the ground. Late morning is usually the better window for outdoor activity — the opposite of most schools' sport timetable, which is worth raising.

Indoor air you control. A mosquito coil, an incense stick or a biomass cooking fire in a closed room can expose a child to more fine particulate than a day outdoors. If you cook on wood or dung, ventilation matters more than anything else here. A purifier with a genuine HEPA filter measurably lowers particulate in one closed room — the bedroom is where it earns its money, because that is where eight hours are spent.

A properly fitted mask, if it must be worn. A well-fitted N95 filters fine particles. Cloth and surgical masks do not, and small children tolerate neither well. For a short walk to school a mask is reasonable; expecting a child to wear one all day is not.

What does not help

Steam inhalation does nothing for airway inflammation. Antibiotics do nothing at all for a cough caused by smoke and dust, and repeating them makes resistance more likely. Houseplants do not measurably change indoor PM2.5. Nasal filters and "anti-pollution" sprays have no good evidence behind them.

What a school can reasonably be asked

Parents often feel they have no standing to raise this. They do, and most schools respond well to a specific request rather than a general worry.

• Move PE and games indoors when the AQI is above about 200, or shift them

to late morning rather than first period. Early-morning assembly and sport are the worst possible timing on an inversion day.

• Let a child carry their reliever inhaler and use it without having to

ask. A child who has to find a teacher, explain, and be escorted to an office will simply not use it.

• Accept a written action plan. One page, from the treating doctor,

saying what the child takes, when, and what to do on a bad day. This removes the guesswork from a teacher's decision.

• Close windows on the worst mornings and avoid burning anything on the

premises.

None of this requires a school to buy equipment, which is usually where these conversations stall.

The part that is not about this winter

The reason this matters beyond a bad week is lung development. Lungs keep growing into the late teens, and the peak lung function a person reaches in early adulthood is the reserve they draw on for the rest of their life. Large studies in several countries have found that children growing up in more polluted air reach a lower peak — and that improvements in air quality are followed by measurable improvements in children's lung growth.

That is a reason for optimism rather than alarm: the effect moves in both directions. It also means the daily decisions are worth making, and that a child whose asthma is well controlled through these months is not simply more comfortable now.

If this happens every October

A cough that returns every autumn, with every change of weather, is a pattern — and a pattern can be diagnosed. A great many children are treated for "recurrent chest infection" for years before anyone performs a breathing test and finds asthma that could have been controlled all along.

If that describes your child, come during the season rather than after it. Assessment while the symptoms are present is far more informative, and it is the difference between managing the air and managing the condition.

To discuss it, book a consultation or call the clinic on 8563816000.