Health Library Respiratory Problems, Age 11 and YoungerFrom Healthwise

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 105 °F (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.
• 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 indicate 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 or Influenza.

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 hospitalization for treatment. For more information, see the topics Acute Bronchitis and Pneumonia.

Severe acute respiratory syndrome (SARS) is caused by a type of coronavirus, a family of viruses that often cause mild to moderate upper respiratory illness, such as the common cold. For more information, see the topic Severe Acute Respiratory Syndrome (SARS).

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 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

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.

Asthma

Babies and small children usually do not have asthma. However, 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 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.

Review the Emergencies and Check Your Symptoms sections to determine if and when your child needs to see his or her doctor.

• Breathing problems occur, such as:
  • Severe difficulty breathing.
  • Breathing stops for longer than 10 to 20 seconds. Note: If breathing has stopped, after calling 911 or other emergency services, begin rescue breathing. Go to the topic Dealing With Emergencies to see Rescue Breathing.
  • Difficulty breathing and choking on an object in the windpipe. Note: If choking is present, go to the topic Choking Rescue Procedure. For babies under 1 year of age, use back blows rather than the Heimlich maneuver. Do not perform the Heimlich maneuver if the child is still coughing or able to speak.
  • Wheezing that lasts for longer than 1 hour in a baby younger than 3 months old who appears sick
• Gray, mottled, or blue skin is present in the fingernail beds, lips, or earlobes.
• Drooling with trouble breathing occurs, or the child is not able to cry or make sounds. This can be caused by epiglottitis.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your child's symptoms.

If your child has any of the following symptoms, evaluate those symptoms first.

• Suspected allergic reaction (other than from a bite or sting): Go to the topic Allergic Reaction.
• Swallowed or inhaled an object: Go to the topic Swallowed Objects.
• Bite or sting: Go to the most closely related topic:
  • Insect Bites and Stings and Spider Bites
  • Tick Bites
  • Snake and Lizard Bites
• A respiratory problem after surgery: Go to the topic Postoperative Problems.

	Yes	Does your child have a cough?
When to See a Doctor See significance of a cough if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Do coughing spasms cause your child to turn blue or purple, but his or her color returns to normal when coughing stops? Yes Does your baby younger than age 3 months have spasms that cause vomiting after coughing spells? Yes Does your baby younger than age 3 months seem more sleepy than usual? Yes Is your child coughing up bloody sputum (mucus from the lungs with more than just an occasional streak of blood)? Yes Does your child make a harsh, high-pitched sound when he or she breathes in (stridor)? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your baby younger than age 3 months have a cough and a change in eating habits? Yes Has your child older than age 3 months had several spasms that caused vomiting after coughing spells? Yes Does your child have a barking cough with signs of mild difficulty breathing? Yes Does your child have an occasional streak of blood in his or her sputum (bloody mucus from the lungs, not bleeding from the nose or the back of the throat)? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Has your baby younger than age 3 months had a cough for longer than 24 hours? Yes Has your child had a barking cough for 24 hours or longer but does not have other signs of difficulty breathing? Yes Has your child had a productive cough for longer than 24 hours? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Has your child older than age 3 months had a cough for longer than 3 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have any signs of mild to moderate difficulty breathing?
When to See a Doctor See significance of mild to moderate difficulty breathing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have to stop to catch his or her breath while eating? Yes Does your child have to use his or her abdominal muscles to breathe? Yes Are your child's face, hands, or feet pale to slightly gray or mottled (but the tongue, gums, and lips remain pink)? Yes Is your child drooling and cannot swallow? Yes Does your child have a sore throat with a hoarse or muffled voice, or a feeling of swelling in his or her throat? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Is your child breathing more rapidly than normal? Yes Does your child sometimes have to stop to catch his or her breath while eating? Yes Does your child sometimes use his or her abdominal muscles to breathe? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have a fever?
When to See a Doctor See significance of fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Note: For information about taking accurate temperatures in babies and children, see the topic Body Temperature. If your child has a fever with signs of a serious illness, go to the topic Fever, Age 3 and Younger or Fever, Age 4 and Older. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your baby younger than age 3 months have a temperature of 100.4 °F (38 °C) or higher? Yes Do you think your baby younger than age 3 months has a fever, but you are unable to measure his or her temperature? Yes Does your child older than age 3 months have a temperature of 105 °F (41 °C) or higher? Yes Do you think your child older than age 3 months has a high fever, but you are unable to measure his or her temperature? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child have a fever and a health problem that may put him or her at higher risk of having a serious problem? Yes Does your child have a temperature higher than 102 °F (39 °C) that has not come down after 12 hours of home treatment and medicine? Yes Do you think your child older than age 3 months has a moderate fever, but you are unable to measure his or her temperature? Yes Does your child have a recurrent or ongoing fever without an obvious cause after traveling outside your own country in the last 6 weeks? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Does your child have a temperature of 100.4 °F (38 °C) or higher that has not come down after 24 hours of home treatment and medicine? Yes Do you think your child has had a mild fever for 24 hours or longer, but you are unable to measure his or her temperature? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your child making a high-pitched noise when breathing (wheezing)?
When to See a Doctor See significance of wheezing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have new wheezing after a choking episode? Yes Does your child have new wheezing with moderate difficulty breathing? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child have wheezing, a cough, and a fever? Yes Is your child's wheezing becoming worse despite using treatment recommended by a doctor? Yes Has your baby age 3 months or younger had new wheezing for longer than 1 hour without other symptoms? Yes Does your child have new wheezing with mild difficulty breathing? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your child's wheezing occur without other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your child's symptoms may be caused by a medicine?
When to See a Doctor See significance of a medicine if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Did your child's difficulty breathing begin after taking a medicine? Call your child's health professional today if you answer "Yes" to the following question. Yes Did your child's symptoms begin after taking a medicine? Note: Call the doctor who prescribed the medicine the same day (before the next dose) to determine whether your child should stop taking the medicine or take a different one. An appointment may not be necessary. If your child is taking a nonprescription medicine, do not give your child another dose. If you feel your child needs to continue taking the medicine, call your child's doctor. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your child taking an antibiotic for an infection and his or her symptoms have not improved or new symptoms have developed?
When to See a Doctor See significance of symptoms that do not improve with antibiotic treatment if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional today if you answer "Yes" to any of the following questions. Note: If you answered Yes to any of the following questions, call your child's doctor to discuss your child's symptoms. An appointment may not be necessary. Yes Have your child's symptoms become worse after 24 hours of antibiotic treatment? Yes Have your child's symptoms not improved after 72 hours of treatment? Yes Has your child developed a rash while taking antibiotics? Yes Has your child developed severe diarrhea? Yes Has your child developed vomiting that limits his or her ability to take the antibiotics as ordered? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have a runny nose?
When to See a Doctor See significance of a runny nose if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Does your child have thick yellow nasal drainage and is acting sicker than you would expect for 24 hours or longer? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Does your baby younger than age 3 months have a runny, stuffy nose that interferes with eating or sleeping? Yes Has your child had thick yellow nasal drainage for 5 to 6 days? Yes Does your child have a runny nose, persistent sneezing, and watery eyes without other cold symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Does your child have any of the following symptoms?

