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Breathing Difficulty in Children: Red Flags Parents Should Know

Recognise increased work of breathing, colour and alertness changes, and act promptly when a child is struggling.

Children's Health · 6 min read

Published · Updated

Editorial note: This article was prepared for this website from the sources listed below. Unless a named clinical reviewer is shown, it has not been attributed to or clinically reviewed by an individual KPMC clinician.

Watch effort, colour and behaviour

Concerning signs include very fast breathing, ribs or the hollow at the neck pulling in, grunting, pauses, inability to speak or feed normally, blue or grey lips, exhaustion, unusual quietness or difficulty waking. Young infants can worsen quickly, and the overall appearance matters more than a single home reading.

Act rather than repeatedly measuring

Keep the child upright and calm where possible and call emergency services for severe signs. Do not delay care to record a video, obtain a temperature or repeat a consumer oxygen reading. Do not give another person's inhaler, antibiotics or cough medicine.

For a child with a diagnosed breathing condition, follow the written action plan and use prescribed medicine with the instructed device and technique. Seek help if the plan is not working.

Give clinicians a clear history

Explain when symptoms began, fever, cough, choking possibility, allergies, known asthma, medicines and fluid intake. Mention premature birth or underlying heart, lung, neurological or immune conditions.

At a glance

Key takeaways

  • Breathing effort, colour and alertness are critical warning signs.
  • Do not rely on a consumer device to rule out serious illness.
  • Use only the child-specific written action plan and prescribed medicines.

When to seek care

  • Call emergency services for blue or grey lips, severe chest recession, pauses in breathing, collapse, inability to speak or feed, or difficulty waking.
  • Get prompt medical advice when breathing is faster or harder than usual, intake falls, or the child is worsening.

General information only. This article does not replace medical advice, diagnosis or treatment. If symptoms are severe or rapidly worsening, seek urgent medical care. In Malaysia, call 999 for an emergency or go to the nearest emergency department.

Source notes

Article sources

  1. NICE NG9: Bronchiolitis in children - diagnosis and management
  2. NHS: Bronchiolitis

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