Malaysia's Recent Haze: Why Children Are Experiencing More Coughs, Respiratory Symptoms and Asthma Attacks

A Paediatrician's Guide to Protecting Your Child During Hazy Weather

By MyLittle Child Specialist Clinic | September 2026

Introduction: Why Should Parents Be Concerned About Haze?

With haze affecting parts of Malaysia recently, many parents are concerned about their children's respiratory health. During periods of poor air quality, children may experience coughing, sneezing, throat irritation, breathing difficulties or worsening asthma symptoms.

As paediatricians, we understand how worrying these symptoms can be, particularly when your child develops a persistent cough or struggles to breathe.

However, not every cough during haze is caused by an infection. Haze can irritate the respiratory system, trigger asthma attacks and worsen existing conditions. Although air pollution is associated with increased respiratory health problems, upper respiratory tract infections (URTIs) are caused by infectious organisms, most commonly viruses.

Understanding the difference and taking appropriate precautions can help parents protect their children.

1. What Is Haze, and Why Are Children More Vulnerable?

Haze occurs when tiny particles and pollutants accumulate in the atmosphere, reducing visibility and affecting air quality.

In Malaysia, it can result from forest and peatland fires, open burning, industrial emissions and vehicle pollution. Smoke from regional vegetation fires may also travel across national borders.

One of its most concerning components is PM2.5: extremely small airborne particles measuring 2.5 micrometres or less in diameter. These particles can travel deep into the lungs, irritating the respiratory system, contributing to inflammation and aggravating existing respiratory conditions.

According to the World Health Organization (WHO), particulate air pollution is associated with respiratory and cardiovascular health risks.

Children require particular attention because their lungs and respiratory systems are still developing. They generally breathe faster than adults and may inhale more air relative to their body weight.

Running, playing and outdoor sports further increase their breathing rates and potential exposure. Children with asthma or other chronic respiratory conditions may also have particularly sensitive airways.

For these reasons, reducing unnecessary exposure during unhealthy air-quality conditions is especially important for children.

2. Does Haze Cause Upper Respiratory Tract Infections?

During haze episodes, parents may notice their children developing coughs, runny noses, sore throats or other respiratory symptoms.

However, respiratory irritation and infection are different conditions.

Respiratory irritation caused by haze

When children inhale polluted air, fine particles and other irritants contact the lining of their noses, throats and airways.

This can cause inflammation and symptoms such as coughing, sneezing, throat irritation, nasal discomfort, watery eyes and chest discomfort.

These symptoms can resemble an infection even when no infection is present.

Upper respiratory tract infections

URTIs are usually caused by respiratory viruses, such as rhinovirus and other common respiratory viruses.

Children may experience fever, coughing, runny noses, nasal congestion, sore throats or reduced appetite.

Haze does not directly cause viral infections. However, studies have associated air-pollution episodes with increased respiratory illnesses and healthcare visits.

Polluted air can also aggravate symptoms in children who already have respiratory infections.

For example, a child with a mild viral cold and underlying asthma may develop more troublesome coughing or wheezing when exposed to haze.

Parents should therefore avoid assuming that every cough is caused by pollution.

If your child develops fever, persistent coughing, worsening symptoms or breathing difficulties, arrange a medical assessment to identify the underlying cause.

3. Why Does Haze Trigger Asthma Attacks?

Children with asthma are particularly vulnerable during haze episodes.

Asthma is a chronic inflammatory condition affecting the airways. Children with asthma have sensitive airways that can react to triggers such as respiratory infections, air pollution, cigarette smoke and allergens.

During an asthma exacerbation, the muscles surrounding the airways may tighten. The airway lining can become swollen and inflamed, while mucus production may increase.

Together, these changes narrow the airways and make breathing more difficult.

Common warning signs of worsening asthma include:

• Persistent coughing, especially at night

• Wheezing or whistling sounds when breathing

• Chest tightness

• Shortness of breath or increased breathing rate

• Difficulty participating in normal activities

• Increased need for prescribed reliever medication

Young children may be unable to describe breathing discomfort. Parents might instead notice unusual tiredness, reduced activity, faster breathing or feeding difficulties.

Asthma attacks can occur even when a child's asthma is usually well controlled.