• Sore throat: Go to the topic Sore Throat.
• Possible ear infection: Go to the topic Ear Problems and Injuries, Age 11 and Younger.
• Facial pain: Go to the topic Facial Problems, Noninjury.
• Signs of an eye infection: Go to the topic Pinkeye.
• Sneezing and has watery eyes and a clear runny nose: Go to the topic Allergic Reaction or Allergic Rhinitis.
• Vomiting: Go to the topic Vomiting, Age 3 and Younger or Nausea and Vomiting, Age 4 and Older.

If your child has other symptoms with his or her respiratory symptoms, such as nausea, diarrhea, or dehydration, evaluate those symptoms also.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Most children have 7 to 10 mild upper respiratory infections each year. Your child may feel uncomfortable and have a stuffy nose. The infection is usually better within a week and is usually gone within 14 days.

Home treatment is appropriate for mild symptoms and can help your child feel better.

• Keep the room temperature comfortable for you and your child. A hot, dry environment will increase nasal congestion.
• Raise the head of your baby's bed about 1 in. (2.5 cm) to 2 in. (5 cm) by placing blocks under the crib. Do not raise just the mattress because it may leave a gap for your baby to roll into. Do not raise the head of the bed if your baby is younger than 6 months.
• Prevent dehydration.
  • Let your baby breast-feed more often or give your baby extra bottles. Liquids may help thin the mucus and also reduce fever (if present).
  • Do not awaken your child during naps or at night to take fluids.
  • Do not force your child to take fluids, which may cause your child to vomit.
• Give your child extra cuddling and distraction.
• Let your child get extra rest to fight the infection.
• Put a vaporizer or humidifier in your child's room if he or she is breathing through the mouth.
  • Warm or cool mist may help your child feel more comfortable by soothing the swollen air passages. It may also help with your child's hoarseness. But do not let your child's room get uncomfortably cold or very damp.
  • Use a shallow pan of water to provide moisture in the air through evaporation if you do not have a humidifier. Place the pan where no one will trip on it or fall into it.
• If your child has a stuffy nose:
  • Use saline nose drops to help with nasal congestion.
  • Use an aspirating bulb sparingly. It will help reduce nasal drainage if your baby is having difficulty breast-feeding or bottle-feeding or seems to be short of breath. Babies often do not like having their noses suctioned with an aspirating bulb.
  • Do not give your child oral antihistamines or decongestants unless directed to do so by your child's doctor. Antihistamines and decongestants can cause your child to behave differently, making it harder to tell how sick he or she really is. Studies show that over-the-counter cough medicines do not work very well. And some of these medicines can cause problems if you use too much of them. It is important to use medicines correctly and to keep them out of the reach of children to prevent accidental use.
  • If your child's doctor prescribes decongestant nose drops for your child's stuffy nose, put 1 or 2 drops in one side of the nose only.
    • Use only when needed, such as before feeding or sleep.
    • Alternate the side of the nose that you put the drops in.
    • Don't use nose drops for longer than 3 days.
    • Don't share the nose drops with other members of the family.
• Honey or lemon juice in hot water or tea may help a dry cough. Do not give honey to a child younger than 1 year old. It may have bacteria that are harmful to babies.
• If your child has a barking cough during the night, you can help him or her breathe better by following the home treatment for a barking cough.
• Do not give your child leftover antibiotics or antibiotics or other medicines prescribed for someone else.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment:

