Recognising Breathing Difficulties in Children

Breathing problems in children can feel very frightening for parents to watch. I have created this video to help you spot the warning signs early and act quickly when needed. Children's breathing changes throughout the day, and having a faster rate during a cold or fever is usually normal. The sign to watch for is how hard your child is working to breathe, rather than the speed alone. Most coughs and colds settle without any difficulty breathing. When breathing does become harder, viral illness is by far the most common cause; and most children recover well at home. A wheeze is a whistling sound, usually heard when your child breathes out - often caused by a viral infection. Most preschool children who wheeze do not have asthma; although a wheeze that returns repeatedly, is worth reviewing. Children under two years of age sometimes develop bronchiolitis - which is a common winter chest infection. This usually starts as a cough and runny nose, with breathing that worsens over two to three days. A different and important sound is stridor, which is a harsh noise heard when your child breathes in. Stridor can be a sign of a narrowed upper airway, as happens in croup; and always needs prompt medical review. Several visible signs can suggest your child is working harder to breathe than usual. These include skin drawing in under the ribs or above the collarbone; head bobbing; or grunting with each breath out. Faster than normal breathing; flaring nostrils; or an inability to speak in full sentences are also significant. In a baby, poor feeding or pauses in breathing are often early and important clues. Colour changes always need urgent attention without any hesitation or delay. Pale, grey, or mottled skin, or a blue tinge around the lips or tongue, requires an immediate 9 9 9 call. Changes in your child's behaviour can be as important as changes to their breathing pattern. Watch for unusual drowsiness; difficulty waking; confusion; floppiness; or extreme agitation that you cannot settle. If you see these warning signs, please call 9 9 9, or go to your nearest emergency department straight away. For less severe breathing concerns - a same-day review by your GP; or paediatrician, is appropriate. If your child has been diagnosed with asthma, and you have a personal action plan, follow it carefully during any flare-up. Also, Salbutamol inhalers should always be used with a spacer in younger children, for best effect. As a paediatric intensive care specialist, I have cared for many children with breathing difficulties. Please contact me or my team if you have further questions; or are concerned about your child's breathing.