We use a different method, called ‘Steps’, to help children understand the process of improving their carbon dioxide levels, simply because children may have difﬁculty using Exercise One. More detailed information on helping children is contained in Chapter Nine.
Steps is also helpful as a measurement of progress, particularly if the child has difficulty in applying the control pause correctly. Steps involves moving the muscles to increase the carbon dioxide level, and this is then combined with the child holding the breath, which will help to retain it.
For the purposes explaining this exercise, let’s imagine again that you’re dealing with a child called Emily. To perform Steps Emily should:
✦ Take a small breath in for two seconds and a small breath out lasting three seconds.
✦ Hold her breath by pinching her nose. It’s better if Emily holds her nose by raising her hand above her mouth so that her mouth is visible. This way, if she takes a breath in through her mouth, it will be noticed.
✦ Get her to walk as many steps as she can until she needs to breathe in again. During Steps, encourage Emily to build up a large air shortage by doing as many steps as she can manage before she breathes in. Ensure she doesn’t overdo it. If she does, it could become too stress- ful for her, and could put her off the exercises altogether.
✦ Encourage Emily to walk as many steps as possible, count aloud every ﬁve or ten steps, again ensuring that she doesn’t overdo it.
✦ When Emily starts breathing, it must be only through her nose and her breathing must be calmed immediately. If her shoulders rise or become tense, point this out to her, and ask her to let her shoulders drop to the normal resting position.
✦ After completing Steps the ﬁrst breath will usually be bigger than normal. Make sure Emily reduces or sup- presses the second and third breaths.
✦ Get her to relax, by explaining that a relaxed body is like jelly on a plate, so that there is no tension and the muscles go all ﬂoppy. The more Emily relaxes, the quicker will be her recovery of normal breathing.
✦ Count each step aloud and record the number. Compare each day’s steps with the previous day’s so that progress can be measured.
If a child is unable to do the control pause correctly, the Steps exercise – the best way of increasing carbon dioxide levels – can be used as a measurement tool. Always encourage the child to increase their steps over time. The goal is for the child to be able to walk a hundred paces without having to take a breath. Steps should be done only while walking. Reasonably fast walking is ﬁne, but the child should not run.
If the child feels a relatively strong need to inhale following completion of Steps, then the exercises are being done correctly. If the child seems to be getting stressed just get her to reduce the number of steps she is taking so that it is not stressful for her.
Make sure to calm the deep breath sometimes taken on completion of the exercise. The Steps exercise is interspersed with reduced breathing called ‘mouse breathing’ and details are contained in the special chapter for children. Two to three sets of Steps should be practised each day, depending on the severity of the asthma condition, and the more severe the condition the greater the number of sets should be completed each day. If the child has severe asthma however, then do make sure that she doesn’t overdo it. Mind you, this applies equally to adults! Don’t push a child too hard. Breathing exercises are not meant to be stressful, because increased stress is completely counter-productive; it will cause increased breathing, and the child may not be willing to continue with the exercises. Again, the best times for the Steps exercises are before breakfast in the morning and at night, just before going to bed.