• Difficulty breathing develops, such as:
  • Shallow, rapid breathing.
  • Flaring nostrils.
  • Using the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
  • Sitting up or leaning forward to breathe.
  • Pale, gray, bluish, or mottled skin.
• Increased drooling develops.
• Persistent thick yellow mucus develops. Persistent yellow mucus may be caused by a secondary infection, such as sinusitis or an ear infection.
• Cough gets worse or a persistent cough develops.
• A sore throat lasts for longer than 2 to 3 days. A sore throat that improves as the day goes on is commonly caused by dryness from breathing through the mouth or drainage down the back of the throat during sleep.
• Signs of an ear infection develop, such as pulling at the ears, crying when sucking, unable to sleep lying down, or being extremely fussy.
• Cold symptoms last longer than 14 days.
• Symptoms become more severe or frequent.

It is common for children to develop respiratory problems (such as viral infections) because they are often exposed to other people who have infections and have not built up immunity. There is no sure way to prevent many respiratory illnesses in babies and children. Very young babies are at greater risk for developing complications from respiratory illnesses, so it is important to do what you can to protect them from exposure. The following may help reduce your child's risk for respiratory problems:

• If you have a respiratory infection, such as a cold or the flu, or if you are caring for someone with a respiratory infection, wash your hands before caring for your child. Hand-washing eliminates the germs on your hands and the spread of germs to your child when you touch your child or touch an object he or she might touch.
• If your child goes to a day care center, ask the staff to wash their hands often to prevent the spread of infection.
• Make sure that your child gets all of his or her vaccinations, especially for diphtheria, tetanus, and pertussis (DTaP) and for Haemophilus influenzae type b (Hib). For more information, see the topic Immunizations.
• Breast-feed your baby for at least the first 6 months after birth, if possible. Breast-fed children develop fewer respiratory problems than those who are not breast-fed.
• If one of your children is sick, separate him or her from other children in the home, if possible. Put the child in a room alone to sleep.
• Do not smoke or use other tobacco products. If you smoke, quit. If you cannot quit, do not smoke in the house or car. Secondhand smoke irritates the mucous membranes in your child's nose, sinuses, and lungs and increases his or her risk for respiratory infections.
• Avoid giving young children food or objects that may be improperly swallowed and inhaled, such as nuts, popcorn, small candies, or small toys. An inhaled object can lead to a respiratory infection. For more information, see the topic Swallowed Objects.
• For information on preventing allergies or asthma, see the topic Allergic Rhinitis or Asthma in Children.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your child's doctor diagnose and treat your child's condition by being prepared to answer the following questions:

• Did the symptoms start as a cold but now appear to be worse than you would expect from a cold?
• What home treatment have you tried? Did it help?
• What nonprescription medicines have you used? Did they help?
• What prescription and nonprescription medicines does your child take?
• Does your child seem to have any symptoms that indicate an infection in one area, such as pain in one ear?
• Has your child had any other recent illnesses?
• Does another member of your family have similar symptoms?
• Has your child been eating, sleeping, and playing normally?
• Have you, your child, or another member of your family recently traveled, either inside or outside of the country?
• Does your child have any health risks?

• Acute Bronchitis
• Allergic Rhinitis
• Asthma in Children
• Body Temperature
• Choking Rescue Procedure (Heimlich Maneuver)
• Coughs
• Croup
• Crying, Age 3 and Younger
• Cystic Fibrosis
• Ear Infections
• Ear Problems and Injuries, Age 11 and Younger
• Ear Problems and Injuries, Age 12 and Older
• Facial Problems, Noninjury
• Fever, Age 3 and Younger
• Fever, Age 4 and Older
• Immunizations
• Influenza
• Nausea and Vomiting, Age 4 and Older
• Pinkeye
• Pneumonia
• Respiratory Syncytial Virus (RSV) Infection
• Sore Throat
• Strep Throat
• Tuberculosis (TB)
• Vomiting, Age 3 and Younger

Author:	Jan Nissl, RN, BS	Last Updated: February 25, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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