The Global Initiative for Asthma (GINA) recognises environmental pollutants and respiratory infections as factors that can contribute to asthma exacerbations.

Children with asthma should therefore continue their prescribed treatment and have an updated asthma action plan.

4. Understanding Malaysia's Air Pollutant Index (API)

Malaysia uses the Air Pollutant Index (API), also known as Indeks Pencemar Udara (IPU), to communicate outdoor air quality.

Parents can use these readings to help plan their children's activities.

API 0–50: Good

Air quality is generally satisfactory. Normal outdoor activities are usually appropriate.

API 51–100: Moderate

Air quality is generally acceptable. Monitor children with asthma or other respiratory conditions, particularly if symptoms develop.

API 101–200: Unhealthy

Reduce children's outdoor exposure and avoid strenuous outdoor exercise. Additional precautions are particularly important for children with respiratory conditions.

API 201–300: Very Unhealthy

Keep children indoors as much as possible and avoid outdoor physical activities.

API Above 300: Hazardous

Avoid unnecessary outdoor exposure. Follow official public health advisories and maintain cleaner indoor air.

These categories follow Malaysia's official air-quality classification.

Air quality can change throughout the day and vary significantly between locations. Parents should regularly check the Department of Environment's official Air Pollutant Index Management System.

Official website: https://eqms.doe.gov.my/APIMS

Remember that children with asthma may develop symptoms even when API readings are relatively low. Always consider your child's individual condition alongside reported air quality.

5. Seven Practical Ways to Protect Your Children During Haze

Although parents cannot control outdoor pollution, several evidence-based precautions can help reduce their children's exposure.

1. Reduce outdoor activities when air quality is poor

When the API reaches unhealthy levels, limit outdoor exposure and avoid strenuous exercise.

Replace outdoor activities with indoor alternatives such as reading, drawing, board games or other age-appropriate activities.

Schools and childcare centres should monitor official air-quality reports, adjust outdoor activities and follow relevant Malaysian authorities' guidance.

2. Improve indoor air quality

During significant haze episodes, close windows and external doors to minimise the entry of polluted air.

If your air-conditioning system has an appropriate recirculation setting, consider using it.

A portable air purifier equipped with a high-efficiency particulate air (HEPA) filter may help reduce indoor particulate pollution. Choose one suitable for the room's size and maintain it according to the manufacturer's instructions.

For children with asthma, consider creating a cleaner-air room, such as a bedroom.

Avoid additional indoor pollutants, including cigarette smoke, incense, candles and unnecessary aerosol sprays.

Air purifiers that deliberately generate ozone should be avoided because ozone can irritate the respiratory system.

3. Understand when face masks may help

Properly fitted particulate respirators, such as N95 respirators, can reduce exposure to fine airborne particles.

However, effectiveness depends on achieving a proper fit. Ordinary surgical masks and cloth masks do not provide equivalent protection against fine smoke particles.

Children aged two years and above may be able to use appropriately sized respirators if they can wear them safely and achieve a suitable fit.

Never place masks or respirators on children younger than two years.

For young children, particularly those with respiratory conditions, reducing outdoor exposure and maintaining cleaner indoor air are generally more practical than relying on masks.

4. Continue prescribed asthma medication

Children with asthma should continue using their prescribed medications according to their doctor's instructions.

Children prescribed inhaled corticosteroid-containing controller medication should not stop treatment simply because their symptoms improve. These medications help control airway inflammation and reduce the risk of asthma exacerbations.

Ensure your child's prescribed reliever inhaler is available and that you understand how and when to administer it.

For younger children using metered-dose inhalers, an appropriate spacer can improve medication delivery.

Every child with asthma should have an individualised written asthma action plan explaining how to recognise worsening symptoms, administer prescribed medication and seek emergency treatment.

5. Encourage adequate hydration and healthy routines

Offer sufficient fluids throughout the day.

Adequate hydration supports normal bodily functions and may improve comfort when children experience throat irritation. However, drinking extra water does not remove inhaled pollutants or prevent asthma attacks.

Maintain balanced meals, sufficient sleep and opportunities for physical activity in environments with suitable air quality.

Expensive supplements and special detoxification products have no reliable evidence of removing haze particles from the lungs.

Reducing pollution exposure remains the priority.

