Seeing your child struggle to breathe can be scary. Whether symptoms come on all at once or get worse over time, you may not know what to do.
Some breathing problems are mild and get better with care at home. Others need medical attention right away. Aaron Leetch, MD, a pediatric emergency medicine specialist with Banner - University Medicine, explained more about what to watch for and when and where to get help.
What “trouble breathing” can look like
“Trouble breathing varies depending on the age, but a common theme is that breathing seems to take effort. Normally, we breathe without even thinking about it. When there is a problem or an illness, a child will put effort into breathing, often using extra muscles like their stomach or neck muscles,” Dr. Leetch said.
Signs may include:
- Fast breathing or breathing that looks hard or labored
- Using their whole body to breathe, with their head and shoulders bobbing as they try to take in air
- Wheezing, grunting or high-pitched breathing sounds
- Skin in the chest, neck, collarbone area or between the ribs pulling in with each breath, called retractions
- Flaring nostrils
- Trouble talking, crying or feeding
- Pale, blue or gray color around the lips or fingernails
- Extreme tiredness or difficulty staying awake
If your child looks like they’re working hard to breathe, it’s important to act quickly.
Common reasons children struggle to breathe
There are a few different things that could make it hard for a child to breathe.
Infections
Respiratory infections are one of the most common causes. “Viral infections can cause swelling in the small airways somewhere between the nose and the lungs, which makes it harder for air to get in and out,” Dr. Leetch said.
These infections can include:
Asthma or reactive airway disease
Asthma can cause wheezing, coughing and chest tightness, especially with colds, exercise or allergens.
Allergic reactions
A severe allergic reaction can cause swelling of the lips or throat, hives and sudden trouble breathing. This is a medical emergency.
Choking or foreign objects
If breathing trouble starts suddenly, choking on something like food or a coin may be why. This is more common in toddlers and young children.
Other causes
“Eating something that’s toxic and untreated or undiagnosed diabetes can both cause breathing trouble but without the retractions,” Dr, Leetch said.
How to help a child who is struggling to breathe
If your child is having trouble breathing but it’s not an emergency, here’s what to do:
- Stay as calm as you can
- Help your child sit upright
- Loosen any tight clothing
- Use prescribed inhalers or breathing treatments, but do not give new medications unless a health care provider tells you to
- Remove triggers like smoke, pets or strong scents if you can
If your child has heavy, labored, whole body breathing, you can try to clear their nose with suction. Use a few drops of saline or water and nasal aspirator like a NoseFrida to try to suction the mucus from the child’s nose.
“A little bit of suctioning can do wonders for difficulty breathing. Your child will probably cry but suction will not hurt them and the crying will often help to clear more mucus out,” Dr. Leetch said. If suctioning at home doesn’t help, you can bring them to the ER for evaluation.
If a virus is behind your child’s breathing problems, the illness will probably get worse between days two and five. Make sure your child blows their nose often and drinks plenty of water. “These are the best ways to keep your child well enough to stay out of the hospital and fight the infection on their own,” Dr. Leetch said.
You can bring your child to the ER if they are not drinking well, not having enough wet diapers or you are worried about dehydration.
You can also bring your child to the ER if you’re concerned about a cough that you think is affecting breathing. But keep in mind that when a child is sick, coughing is good. “Many parents come to the ER because they are afraid that a cough sounds bad. The cough that comes from your lungs is the body’s protective mechanism to get rid of the infection and mucus from your lungs to make you better,” Dr. Leetch said.
When to call your child’s provider
“If you notice that your child has a bad cough or retractions around their chest or neck but they are active, playful and happy, you can make an appointment with your doctor,” Dr. Leetch said.
Contact your child’s provider if:
- Symptoms are mild but aren’t going away
- Breathing seems worse with activity or at night
- Your child has asthma and symptoms are getting worse
- You’re not sure if you should go to urgent care or the ER
Your provider can recommend the next steps you should take.
When to go to the ER
Sometimes, when a child can’t breathe, it’s an emergency. Call 911 right away if your child:
- Is unresponsive
- Is struggling to breathe or gasping for air
- Has blue or gray lips, face or fingernails
- Can’t speak, cry or feed because of breathing trouble
- Has severe chest or neck pulling with breaths
- Becomes very drowsy or hard to wake
- Has sudden breathing trouble after choking or an allergic reaction
- Is choking and cannot speak or cry
- Is not improving with prescribed rescue medications
You may need to perform CPR. “We strongly recommend that all parents learn CPR but, in an emergency, a 911 operator can walk you through the steps,” Dr. Leetch said.
“If your child is choking, you can give back blows between the shoulder blades or press on the breastbone to use the air in your child’s lungs to blow the obstruction free. Do not stick your finger in their mouth to grab the object, as this is more likely to push it further in,” Dr. Leetch said.
Trust your instincts. If something feels wrong, it’s always okay to get emergency care.
What to expect at the emergency room
When you arrive, the ER staff will evaluate your child and check their breathing, oxygen levels and heart rate. Depending on symptoms, your child may get:
- Suctioning
- Oxygen
- Breathing treatments for asthma or croup
- Medications to reduce inflammation, like steroids
- Antibiotics to treat an infection
- Fluids
- Monitoring
- X-rays, in some cases
Some children get better quickly and can go home. Others may need observation or admission to the hospital for care. The goal is always to help your child breathe more comfortably and safely.
The bottom line
Breathing problems can be scary but knowing what to watch for can help you take the right action. Never ignore signs of breathing distress and don’t wait to seek care.
If your child needs emergency care, Banner Children’s emergency teams are trained to quickly evaluate and treat breathing concerns in babies, children and teens.
