Breathing Together: Children Co-constructing Asthma Self-Management in the United States

Julie Spray, Jean Hunleth

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Pediatric asthma management in the U.S. is primarily oriented around caregivers. As evident in policy, clinical literature and provider practices, this caregiver-centric approach assumes unidirectional transfer of practices and knowledge within particular relational configurations of physicians, caregivers, and children. Reflecting broader societal values and hierarchies, children are positioned as passive recipients of care, as apprentices for future citizenship, and as the responsibility of parents who will train them in the knowledge and labor of asthma management. These ideas, though sometimes contradictory, contribute to a systemic marginalization of children as participants in their health care, leaving a conceptual gap regarding children’s inclusion in chronic illness management: what children’s roles in their health care are or should be. We address this conceptual gap by asking, what does pediatric asthma management look like when we center children, rather than caregivers in our lens? We draw data from a study of asthma management in St. Louis, Missouri, and Gainesville, Florida, which included 41 caregivers, 24 children, and 12 health-care providers. By asking children to show us how they manage asthma, we find that children actively co-construct health practices within broader interdependencies of care and the structural constraints of childhoods.

Original languageEnglish
Pages (from-to)301-328
Number of pages28
JournalCulture, Medicine and Psychiatry
Issue number2
StatePublished - Jun 2023


  • Asthma
  • Care
  • Childhood
  • Responsibility
  • Self-management


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