If your child has asthma, you may know which triggers can worsen their symptoms, but what if some asthma triggers are hiding in or on their backpack? One out of every 12 school-age children has asthma, which is the most common reason for missed school days.

Any time a child develops asthma symptoms, it’s worth looking at what they ate, touched, or did just before and keeping track of recurring symptoms after another exposure, says Allen J. Dozor, MD, a pediatric pulmonologist and professor of pediatrics at New York Medical College. “The first time could be a coincidence, the second time raises suspicion, and the third time a child develops symptoms of asthma exposed to the same trigger, it’s probably the culprit,” says Dr. Dozor.

Children with asthma have more trouble succeeding in school when their symptoms aren’t well-controlled, but if you can identify their triggers you can keep symptoms at bay.Here are the most common triggers that may live in or on your child’s backpack.

1. Dust Mites

Tiny bugs that eat dead skin — dust mites — thrive anywhere they can get a good meal. You can’t see them, but they live on skin, in pet fur, and on fabrics.

“[Dust mites] are in everything from stuffed animals to pillows to mattresses,” says Ceila Loughlin, MD, a pediatric pulmonologist at UNC Health and professor of pediatrics at the UNC School of Medicine in Chapel Hill, North Carolina. “It is not just the dust you see on your shelves or window blinds.”

While enough dust can make anyone sneeze, some people have a stronger reaction to dust mites, which can trigger asthma symptoms.

To minimize dust in or on your child’s backpack, wash it (and anything you put in it) frequently, says Dozor, who also recommends avoiding backpacks with lots of decorative fabric elements, as they can make it easy for dust mites to stick around. “[Instead,] choose an asthma-friendly backpack made from smooth, nonporous materials that are easy to wipe down and don’t trap dust and allergens.”

2. Pet Hair

Pet fur and dander can also cause allergic reactions besides those associated with dust mites. “House pets (not just cats and dogs, but even rabbits, guinea pigs, birds, and more) are easily overlooked,” says Cindy Salm Bauer, MD, the division chief and medical director of allergy and immunology at Phoenix Children’s in Arizona.When a child is sensitive to pet hair or dander, they can experience chronic airway inflammation, says Dr. Bauer. And a backpack can easily carry these triggers to school. To keep your child’s backpack free of pet allergens, wash it often and keep it in a place pets rarely go, such as the garage or even your car.

3. Cockroaches

Cockroach droppings, shells, and saliva carry proteins that can trigger asthma, says Dr. Loughlin.“Cockroaches are everywhere, even in the cleanest house,” Loughlin says.Still, you can make your home and your child’s backpack unwelcoming to cockroaches by cleaning them often, calling an exterminator for frequent checks and treatments, and sealing food sources well.

4. Strong Scents

Fragrant air fresheners and lotions may smell nice, but if they’re too strong they can prompt severe asthma attacks. “Irritants like strong smells from scented candles, perfumes, and cleaning supplies can be a trigger for asthma,” says Loughlin, so be sure to clean your child’s backpack with unscented soap and avoid spraying it with a perfumed fabric freshener.

Dozor also recommends against packing strong-smelling items like scented markers, crayons, or glue for school. Even some hand sanitizers can smell too strong, says Loughlin, who suggests using unscented options instead.

5. Pollen and Mold

Both pollen and mold can trigger asthma symptoms, and sticky pollen can easily cling to your child’s backpack without them noticing. Mold can also grow on a backpack easily. These organisms reproduce by sending out tiny spores, which float through the air. Once these spores land on something (like a backpack), they spread even more.

You can reduce pollen and mold on your child’s backpack through frequent cleaning. “Regularly empty all contents, shake it out to remove loose dirt and crumbs, wipe the inside and outside with a damp cloth and a mild, fragrance-free soap,” says Dozor. “Allow it to air-dry completely to prevent mold and mildew.”

Dozor also recommends keeping a clean T-shirt or jacket in a sealed plastic bag in your child’s backpack. “This can be helpful if your child gets wet or their clothes are exposed to a trigger like pollen during outdoor play,” he says.

6. Dried Fruit

Some people with asthma experience trouble breathing when they eat food with sulfites, a group of chemicals that occur naturally but that can also be used as a preservative. You can find sulfites in dried fruit and grape juice. Fresh grapes also contain some sulfites, but typically not enough to provoke an allergic response.

For children with a food allergy and asthma, it’s extremely important that they avoid exposure to the foods they are allergic to, says Loughlin. “Sometimes these sneak into backpacks from well-meaning friends or [are hidden] in the ingredients of a snack.” To protect against these triggers, teach your child from an early age to read ingredient labels, and empower them to avoid foods they are allergic to, Loughlin adds.

Dozor agrees and suggests packing your child’s lunch and snacks in a sealed container to avoid cross-contamination from any food allergens.

7. Processed Lunch Foods

Hot dogs, bologna, and salami are lunchtime favorites for many kids, but processed meat may spark asthma symptoms. One study of more than 35,000 adults found that eating more than five servings of processed meats a week correlated with increased asthma symptoms. Although more research is needed to prove this connection, you can still monitor your child’s symptoms after eating processed meats, and avoid packing them for lunch.Meats don’t hold the only processed-food risk. Artificial sweeteners like aspartame and sucralose in processed snacks and drinks can also have respiratory effects. Experts think this may happen because of the body’s stress response after consuming them. If you notice your child’s symptoms get worse after eating or drinking anything with artificial sweeteners, you can identify them as a trigger and avoid them.

8. Over-the-Counter Medications

Older kids may take pain relievers to school, but some medications — like aspirin, ibuprofen (Advil), and naproxen (Aleve) — can cause serious breathing problems in children with asthma. Ibuprofen can actually protect against trouble breathing in the general population, but it can worsen symptoms if you have asthma.If your child needs pain relief at school, you can ask your provider for their recommendations. They may suggest acetaminophen (Tylenol) as a safer option.

9. Stressful (or Heavy) Schoolwork

Both stress and strenuous activity can trigger an asthma attack, and kids may experience both at school. Your brain loves to create emotional associations, and if your child has a lot of school-related stress, simply putting on their backpack could prompt powerful emotions and potentially worsen asthma symptoms.Beyond the emotional weight of school stress, a backpack’s physical weight can also cause a problem. “If the backpack is heavy and the child is walking a lot with it, that could trigger asthma, knowing activity is a common trigger,” says Salm Bauer.If your child develops symptoms while wearing a heavy backpack, you may want to discuss it with their healthcare provider. They may recommend treating that time as “exercise” and giving a dose of their rescue inhaler beforehand. You can also discuss the issue with their teacher, who may offer an extra textbook to keep at home so they don’t have to carry heavy books back and forth.

The Takeaway

• Asthma triggers like dust mites, pet hair, pollen, mold, and insect droppings are everywhere, and some may gather in or on your child’s backpack.

• Lunches and snacks in your child’s backpack can also trigger symptoms, as can the weight of the bag itself.

• You can lessen asthma triggers on a backpack through frequent washing, keeping it free of strong scents, and speaking to your child’s healthcare provider if symptoms persist.