Difficulty breathing can occur when a child's lungs or heart are not working well.

Symptoms of mild difficulty breathing

The child:

• Breathes slightly faster than normal. Most healthy children breathe less than 40 times each minute.
• Uses his or her stomach muscles more than normal to help with breathing.
• Has normal skin color in his or her face, hands, and feet.

Symptoms of moderate difficulty breathing

The child:

• Breathes fast.
• Tires during feeding and may stop often to catch his or her breath. This may cause the child to lose interest in food and eat less.
• Needs to use his or her stomach muscles to help with breathing.
• Has pale, slightly gray, or blotchy skin, particularly the face, hands, and feet. The tongue, gums, and lips still look pink.

Symptoms of severe difficulty breathing

The child:

• Breathes very fast or grunts with each breath.
• Looks anxious or exhausted during feeding or is unable to nurse or take a bottle.
• Uses his or her neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
• May flare his or her nostrils when breathing in.
• May need to sit up and lean forward or tilt the nose up as if sniffing the air.
• May fight any attempt to change his or her position.
• Has pale, gray, or bluish skin (especially the tongue, lips, earlobes, and nail beds), or the skin is mottled (patchy pale and blue pattern).

By	Healthwise Staff
Primary Medical Reviewer	David Messenger, MD
Specialist Medical Reviewer	Kathleen Romito, MD - Family Medicine
Last Revised	February 25, 2010