Breathing Difficulty in Children

Brief introduction

Children may breathe faster or work harder when they have an infection, wheeze, airway irritation, choking concern, allergy, or another illness. The sound alone does not tell how serious the problem is.

Look at the whole child: breathing effort, colour, alertness, feeding, ability to speak or cry, and whether symptoms are improving or worsening. Clinical assessment is needed to determine the cause.

What parents may notice

• Breathing that seems faster, harder, noisier, or different from the child's usual pattern.
• Shortness of breath during feeding, crying, speaking, walking, or playing.
• Reduced feeding, shorter feeds, vomiting after coughing, or tiring easily.
• Unusual sleepiness, irritability, restlessness, or reduced interest in surroundings.
• Blue, grey, very pale, or mottled colour, especially around the lips or face.

Signs of increased breathing effort

• Skin pulling in between the ribs, below the ribs, above the breastbone, or at the base of the neck.
• Nostrils widening with each breath.
• Head bobbing in a baby or a child needing to sit upright to breathe comfortably.
• Pauses in breathing, grunting, or breathing that looks tiring.
• A child who cannot feed, drink, speak, cry, or settle because of breathing effort.

Different sounds parents may describe

• Wheeze: a whistling sound, often heard more when breathing out. It can occur with asthma tendency, viral wheeze, bronchiolitis, allergy, or other airway problems.
• Stridor or noisy breathing in: a harsh or high-pitched sound when breathing in. It may happen with upper-airway swelling such as croup, but other causes need medical assessment.
• Grunting: a short sound at the end of breathing out. This can be a sign that breathing is hard work and should be assessed urgently if present.

These descriptions are clues, not diagnoses. A clinician needs to assess the child to decide what is causing the sound and how urgently treatment is needed.

Broad possible causes

• Viral respiratory illness: colds and other viral infections can cause cough, fever, blocked nose, and faster breathing.
• Asthma or wheeze: recurrent cough, wheeze, chest tightness, or breathlessness may need an asthma or wheeze review.
• Croup: a barking cough and noisy breathing in may occur, often worse at night.
• Bronchiolitis in babies: cough, wheeze or noisy breathing, and feeding difficulty may occur in infants.
• Pneumonia: cough or fever with fast or hard breathing, chest pain, poor feeding, or a very unwell child needs assessment.
• Choking or inhaled foreign body: sudden cough, choking, noisy breathing, or symptoms after eating or playing with small objects needs urgent care.
• Severe allergy: breathing difficulty with swelling, hives, vomiting, collapse, or sudden widespread symptoms can be an emergency.

Clinical assessment is needed to determine the cause. Do not use this guide to decide that a serious illness has been excluded.

Safe immediate principles

• Keep the child as calm as possible. Crying and agitation can make breathing look and feel harder.
• Allow a comfortable upright position. Do not force the child to lie flat if this worsens breathing.
• Avoid smoke, vaping, incense smoke, mosquito-coil smoke, strong fumes, and dusty air.
• Observe colour, alertness, feeding or drinking, and whether the child can speak, cry or interact normally.
• If breathing seems severe, worsening, or frightening, arrange urgent medical help rather than watching at home.

Emergency warning signs

A checklist cannot prove a child is safe. If the child looks very unwell, is worsening, or you feel something is seriously wrong, seek urgent care.

When urgent same-day assessment is needed

• Breathing is faster or harder than usual and not settling.
• There is wheeze, noisy breathing, chest indrawing, fever with breathing difficulty, or poor feeding.
• The child has a known lung, heart, immune, or neuromuscular condition.
• A young baby has cough, fever, feeding difficulty, pauses, or any breathing concern.
• Symptoms are getting worse after initially seeming like a mild cold.

When to contact the child's paediatrician

• Breathing symptoms are mild but recurring, lasting longer than expected, or affecting sleep, feeding, school, or play.
• The child has repeated wheeze, night cough, exercise-related breathlessness, or needs an asthma/wheeze review.
• You are unsure whether symptoms need urgent care.
• The child has recently been seen but is not improving as advised.

What parents should not do

• If the child has a current written asthma, wheeze or allergy emergency plan, follow that plan exactly.
• Do not start, borrow, share or repeat inhalers, nebuliser medicines, steroids, antibiotics or cough medicines outside the child's current plan or current medical advice.
• Do not force food, drink, throat inspection, or lying flat when a child is struggling to breathe.
• Do not use steam inhalation or hot-water treatments for breathing difficulty.
• Do not delay emergency assessment while searching online if breathing is severe or worsening.

Medical disclaimer

References

1. National Health Mission, Ministry of Health and Family Welfare. FIMNCI Chart Booklet English 2023. https://www.nhm.gov.in/index4.php?lang=1&level=0&lid=830&linkid=526
2. National Health Mission, Ministry of Health and Family Welfare. IMNCI Chart Booklet Medical Officer 2023. https://www.nhm.gov.in/index4.php?lang=1&level=0&lid=830&linkid=526
3. Indian Academy of Pediatrics. Standard Treatment Guidelines 10: Croup in Children. 2022. https://iapindia.org/pdf/Ch-010-croup-in-children.pdf
4. Indian Academy of Pediatrics. Standard Treatment Guidelines 11: Community-Acquired Pneumonia. 2022. https://iapindia.org/pdf/Ch-011-Community-Acquired-Pneumonia.pdf
5. Indian Academy of Pediatrics. Standard Treatment Guidelines 27: Bronchiolitis. 2022. https://iapindia.org/pdf/Ch-027-STG-Bronchiolitis.pdf
6. Indian Academy of Pediatrics. Standard Treatment Guidelines 35: Bronchial Asthma. 2022. https://iapindia.org/pdf/Ch-035-STG-bronchial-asthma.pdf
7. World Health Organization. Guideline on management of pneumonia and diarrhoea in children up to 10 years of age. 31 December 2024. https://www.who.int/publications/i/item/9789240103412
8. Royal Children's Hospital Melbourne. Kids Health Info: Croup. Reviewed May 2025. https://www.rch.org.au/kidsinfo/fact_sheets/Croup/
9. Royal Children's Hospital Melbourne. Kids Health Info: Bronchiolitis. Reviewed July 2025. https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/
10. NICE. Bronchiolitis in children: diagnosis and management, NG9. Last updated 9 August 2021. https://www.nice.org.uk/guidance/ng9