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How to assess breathing difficulties in children

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 3 minutes read

It can feel scary when your child is having breathing problems, and difficult to know when to wait and see, and when to know that they are really struggling. Let’s talk you through the tell-tale signs doctors look for that indicate a child’s breathing is a concern.

Signs your child is struggling to get air in include a grunting sound or nodding their head with each breath, if they flare their nostrils or purse their lips to breathe.

You might notice the muscles under their ribs are being sucked inwards, or their tummy goes out to help them draw air in.

Signs of life-threatening difficulty are any episodes where they stop breathing for 20 seconds or longer, they become pale or blue around the lips, or they have a seizure or become unresponsive. They may be breathing very fast, but it is also important if they start looking very tired from the work of breathing.

How can I check how fast they are breathing?

If your child starts breathing fast, this might be one of the first signs that they are unwell. The best thing to do is to count the number of breaths they take in one minute to decide if the rate is too fast. You’ll need to uncover their whole chest and belly.

From newborn to 5 months old, you would expect less than 60 breaths a minute.

An infant aged 6 to 12 months should be taking no more than 50 breaths a minute.

A toddler aged 1 to 5 years should be taking no more than 40 breaths a minute.

Children aged over 6 years should be taking no more than 30 breaths a minute.

Older teenagers should have a breathing rate closer to that of an adult, less than 20 breaths a minute.

What do I do if my child has breathing problems?

A breathing rate faster than those discussed is a reason to call an ambulance immediately by dialing 911. Difficulty breathing and lack of oxygen can have life-threatening consequences and so needs to be managed immediately.

If you feel they are on the border of these signs, you can call your doctor for an urgent appointment, or you can take them to the nearest emergency department for assessment.

What causes sudden breathing difficulties in a child?

Difficulty in breathing most often results from congestion, infection, or inflammation in the airways or lungs. This includes the upper airways, the nose and throat, so a cold can cause breathing difficulties, but deeper viral infections like bronchiolitis, croup, flu, or bacterial infections like pneumonia in the lungs can be more severe.

Asthma can cause a sudden deterioration in breathing, as can severe allergic reactions or anaphylaxis. Children inhaling or swallowing a foreign body can also cause these rapid changes.

Breathing difficulties can relate to general illness, such as a urinary tract infection, meningitis, sepsis, or Type 1 diabetes. In these cases – where you can’t see an obvious respiratory cause, or you have other concerns – this can be a serious sign of illness, so make sure you seek urgent help.

Is there anything I can do to prevent this from happening?

It’s very difficult to prevent these from happening as viruses and bacteria can spread easily and quickly, especially among children, and they are part of them building up their immunity. It is important, as always, to maintain good hygiene – making sure children wash their hands regularly and dispose of used tissues appropriately.

If your child has a diagnosis of asthma or allergies, it’s important to avoid any known allergens and keep up with any asthma checks with their doctor or nurse. They should always carry their medication with them – their inhaler or EpiPen – and make sure their school or any babysitters or family members looking after them are trained to use these.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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