Breathing difficulties in children

Breathing difficulties in children can be caused by:

• viral infections such as bronchiolitis, croup, COVID-19 or pneumonia 
• bacterial infections such as tonsillitis, epiglottitis or pneumonia
• chronic conditions such as asthma
• allergies or anaphylaxis
• exposure to tobacco or other smoke
• exposure to harmful gases
• blockage of airways by inhaled object, eg, choking on food or any small objects
• uncommon inborn genetic conditions such as cystic fibrosis.

Your child might be struggling to breathe if they have any of the following symptoms:

• shortness of breath or breathing faster than usual
• making extra noises while breathing in or out 
• runny nose, stuffy nose, blocked nose or sneezing
• worsening cough 
• producing phlegm, which can be white, yellow or green in colour.

Depending on the cause of your child's breathing difficulty, they may also have other symptoms such as fever, reduced feeding or appetite, or aches and pains.

Younger children may not tell you that they're struggling to breathe, so it's important you recognise signs that show they're having breathing difficulties. 

Signs that your baby is struggling to breathe:

• breathing fast
• sucking or pulling in under their ribcage (subcostal retraction)
• sucking or pulling in between each rib (intercostal retraction)
• their head is bobbing up and down as the muscles around their neck are working hard during breathing
• their nostrils move out as they breathe (flaring of the nostrils)
• they are making extra noises when breathing in or out or both.

Signs that your child is struggling to breathe

• breathing fast
• sucking or pulling in under their ribcage (subcostal retraction)
• sucking or pulling in between each rib (intercostal retraction)
• is using the muscles around the neck during breathing
• their nostrils move out as they breathe (flaring of the nostrils)
• they make extra noises when breathing in or out or both 
• they are so breathless that they can only speak a few words at a time. 

If you notice the above signs and symptoms, your child is struggling to breathe. You should take your child to see your healthcare provider. You should also see your healthcare provider if you are worried about your child. If you are unsure what to do, call Healthline on 0800 611 116 or PlunketLine 0800 933 922 to ask for advice. These are free services.

Signs that they need urgent help

Go to the nearest emergency department immediately or call 111 for an ambulance if your baby or child has any of the following symptoms: 

• your baby or child looks blue, or has blue lips or tongue
• your baby or child is agitated or very drowsy 
• your baby or child is floppy and very tired
• your baby or child is becoming less responsive
• your baby has pauses in their breathing
• your older child can only speak 1 or 2 at a time words and is very breathless. 

Apps reviewed by Healthify

You may find it useful to look at some first aid and emergency apps, asthma apps, and breathing apps.

There are 3 types of noises that your baby or child can make when they are struggling to breathe – wheeze, stridor or grunting. 

Wheeze

Wheezing is a musical, whistling sound that children make when breathing out. It can also happen when they breathe in. The sound comes from their chest, not from their nose or throat. It can happen if your child has a condition like bronchiolitis, asthma or viral wheeze.

Stridor

Stridor is a harsh, high-pitched noise your child might make when breathing in. It can happen if your child has a condition such as croup.

The following video is of a baby in hospital with breathing problems.

Video: Baby with stridor

(Kids Health, NZ, 2021)

Grunting 

A grunt, moan or a short sigh is a noise your child might make when breathing out. It can happen if your child has a condition such as pneumonia.

Video: Example of wheezing, grunting, and squeaking in infant in respiratory distress

(Rhiannon Giles, US, 2018)

More videos can be seen on the Physio-pedia website(external link).