Difficulty breathing — what to look for.
When a child is sick, their breathing can tell you a great deal. Breathing a little faster with a fever or stuffy nose can be normal — but difficult breathing, also called respiratory distress, means your child is working too hard to get air and may need medical attention.
Signs your child may be struggling to breathe
Difficulty breathing in young children shows up in three ways — physical changes, behavioral changes, and changes to skin color. Any combination of these is a signal to act.
Physical signs
- Belly breathing — chest rising and falling rapidly
- Nasal flaring — nostrils widening with each breath
- Retractions — skin pulling in around the ribs, collarbone, or below the ribs when inhaling
- Grunting — a soft sound at the end of each breath out
- Head bobbing — especially common in babies
- Breathing pauses or very irregular breathing
Behavioral signs
- Trouble feeding or drinking — especially in infants
- Not playing, sleeping, or interacting as usual
- Tiredness, limpness, or fussiness out of proportion to the illness
- Looking anxious or panicked when trying to breathe
- Sitting in an unusual position to breathe more easily
How to check for retractions
- Look at your child’s bare chest when they breathe in
- Watch for skin being sucked inward — under the ribs, between the ribs, or at the base of the throat
- The belly should jut outward as the chest rises in infants — this is normal
- The more pulling you see, the harder your child is working to breathe
Pale, bluish, or grey — what it means
Changes in skin, lip, or nail color can be signs your child isn’t getting enough oxygen. These are urgent warning signs that should not be ignored.
Pale
Lips or fingertips look unusually light or washed out — lighter than normal for your child. Often one of the first color changes to appear.
Bluish (Cyanosis)
Lips or nail beds have a faint purple or blue tint, especially around the edges. Most visible inside the lips and at the fingertips.
Grey or ashy
A dull, dusky, or ashy look to the skin, lips, or nail beds. This is a serious sign — seek care immediately.
Where to check
When to call — and when to call 911
The combination of symptoms matters more than any single sign. When in doubt, contact your provider.
Call your pediatrician or go to urgent care
- —Fast breathing plus one or more of the signs above
- —Breathing seems to be getting worse over time
- —Trouble talking, feeding, or drinking
- —Any skin color changes you’re uncertain about
- —Your child seems more tired or unwell than expected
Call 911 immediately
- —Your child is struggling to breathe or gasping
- —Lips, fingertips, or skin are turning blue or grey
- —Your child is unresponsive or very difficult to wake
- —Breathing stops — even briefly
- —You are frightened by what you’re seeing
Check your child’s breathing rate
Use the tool below to count your child’s breaths and check whether their breathing rate is within the normal range for their age. Count when they are calm and resting — not crying or active.
See it. Treat it. Track it.
Capture a 15-second breathing video in MamaBear and share it directly with your provider — no appointment needed.