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Trouble Breathing


  • Trouble breathing means working hard to breathe
  • The medical name is respiratory distress
  • Normal breathing should be easy and quiet

Trouble Breathing: Symptoms

Trouble breathing is a reason to see a doctor right away. Here are symptoms to watch for:

  • Struggling for each breath or short of breath.
  • Tight breathing so that your child can barely speak or cry.
  • Ribs are pulling in with each breath (called retractions).
  • Breathing has become noisy (such as wheezing).
  • Breathing is much faster than normal.
  • Lips or face turn a blue color.

Trouble Breathing: Importance

  • Trouble breathing is the most common type of pediatric emergency.
  • Trouble breathing is the most common reason for getting admitted to the hospital.
  • Many of these children need oxygen.
  • The first year of life is the most dangerous time to have trouble breathing. Reason: lung infections cause swelling of the airways. Babies have narrow airways to begin with. Small airways can close off quickly.

Causes of Trouble Breathing

Trouble breathing comes from problems in the lower throat, voice box, windpipe, or lung airways. Here are the common ones:

  • Anaphylaxis (severe allergic reaction). Suspect when there is a sudden onset of trouble breathing and widespread hives. Common causes are bee stings or food allergies such as peanuts.
  • Asthma. Symptoms of an asthma attack are wheezing, a cough, and trouble breathing.
  • Bronchiolitis. A viral infection of the smallest airways in the lungs. Wheezing during the first 2 years of life is often caused by bronchiolitis. Main symptoms are fast breathing and wheezing.
  • Croup. A viral infection of the voice box and windpipe. Main symptoms are a barky cough and hoarse voice. Some children with severe croup get a harsh, tight sound while breathing in. This is called stridor.
  • Foreign Object in Airway. Suspect when there is a sudden onset of coughing and choking. Common objects are peanuts and seeds. Peak age is 1 to 4 years.
  • Influenza. Main symptoms are a fever with a runny nose, sore throat, and bad cough. The flu virus can also cause complications such as pneumonia. Vaccine may prevent the disease.
  • Pneumonia. An infection of the part of the lungs that supplies oxygen to the blood. Having pneumonia may lower blood oxygen levels and cause trouble breathing. Many bacterial causes can be prevented by vaccine.
  • Whooping Cough. A bacterial infection of the airway. Main symptoms are long coughing spells and choking. Very serious in infants. Can be prevented by vaccine.

Vaping and Lung Damage

  • Talk with your teen about the dangers of vaping.
  • Vaping can cause severe lung damage. It can become permanent.
  • Vaping can even cause death (50 in the US in 2019).
  • Vaping tobacco also causes nicotine addiction.
  • For these reasons, the legal age to purchase vaping products is 21 in the US.
  • Encourage your teen to not start vaping or to give it up.
  • Warning: home-made or street-purchased vaping solutions are the most dangerous.

When To Call

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out or stopped breathing
  • Lips or face are bluish when not coughing
  • Choked on a small object that could be caught in the throat
  • Trouble breathing started suddenly after bee sting, new medicine or an allergic food
  • You think your child has a life-threatening emergency

Go to ER Now

  • Age less than 1 year with trouble breathing
  • Ribs are pulling in with each breath (called retractions)
  • Trouble breathing and loud wheezing (tight sound with breathing out)
  • Trouble breathing and stridor (harsh sound with breathing in)

Call Doctor or Seek Care Now

  • Soft wheezing (tight sound with breathing out)
  • Breathing is much faster than normal
  • All less severe trouble breathing
  • Lips or face have turned bluish during coughing
  • Nonstop coughing and not able to sleep or do normal activity
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Care Advice

What You Should Know About Trouble Breathing:

  • Children with trouble breathing need to be seen now.
  • The causes of trouble breathing are often serious.
  • In young children, trouble breathing can get worse quickly.
  • Many of these children need oxygen.
  • Sometimes, you might not be sure if your child is having trouble breathing. If you are worried, call your child's doctor now.
  • Here is some care advice that may help until you talk with your doctor.

Coughing Fits or Spells:

  • Breathe warm mist (such as with shower running in a closed bathroom).
  • Reason: relax the airway and loosen up any phlegm.

Nasal Saline to Open a Blocked Nose:

  • Your baby can't breastfeed or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus.
  • Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. If less than 1 year old, use bottled water or boiled tap water that has cooled.
  • Step 1: put 3 drops in each nostril. If age less than 1 year old, use 1 drop.
  • Step 2: suction each nostril out while closing off the other nostril. Then, do the other side.
  • Step 3: repeat nose drops and suctioning until the discharge is clear.
  • How often: do saline nose drops when your child can't breathe through the nose. Limit: no more than 4 times per day.
  • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.

Avoid Tobacco Smoke:

  • Tobacco smoke makes coughing and trouble breathing much worse.

Go to the ER Now If:

  • You have not heard back from a doctor or nurse within 30 minutes after placing your call
  • Ribs start pulling in with each breath (retractions)
  • Wheezing becomes loud or tight
  • Trouble breathing gets worse


Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
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