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Respiratory Problems, Age 11 and Younger

Overview

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 include:

A runny or stuffy nose. It may lead to blocked nasal passages that cause the child to breathe through the mouth.
Feeling cranky or restless, having a poor appetite, and being less active than usual.
Coughing, especially when lying down.
Fever.

Lower respiratory system

The lower respiratory system includes the bronchial tubes and lungs. These types of problems are less common than ones in the upper respiratory system. But they are usually more severe. They are more likely to need a doctor's care.

Symptoms of lower respiratory system infections include:

Coughing that lasts through the day and night.
Fever. It may be high with some infections, such as pneumonia.
Feeling cranky or restless, having a poor appetite, and being less active than usual.
Difficulty breathing. You may notice:
- Rapid breathing.
- Grunting, which is heard when the child breathes out (exhales). Most babies grunt now and then when they sleep. But grunting that occurs with rapid, shallow breathing may mean a lower respiratory system infection.
- Wheezing. (This is a different sound than croup.)
- Using the neck, chest, and belly muscles to breathe. This causes a "sucking in" between or under the ribs (retractions).
- Flaring the nostrils when breathing.

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 sometimes they can be severe.

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 aren't used to treat viral illnesses. They don't change the course of viral infections. Using an antibiotic when it's not needed exposes your child to the risks of an allergic reaction and antibiotic side effects. These side effects include nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill helpful bacteria and encourage the growth 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 have severe blockage of the air passages. They need treatment in a hospital.

Bacterial infections

The most common sites for bacterial infections in the upper respiratory system are the sinuses and throat.

Bacterial pneumonia may follow a viral illness as a secondary infection. Or it can appear as the first sign of a lower respiratory infection. In babies and small children, the first sign of infection often is rapid breathing, crankiness, being less active than usual, and poor feeding. Antibiotics work well against bacterial infections.

Allergies

Allergies are a common cause of respiratory problems. The 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").
Crankiness and loss of appetite.

Asthma

Babies and small children usually don't have asthma. But 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 gets worse, symptoms may include wheezing and shortness of breath after exercise or at nighttime.
In severe asthma, the most common symptoms are trouble breathing (using the neck, chest, and belly muscles to breathe) and a high-pitched sound when breathing (wheezing).
Allergies and asthma often occur together.

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 this 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.
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. What type of symptoms your child has and how severe they are will help you know if your child needs to see a doctor.

Check Your Symptoms

Does your child have a respiratory problem?

Respiratory problems can affect the nose, mouth, sinuses, and throat (upper respiratory system) or the bronchial tubes and lungs (lower respiratory system).

Yes

Respiratory problem

How old are you?

Less than 3 months

3 to 5 months

6 to 11 months

12 months to less than 3 years

3 to 11 years

12 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Has your child swallowed or inhaled an object?

Yes

Swallowed or inhaled object

Has your child had surgery in the past 2 weeks?

Surgery can cause problems that make your child cough.

Yes

Surgery within past 2 weeks

Does your baby seem sick?

A sick baby probably will not be acting normally. For example, the baby may be much fussier than usual or not want to eat.

Yes

Baby seems sick

How sick do you think your baby is?

Extremely sick

Baby is very sick (limp and not responsive)

Sick

Baby is sick (sleepier than usual, not eating or drinking like usual)

Is your baby having trouble breathing?

Sometimes babies may have trouble breathing because of a stuffy nose. If your baby's nose is stuffy, clearing the nose with a rubber bulb may help.

Yes

Difficulty breathing

Would you describe the breathing problem as severe, moderate, or mild?

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Is your child having trouble breathing (more than a stuffy nose)?

The symptoms of difficulty breathing in an older child may be different than symptoms in a baby or young child.

Yes

Difficulty breathing more than stuffy nose

Is your child drooling and unable to swallow, cry, or make sounds?

Yes

Drooling and unable to swallow

Would you describe the breathing problem as severe, moderate, or mild?

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Does your child have a chronic health problem that affects his or her breathing, such as asthma?

A breathing problem may be more of a concern if your child normally does not have breathing problems.

