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Difficult, Noisy, or Labored Breathing


Newborns

A newborn baby breathes 40-60 times a minute, in comparison to 12-20 times a minute for an adult. Newborns also do something called periodic breathing. This is when they breathe fast and shallow (almost like they're panting), followed by several second long pauses in their breathing. This is normal. Only be concerned if your baby is also limp, pale, or blue (which would be very unusual). Newborns also have tiny noses, breathe only through their noses, and don't know how to clear nasal secretions. Many seem like they are always congested, even when they're not sick. If your baby is sleeping and eating comfortably, do nothing. If she is uncomfortable, then try putting a few saline drops in her nose and then suction with a blue bulb syringe. Newborns also sneeze, hiccup, sniffle, and snort (like little piglets)! They also cough occasionally to help clear their secretions. Don't let it bother you, as it usually doesn't bother the baby.

When to worry

Worry if your newborn (less than two months of age) is consistently breathing faster than 60 times a minute; is limp, pale, or blue; is coughing more than occasionally (having coughing fits); or has a fever over 100.4 rectally. Worry if your baby looks like he is struggling to breathe, is unable to eat or sleep because of difficulty breathing even after you have suctioned his nose, or if you see his skin "sucking in" between, above, or below the rib cage. Abdominal breathing (when you see her belly going up and down with breathing) is also a sign of distress. Call the office immediately for these signs and symptoms.

If your infant or child ever stops breathing, is having an extremely hard time breathing, is unresponsive, or is limp, pale, or blue call 911 IMMEDIATELY!

Infants and Children

There are quite a few reasons why your child may be having fast, noisy, or labored breathing.

Nasal Congestion

Is the problem that he can't breathe because his nose is so stuffy? Is he breathing through his mouth? Having nasal discharge? If this is the case, he likely has a cold virus that needs to run it's course. Neo-synephrine or Afrin nasal spray (1-2 sprays each nostril 1-2 times per day) can be very helpful in the short term for nasal congestion. One should not use nasal decongestants for longer than 3 days or he will develop a rebound congestion even when he's no longer sick. Over-the-counter cough and cold preparations are of unproven benefit, so if it seems like the medicine isn't working, don't bother. However, OTC cold medicines are generally safe, so if it seems to help, go ahead and use it. If a cold virus is lasting longer than 10-14 days, call the office during office hours.

Fever

When children have a fever, they breathe fast as a way to dissipate heat. If this is the case, they often look like they are panting or breathing fast despite little or no other respiratory symptoms. Give your child Tylenol or Motrin and reassess her breathing after you have waited 30-60 minutes for the fever to decline. Her breathing should improve with improvement of the fever.

Barky cough and/or difficulty inhaling

The sudden onset of a barky cough that is described as a seal or dog bark is likely attributable to croup. Croup is caused by a cold virus that likes to affect the voice box. Inflammation and swelling of the voice box then causes a hoarse voice, a dry, loud, barky cough, and stridor. Stridor is a noise made as your child is attempting to breathe in. Initially, stridor occurs only when the child is upset, active, or coughing. As croup progresses, the struggling to breathe in occurs even at rest. Cold air (bundle her up and take her outside for a walk) or a steamy shower room often is very helpful for these symptoms. If stridor continues at rest despite trying cold air and steam, call the office or go to the nearest emergency room immediately. See croup handout for further information.

Wheezing

Wheezing is a symptom of asthma in older kids, and a symptom of either asthma or viral induced wheezing (bronchiolitis) in younger children and infants. Wheezing occurs as air tries to move out through narrowed airways in the lungs, and is therefore a sound heard as your child breathes out. Mild to moderate wheezing can only be heard with a stethoscope. Moderate to severe wheezing can often be audible without a stethoscope. Often, a parent will describe hearing a "wheezy" sound when their child is sick. This is often just from congestion in the head and upper airway, and not true wheezing. This is likely what is happening if your child is congested with a bad cold, is making the sound while breathing in AND out, is not breathing fast or hard, and looks comfortable. If your child has true audible wheezing (from asthma or viral induced wheezing/bronchiolitis), then he will likely also be breathing fast and/or hard, seem tired, may or may not also have a cold, and will likely have a bad cough. Tugging in of the skin around the ribs or abdominal breathing (where the belly goes up and down with breathing) is further evidence of true wheezing and significant respiratory distress. If your child has known asthma and is having these symptoms, give her rescue albuterol inhaler or nebulizer. If you suspect your child is truly wheezing and having difficulty breathing, call the office immediately.

Pneumonia

Children do occasionally develop pneumonia. A typical scenario for pneumonia is a child or infant who has been sick with a cold, but then develops a new high fever, bad cough, and fast or difficult breathing. Pneumonia is unusual in the absence of fever, but may occur without a preceding head cold. If you suspect pneumonia, call the office to have your child evaluated.