Respiratory Distress – When Your Child Can’t Breathe

As the weather turns colder, the number of children we see with respiratory infections rises. Pediatric medicine is very cyclical – we see large amounts of well-child-checkups in the summer, then after a brief lull we start to see large numbers of cough, cold symptoms, and other respiratory infections. Right now we are definitely seeing an uptick in respiratory illnesses. These visits can range from very mild, otherwise well-appearing children to those in significant respiratory distress. 

“Respiratory distress” is a medical description for breathing problems or difficulty breathing. It indicates a child who is in significant discomfort in regards to breathing (respiration). It is typically caused by infections but can also be related to other chronic illnesses or to a blockage in the airway (inhaled foreign body, such as a peanut). When a child has to work harder to breathe, it can mean that there is not enough oxygen getting into the lungs. 

Symptoms

A child in respiratory distress can be very frightening for parents and caregivers. This is not the child who is mouth-breathing because of sinus congestion, or who can’t sleep well due to a cough and may be cranky but is otherwise acting fine. Children in respiratory distress will have one or more of the following symptoms: 

• Increased rate of breathing: breaths will be shallow and fast. Count the number of breaths per minute. Normal rate of breathing in infants is fast at 30-60, but drops to 25-40 after 6 months, and further to 20-30 in toddlers and preschool aged children. Children and teens normally breathe 15-22 times per minute. If your child is breathing much faster than these values, he or she needs to be evaluated right away. 

• Retractions: this indicates increased effort with breathing. Look at the skin around your child’s ribs, collar bones, and abdomen. If it sucks in significantly while your child takes a breath in, he or she needs to be evaluated right away.

• Noisy breathing: listen for abnormal breathing sounds – squeaking, grunting, wheezing, rattling. Pay attention to whether the noises are occurring with breathing in or breathing out (your Pediatrician will ask)

• Nasal flaring: if nostrils widen while breathing in, this can be a sign of increased effort with breathing.

• Color changes: check for bluish discoloration around the lips, eyes, hands, feet. If this is present in your child, he or she needs to be evaluated right away.

• Positional changes: children may change positions to breathe easier. Watch for leaning forwards and bracing on arms (tripod position), tilting head upwards or backwards. 

• Mental status changes: children who have been working hard to breathe for a long time will start to fatigue and be less responsive. These children need to be evaluated right away. 

Causes

As mentioned before, there are several causes of respiratory distress in children, and most of them are related to infection or chronic disease process. Some children will have repeat episodes while many will never encounter respiratory distress at all. 

• Bronchiolitis: one of the most common causes of respiratory distress in infants and toddlers. Bronchiolitis is a viral infection of the small airways of the lungs. I often describe this to parents in this way: think of the lungs as an upside-down tree. The trachea and the large airways are the trunk and the large branches. Then you have the small branches and the leaves – this is where bronchiolitis hits. These small airways and air sacs get filled up with mucous and make it hard for young children to breathe and exchange oxygen effectively. There are many viruses that cause bronchiolitis but the most well known is Respiratory Syncytial Virus, or RSV. I wrote an article about bronchiolitis last winter.

• Asthma: one of the most common causes of respiratory distress in children of all ages is airway constriction caused by a flare up of asthma.  This causes difficulty in breathing air OUT of the lungs, and is recognizable by the wheezing that occurs with expiration. Asthma can flare up with viral colds, sudden weather changes, allergens, and exercise. 

• Croup: croup is a viral infection of the trachea, or large airway in the throat. It causes swelling and narrowing of this airway, which causes difficulty with breathing air IN. It is characterized by a “bark” or “seal-like” cough. When croup worsens, it causes an inspiratory noise called stridor, which is a sharp, gasping noise. Croup symptoms are always worse at night. It is caused by many different upper respiratory viruses. 

• Influenza: the influenza virus is common in the fall and winter months, and causes fever and upper respiratory congestion. It can cause more serious illness and lead to respiratory distress, particularly in infants or those with underlying medical conditions such as asthma or other chronic lung disease. For more information on influenza, see my previous article.

• Pneumonia: this is an infection within the tissue of the lung itself, rather than the airways. It can be caused by viruses or bacteria, and is usually accompanied by fever. It can cause difficulties with getting oxygen from the lungs into the blood. This is either diagnosed through lung exam, chest X-ray, or both. 

• Foreign Body Inhalation: sudden respiratory distress can occur when a young child inhales a piece of food or a toy into the lungs. If you suspect this in your child, he or she needs to be evaluated right away. 

What you should do

If your child is having mild respiratory symptoms – such as nasal congestion, runny nose, cough, watery eyes, throat or ear pain – go to the Pediatrician after a few days if not improving or if worsening. 

If your child seems to worsen quickly, is having persistent fevers along with the mild respiratory symptoms, make an appointment with the Pediatrician or urgent care facility if the Pediatrician is not available. 

If your child is demonstrating any of the symptoms of respiratory distress that were mentioned today, go to the emergency room, or call 911 if you need to. Do not ignore respiratory distress. It can lead to respiratory failure, which is life-threatening. 

Final thoughts

Respiratory symptoms are among the most common complaints in Pediatric visits, seen multiple times per day by providers in the fall and winter months. It is more rare to see respiratory distress in the clinic, but it does happen. A few times every winter our office must call emergency medical services to transport a child to the hospital due to breathing issues. Ideally, we would like to prevent this but respiratory symptoms can progress rapidly in young children. If you have concerns about the way your child is breathing, he or she should be seen by a doctor. Look over the symptoms of respiratory distress again to help you decide whether it is best to go to the Pediatrician’s office or the emergency room. Children are resilient and they compensate well with illness very well, but there often comes a point when they need help to overcome it. 

---

If you enjoyed this post, please sign up below to subscribe for blog emails. You will receive notification when new posts are available. If you do not receive a welcome email upon registering, please check your spam folder.