Yes

Has chronic breathing problems

Is the problem your child is having right now different than what you are used to?

Yes

Breathing problem is different than usual symptoms

Is your child's ability to breathe:

Getting worse?

Breathing problems are getting worse

Staying about the same (not better or worse)?

Breathing problems are unchanged

Getting better?

Breathing problems are getting better

Is your child's ability to breathe:

Quickly getting worse (within minutes or hours)?

Breathing problems are quickly worsening

Slowly getting worse (over days)?

Breathing problems are slowly worsening

Staying about the same (not better or worse)?

Breathing problems are unchanged

Getting better?

Breathing problems are getting better

Does your child make a harsh, high-pitched sound when he or she breathes in?

This often occurs with a loud cough that sounds like a barking seal.

Yes

Harsh, high-pitched sound when breathing

Does your child have symptoms of a serious illness?

The symptoms in a baby are different than the symptoms in an older child.

Yes

Symptoms of serious illness

Do you think your baby has a fever?

Yes

Fever

Did you take your child's temperature?

This is the only way to be sure that a baby this age does not have a fever. If you don't know the temperature, it's safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious. Rectal temperatures are the most accurate. Taking an axillary (armpit) temperature is also an option.

Yes

Temperature taken

Is it 38°C (100.4°F) or higher, taken rectally?

This would be an axillary temperature of 37.5°C (99.5°F) or higher.

Yes

Temperature at least 38°C (100.4°F) taken rectally

Do you think your child has a fever?

Yes

Fever

Did you take your child's temperature?

Yes

Temperature taken

How high is the fever? The answer may depend on how you took the temperature.

NOTE: Most people have an average body temperature of about 37°C (98.6°F). But it can vary by a degree or more and still be considered normal. If a low body temperature is the only symptom, it’s usually not something to worry about. But be sure to watch for other symptoms.

High: 40°C (104°F) or higher, oral

High fever: 40°C (104°F) or higher, oral

Moderate: 38°C (100.4°F) to 39.9°C (103.9°F), oral

Moderate fever: 38°C (100.4°F) to 39.9°C (103.9°F), oral

Mild: 37.9°C (100.3°F) or lower, oral

Mild fever: 37.9°C (100.3°F) or lower, oral

How high do you think the fever is?

High

Feels fever is high

Moderate

Feels fever is moderate

Mild or low

Feels fever is mild

How long has your child had a fever?

Less than 2 days (48 hours)

Fever for less than 2 days

From 2 days to less than 1 week

Fever for more than 2 days and less than 1 week

1 week or longer

Fever for 1 week or more

Does your child have a health problem or take medicine that weakens his or her immune system?

Yes

Disease or medicine that causes immune system problems

Does your child have shaking chills or very heavy sweating?

Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.

Yes

Shaking chills or heavy sweating

Does your child have a cough?

Yes

Cough

When your child is coughing, does his or her face turn blue or purple?

Yes

Colour changes to blue or purple when coughing

Color changes to blue or purple when coughing

Has the coughing been so bad that it has made your baby vomit?

Yes

Vomiting after coughing spasm

Is your baby coughing up blood?

Yes

Coughing up blood

Is your baby eating less than usual?

Yes

Change in eating habits

Has your baby had a cough for more than 1 full day (24 hours)?

Yes

Cough for more than 24 hours

Cough for 24 hours or less

Is your child coughing up mucus, phlegm (say "flem"), or blood from the lungs?

This is called a productive cough. Mucus or blood draining down the throat from the nose because of a cold, a nosebleed, or allergies is not the same thing.

Yes

Coughing up sputum or blood

Is your child coughing up blood?

Yes

Coughing up blood

How much blood is there?

Thin streaks of blood

Streaks

More than just streaks

More than streaks

Has this been going on for more than 2 days?

Yes

Coughing up mucus for more than 2 days

Has the coughing been so bad that it has made your child vomit?

Yes

Vomiting after coughing spasm

Has your child had a cough for more than 2 weeks?

Yes

Cough for more than 2 weeks

Did the symptoms start after your child took a new medicine?

