Respiratory Distress

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Respiratory distress describes symptoms related to breathing problems. There can be many causes of respiratory distress in children. Usually it is caused by infections, chronic illness or a blocked airway. A child who was premature at birth or has been in the hospital for respiratory problems may be at greater risk.

When your child has to work hard to breathe, it can mean he or she is not getting enough oxygen to the lungs or is starting to get an infection.

Signs and symptoms

To know if your child may be in respiratory distress, look for the following signs and symptoms (Picture 1):

  • Pale or bluish skin color - Check around the lips, eyes, hands and feet, especially the nail beds.HHI178_Photo_1
  • Increased breathing rate - Count the number of breaths for one minute. Is your child breathing faster than usual?
  • Retractions - Check to see if the chest pulls in with each breath, especially around the collarbone and around the ribs.
  • Nasal flaring - Check to see if nostrils widen when breathing in.
  • Noisy breathing - Listen for breathing that sounds like grunting
    (“Ugh” sound), wheezing or like mucus is in the throat.
  • Clammy skin – Feel your child's skin to see if it is cool but also sweaty. The head may be sweaty while the skin feels cool or clammy.
  • Mood change – Check to see if your child is sleepier, difficult to wake, fussier than usual, or "just not acting like himself."
  • Change in body position – Your child may change his posture to try to breathe easier, like leaning forward or tilting his head up or backwards.

What to do if your child is in respiratory distress

  • Stay calm and reassure your child
  • Place your child in a comfortable position, usually sitting up.
  • If you think your child has a fever, take his temperature:
    • in baby’s bottom (rectally) if under 4 months
    • under the arm (axillary) if he is older than 4 months
    • in the mouth (oral) if older than 4 years

When to call the doctor

Call the doctor if your child:

  • shows any signs of respiratory distress
  • has a fever
    • rectal temperature is more than 100.4 F or less than 96.5 F if younger than 4 months
    • axillary temperature is more than 103 F, if older than 4 months.
    • oral temperature is more than 102 F for 3 days or more than 104 F, if older than 4 years
  • has a cough and phlegm or drainage is thick and yellow-green colored

Call 911 or take your child to the nearest emergency room if your child’s lips or face turns bluish, if he is working hard to breathe or you think that your child’s life is in danger.

How to prevent respiratory infections

Not all breathing problems can be avoided. You can help prevent many respiratory infections by taking these steps:

  • Do not smoke around your child or in places that he goes, even when he is not there. Children who are around smokers get twice as many respiratory infections and colds as those who do not live with smokers. Smoke residue can build up on surfaces in rooms and in cars.
  • Keep places where your child will be dust-free.
  • Do not use baby powder or cornstarch on your child. These things can irritate a baby's lungs.
  • Everyone should practice good hand washing to prevent the spread of germs.
  • If possible, keep your child away from people who are sick.

Respiratory Distress (PDF)

HH-I-178 11/93, Revised 06/18 | Copyright 1993, Nationwide Children’s Hospital