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Breathing difficulties

Breathing difficulties

Most babies and older children have several mild infections of the respiratory system each year.

Upper respiratory system

The upper respiratory system includes the nose, mouth, sinuses, and throat. A child with an upper respiratory infection may feel uncomfortable and sound very congested. Other symptoms of an upper respiratory infection include:

  • A runny or stuffy nose. This may lead to blockage of the nasal passages, causing the child to breathe through his or her mouth.
  • Irritability, restlessness, poor appetite, and decreased activity level.
  • Coughing, especially when lying down.
  • Fever that occurs suddenly and may reach 41°C.

Lower respiratory system

The lower respiratory system includes the bronchial tubes and lungs. Respiratory problems are less common in the lower respiratory system than in the upper respiratory system.

Symptoms of a lower respiratory (bronchial tubes and lungs) problem usually are more severe than symptoms of an upper respiratory (mouth, nose, sinuses, and throat) problem. A child with a lower respiratory problem is more likely to require a visit to a doctor than a child with an upper respiratory problem.

Symptoms of lower respiratory system infections include:

  • Shallow coughing, which continues throughout the day and night.
  • Fever, which may be high with some lower respiratory system infections, such as pneumonia.
  • Irritability, restlessness, poor appetite, and decreased activity level.
  • Difficulty breathing. You may notice:
    • Rapid breathing.
    • Grunting, which is heard during the breathing out (exhaling) phase of breathing. Most babies grunt occasionally when they sleep. But grunting that occurs with rapid, shallow breathing may mean lower respiratory system infection.
    • Wheezing (which is a different sound than croup).
    • Flaring the nostrils and using the neck, chest, and abdominal muscles to breathe, causing a “sucking in” between or under the ribs ( retractions).

Respiratory problems may have many causes.

Viral infections

Viral infections cause most upper respiratory infections. Sore throats, colds, croup, and influenza (flu) are common viral illnesses in babies and older children. These infections are usually mild and go away in 4 to 10 days, but they can sometimes be severe. For more information, see the topics Croup and Influenza (Seasonal Flu).

Home treatment can help relieve the child’s symptoms. The infection usually improves on its own within a week and is gone within 14 days.

Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes your child to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.

Viral lower respiratory system infections may be mild, similar to upper respiratory system infections. An example of a possibly serious viral infection is bronchiolitis. Up to 10% of babies and children with viral infections of the lower respiratory system, such as those caused by respiratory syncytial virus (RSV), may develop severe blockage of the air passages and require hospitalisation for treatment. For more information, see the topics Acute BronchitisPneumonia, and Respiratory Syncytial Virus (RSV) Infection.

Bacterial infections

The most common sites for bacterial infections in the upper respiratory system are the sinuses and throat. A sinus infection is an example of an upper respiratory bacterial infection.

Bacterial pneumonia may follow a viral illness as a secondary infection or appear as the first sign of a lower respiratory infection. In babies and small children, the first sign of infection often is rapid breathing, irritability, decreased activity, and poor feeding. Antibiotics are effective against bacterial infections.

Tuberculosis is a less common bacterial infection of the lower respiratory system.


Allergies are a common cause of respiratory problems. Allergy symptoms in children include:

  • Clear, runny drainage from the nose or a stuffy nose. Children often rub their noses by pushing the tip upward with the palm of the hand (“allergic salute”).
  • Sneezing and watery eyes. Often there are dark circles under the eyes (“allergic shiners”).
  • Irritability and loss of appetite.


Babies and small children usually do not have asthma. But the number of new cases of asthma increases with age.

  • In babies and small children, a hacking cough may be the only symptom of mild asthma.
  • If asthma worsens, symptoms may include wheezing and shortness of breath after exercise or at nighttime.
  • In severe asthma, difficulty breathing (using the neck, chest, and abdominal muscles to breathe) and a high-pitched sound when breathing (wheezing) are the most common symptoms.
  • Allergies and asthma often occur together. For more information, see the topic Asthma in Children.

Other causes

Besides asthma, allergies, and infection, other possible causes of respiratory problems in children include:

  • Exposure to cigarette smoke. Tobacco smoke impairs lung growth and development. Children who are exposed to tobacco smoke, even before birth (prenatal), are more likely to have asthma and other respiratory problems.
  • Blockage of the airway by an inhaled object, such as food, a piece of a balloon, or a small toy. For more information, see the topic Swallowed or Inhaled Objects.
  • Problems that have been present from birth (genetic causes), such as cystic fibrosis.

Babies and children younger than age 3 may have more symptoms with respiratory problems than older children, and they may become more ill. For this reason, younger children need to be watched more closely. The type and severity of the symptoms helps determine whether your child needs to see a doctor.

Check your child’s symptoms to decide if and when your child should see a doctor.

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