Do not give your child any more of the medicine until you have talked to the child's doctor.

Yes

Medicine may be causing problems

Does your child have a runny nose?

Yes

Runny nose

Does your baby have trouble eating or sleeping because of a runny, stuffy nose?

Yes

Trouble eating or sleeping because of nasal congestion

Is there thick, yellow drainage coming from your child's nose?

Yes

Thick, yellow nasal drainage

Has your child had the nasal drainage for more than 2 days?

Yes

Nasal drainage for more than 2 days

Is your child acting sicker than you would expect if he or she had a minor illness, like a cold?

Yes

Seems sicker than expected

Does your child have a runny nose, watery eyes, and a lot of sneezing without other cold symptoms?

Yes

Allergy symptoms

Have your child's symptoms lasted longer than 2 weeks?

Yes

Symptoms for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you're at rest (severe difficulty breathing).

Symptoms of difficulty breathing in a baby or young child can range from mild to severe. For example:

The child may be breathing a little faster than usual (mild difficulty breathing), or the child may be having so much trouble that the nostrils are flaring and the belly is moving in and out with every breath (severe difficulty breathing).
The child may seem a little out of breath but is still able to eat or talk (mild difficulty breathing), or the child may be breathing so hard that he or she cannot eat or talk (severe difficulty breathing).

Severe trouble breathing means:

The child cannot eat or talk because he or she is breathing so hard.
The child's nostrils are flaring and the belly is moving in and out with every breath.
The child seems to be tiring out.
The child seems very sleepy or confused.

Moderate trouble breathing means:

The child is breathing a lot faster than usual.
The child has to take breaks from eating or talking to breathe.
The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

The child is breathing a little faster than usual.
The child seems a little out of breath but can still eat or talk.

If you're not sure if a child's fever is high, moderate, or mild, think about these issues:

With a high fever:

The child feels very hot.
It is likely one of the highest fevers the child has ever had.

With a moderate fever:

The child feels warm or hot.
You are sure the child has a fever.

With a mild fever:

The child may feel a little warm.
You think the child might have a fever, but you're not sure.

Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.

Oral (by mouth), ear, or rectal temperature

High: 40° C (104° F) and higher
Moderate: 38° C (100.4° F) to 39.9° C (103.9° F)
Mild: 37.9° C (100.3° F) and lower

A forehead (temporal) scanner is usually 0.3° C (0.5° F) to 0.6° C (1° F) lower than an oral temperature.

Armpit (axillary) temperature

High: 39.5° C (103° F) and higher
Moderate: 37.5° C (99.5° F) to 39.4° C (102.9° F)
Mild: 37.4° C (99.4° F) and lower

Note: For children under 5 years old, rectal temperatures are the most accurate.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:

Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
Steroid medicines, which are used to treat a variety of conditions.
Medicines taken after organ transplant.
Chemotherapy and radiation therapy for cancer.
Not having a spleen.

Symptoms of serious illness in a baby may include the following:

The baby is limp and floppy like a rag doll.
The baby doesn't respond at all to being held, touched, or talked to.
The baby is hard to wake up.

Symptoms of serious illness may include:

A severe headache.
A stiff neck.
Mental changes, such as feeling confused or much less alert.
Extreme fatigue (to the point where it's hard for you to function).
Shaking chills.

Sudden drooling and trouble swallowing can be signs of a serious problem called epiglottitis. This problem can happen at any age.

The epiglottis is a flap of tissue at the back of the throat that you can't see when you look in the mouth. When you swallow, it closes to keep food and fluids out of the tube (trachea) that leads to the lungs. If the epiglottis becomes inflamed or infected, it can swell and quickly block the airway. This makes it very hard to breathe.

The symptoms start suddenly. A person with epiglottitis is likely to seem very sick, have a fever, drool, and have trouble breathing, swallowing, and making sounds. In the case of a child, you may notice the child trying to sit up and lean forward with his or her jaw forward, because it's easier to breathe in this position.

You can use a small rubber bulb (called an aspirating bulb) to remove mucus from your baby's nose or mouth when a cold or allergies make it hard for the baby to eat, sleep, or breathe.