6. Maintain good infection-prevention practices

Although haze does not directly cause viral infections, children can still contract respiratory illnesses during haze episodes.

Encourage regular handwashing, appropriate cough and sneeze etiquette, and avoiding unnecessary close contact with individuals experiencing contagious respiratory illnesses.

Keep your child's routine vaccinations up to date, including seasonal influenza vaccination when recommended.

These measures help reduce certain infections but do not replace precautions against air pollution.

7. Avoid unnecessary medication

Not every child who coughs during haze requires antibiotics, nebulisation or oral steroids.

Antibiotics do not treat pollution-related irritation or uncomplicated viral respiratory infections.

Most uncomplicated viral URTIs can be managed with appropriate supportive care. However, children with asthma or underlying respiratory conditions may require specific treatment following medical assessment.

Avoid giving young children over-the-counter cough and cold medications without appropriate medical advice.

If symptoms persist or worsen, consult a healthcare professional rather than repeatedly administering medication without identifying the cause.

6. When Should Parents Bring Their Child to a Doctor?

Most mild respiratory irritation improves when exposure to polluted air is reduced.

However, seek medical advice if your child develops persistent coughing, fever, wheezing, reduced feeding, worsening asthma symptoms or difficulty participating in normal daily activities.

Children with asthma should receive medical attention if their symptoms become more frequent, their need for reliever medication increases or their asthma action plan indicates that assessment is necessary.

Young infants and children with existing respiratory or cardiac conditions may require earlier assessment.

Warning Signs: Seek Emergency Medical Care

Bring your child to the nearest emergency department immediately if they experience:

• Severe difficulty breathing

• Rapid breathing with visible pulling in of the chest or ribs

• Difficulty speaking, crying or feeding because of breathlessness

• Blue or grey lips

• Unusual drowsiness, confusion or reduced responsiveness

• A severe asthma attack that does not respond adequately to prescribed emergency treatment

These symptoms may indicate a serious respiratory problem. Never delay emergency treatment while waiting for haze conditions to improve.

7. A Final Message to Parents

Haze is an important environmental health concern, particularly for children whose lungs are still developing.

It can irritate the respiratory system, worsen existing respiratory conditions and trigger asthma attacks. Understanding the difference between pollution-related symptoms and infections is important because they may require different treatments.

Parents can help protect their children by monitoring air quality, reducing unnecessary outdoor exposure, maintaining cleaner indoor environments and ensuring that prescribed asthma treatments are used correctly.

Children with asthma should have an updated asthma action plan, and parents should recognise the early warning signs of respiratory distress.

Most importantly, pay attention to your child. If they develop unusual breathing difficulties, persistent symptoms or changes in their normal activity level, seek appropriate medical attention.

At MyLittle Child Specialist Clinic, we believe that caring for children goes beyond treating illness. It also means helping parents understand how to protect their children's health through reliable medical information.

MyLittle Child Specialist Clinic

Little Hearts, Big Care.

Medical disclaimer: This article provides general health education and does not replace an individual medical consultation, diagnosis or treatment. Every child's medical needs are different.

Medical References and Guidelines

This article draws on established public health guidance and evidence-based medical resources.

1. World Health Organization (WHO) — WHO Global Air Quality Guidelines: Particulate Matter (PM2.5 and PM10), Ozone, Nitrogen Dioxide, Sulfur Dioxide and Carbon Monoxide.
   https://www.who.int/publications/i/item/9789240034228

2. Malaysian Ministry of Health — Haze-Related Health Information and Preventive Measures.
   https://www.moh.gov.my/

3. Department of Environment Malaysia — Air Pollutant Index Management System.
   https://eqms.doe.gov.my/APIMS

4. Global Initiative for Asthma (GINA) — Global Strategy for Asthma Management and Prevention, 2026.
   https://ginasthma.org/

5. United States Environmental Protection Agency (EPA) — Wildfire Smoke: A Guide for Public Health Officials.
   https://www.epa.gov/wildfires/wildfire-smoke-guide-public-health-officials

6. Centers for Disease Control and Prevention (CDC) — Asthma Management and Clinical Guidance for Paediatric Respiratory Infections.
   https://www.cdc.gov/asthma/
   https://www.cdc.gov/antibiotic-use/hcp/clinical-care/pediatric-outpatient.html