To use the bulb:

Put a few saline nose drops in each side of the baby's nose before you start.
Position the baby with his or her head tilted slightly back.
Squeeze the round base of the bulb.
Gently insert the tip of the bulb tightly inside the baby's nose.
Release the bulb to remove (suction) mucus from the nose.

Don't do this more than 5 or 6 times a day. Doing it too often can make the congestion worse and can also cause the lining of the nose to swell or bleed.

A baby that is extremely sick:

May be limp and floppy like a rag doll.
May not respond at all to being held, touched, or talked to.
May be hard to wake up.

A baby that is sick (but not extremely sick):

May be sleepier than usual.
May not eat or drink as much as usual.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

Post-Operative Problems

Respiratory Problems, Age 12 and Older

Swallowed or Inhaled Objects

Self-Care

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.

Here are some things you can do to ease mild symptoms and help your child feel better.

Be safe with medicines. Read and follow all instructions on the label.
- Ask your doctor if you can give your child acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Do not use ibuprofen if your child is less than 6 months old unless the doctor gave you instructions to use it.
- Do not give aspirin to anyone younger than 18. It has been linked to Reye syndrome, a serious illness.
- Be careful with cough and cold medicines. Don't give them to children younger than 6, because they don't work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included.
- Be careful when giving your child over-the-counter cold or influenza (flu) medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. Read the labels to make sure that you are not giving your child more than the recommended dose. Too much acetaminophen (Tylenol) can be harmful.
- Don't give your child leftover antibiotics. And don't give your child antibiotics or other medicines prescribed for someone else.
Have your child drink plenty of water and other fluids.
This may help soothe a dry or sore throat. Honey or lemon juice in hot water or tea may ease a dry cough. Do not give honey to a child younger than 1 year old. It may contain bacteria that are harmful to infants.
Try moist air.
Place a cool-mist humidifier by your child's bed or close to your child. This may make it easier for your child to breathe. Follow the directions for cleaning the machine.
Treat a stuffy nose.
- If your child has problems breathing because of a stuffy nose, squirt a few saline (saltwater) nasal drops in one nostril. Then have your child blow their nose. Repeat for the other nostril. Do not do this more than 5 or 6 times a day.
- For babies and children who aren't able to blow their nose, put a few saline drops in one nostril. Using a soft rubber suction bulb, squeeze air out of the bulb and gently place the tip of the bulb inside the baby's nose. Relax your hand to suck the mucus from the nose. Repeat in the other nostril.
Make sure your child rests.
Keep your child at home if they have a fever.
Keep your child away from smoke.
Do not smoke or let anyone else smoke around your child or in your home.

Using decongestants

Here are some precautions to take when using decongestants.

Be safe with medicines. Read and follow all instructions on the label.
Decongestants are not recommended for children younger than age 6. If your child's doctor tells you use these medicines, always follow the directions about how much to use based on age and in some cases weight. Not everyone needs the same amount of medicine.
Decongestants can cause problems for people who have certain health problems, such as heart disease, high blood pressure, glaucoma, diabetes, or an overactive thyroid. Decongestants may also interact with some drugs, such as certain antidepressants and high blood pressure medicines. Read the package carefully or ask your pharmacist or doctor to help you choose the best decongestant for you.
Drink extra fluids when you are taking cold and allergy medicines.
Don't use decongestant nasal sprays, drops, or gels more times in one day or for more days in a row than the label says. Overuse can cause rebound congestion. It makes your mucous membranes swell up more than before you used the spray.
If you are pregnant or breastfeeding, check with your doctor or pharmacist before using a decongestant.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

New or worse trouble breathing.
New wheezing.
New or worse cough.
Symptoms occur more often or are more severe.

Learn more

Over-the-counter medicines

More self-care

Watch

Children and Cough and Cold Medicines

Preparing For Your Appointment

You can help your doctor diagnose and treat your condition by being prepared for your appointment.

Making the Most of Your Appointment

Related Information

Credits

Current as of: August 6, 2023

Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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