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Children who present to the emergency department with wheezing and difficulties breathing, are a large and often prioritized group. There are a number of causes. Many children have asthma and others have croup. It could be severe like pneumonia, or cough and congestion. Whatever it may be, the most important thing is to learn how to recognize when your child is having difficulties breathing and what to do about it. Don’t forget to watch the YouTube videos as guidance. It’s very helpful!
Note: as a general rule, children with difficulties breathing need assistance from a health care professional. Especially if it’s the first time they have experienced it.
How do I know when a child has difficulty breathing?
- Undress the upper body of the child and observe how they breathe.
- Undress the baby and observe them.
- UNDRESS THE BABY and observe!
No one can judge whether a child has difficulty breathing without undressing them first! When I work at the children’s emergency room and come in to see a child with suspected breathing difficulties, I always ask a parent to take off the child’s shirt as soon as I say hello. That way, I can observe their child breathe while I talk to the parents and confirm whether the child has difficulty breathing or not.
What am I looking for?
A healthy child breathes effortlessly. You’ll notice the child, and sometimes their chest, moving a few centimeters up and down at a steady, relaxed pace. The rest of their body, head and their nose wings are still. Observe your child breathing tonight to get an idea of what they look like when they’re healthy.
1. Does your child struggle with every breath?
When you see a child who has difficulty breathing, you immediately get the impression that they need to physically exert themselves with every breath. It may be more or less pronounced depending on the severity. The abdomen often goes in and out in a way that looks strained.
2. Is the child breathing faster than usual?
Don’t count your child’s respiratory rate at home! In my experiences, this becomes more confusing for the parent than it is helpful. But I do encourage you to observe and know how your baby breathes when they’re healthy. You will notice that when your baby is sick, they will breathe faster than usual. If they have a high fever, they will breathe faster because of it. If they do not have to physically struggle with breathing, you can give the child antipyretics and see if the breathing becomes normal again. In that case, you can calmly continue to take care of the baby at home. But if the child breathes significantly faster than usual, even when the fever goes down, or if at the same time they struggle physically with breathing, then you should visit a doctor for assessment.
3. Does the child have retractions?
Children’s chest are much softer than adults’. When they have difficulty breathing, the skin between the ribs are pulled in between the ribs of each breath. If there is severe breathing problems, the entire chest can also move in and out. This is hard to explain in words, and therefore best if you watch a video.
Here is a youtube video showing a child with heart disease and with retractions. This child’s signs and symptoms present exactly the same as a child with asthma, except calmer. NB: The baby also breathes faster than normal for their age.
Another video of a child with croup having retractions. Here, both inhalations and exhalations are signs of swelling in the upper respiratory tract. I really hope this video was taken in a hospital, because a child with this much breathing problems needs to be cared for and monitored by medical professionals!
4. Are the exhalations high-pitched and whistling?
In asthma, it’s hard for a child to expel air out of their lungs. In milder cases, you’ll notice that the child’s exhalation takes longer than their inhalation. In more severe cases, the exhalation is gives off a high-pitched sound. This YouTube video shows a child exhaling in high-pitch. This child also has retractions, which is very common in asthma. He would need to be treated at the children’s hospital!
5. Does the baby have terrible coughing attacks and whistles upon inhalation?
If your child is wheezing and it sounds slimy at every inhalation and exhalation, but they do not seem to have difficulty breathing, has a normal appetite and is alert, then there is no need to panic. What you hear is mucus in the airways. It could be a cold or RS virus. Often mucus in the upper respiratory tract (pharynx) sounds the worst.
What should you do when your child has difficulty breathing?
Welcome to the children’s emergency department! We are happy to help you and your child 24/7 🙂
If your child has asthma and you have treatment at home, try to increase the amount of inhalations according to your asthma management guide. However, if this doesn’t help, visit the children’s emergency department. If you don’t have asthma medications at home, clear your child’s nose with saline. If your child feels better after the saline, then you can stay at home. But, if they are still having difficulty breathing, you can visit the hospital. Often it is easier for children to breathe in a sitting position than lying down. So allow them to sit on your lap while you hold, caress and calm them down (maybe read a fairytale to them) until they have received treatment. The calmer your child is, the less strenuous the breathing.
What about the general medical center?
If you have a health center where doctors are used to, and are good, with children, most breathing problems can be treated there. If your child needs to be hospitalized, the doctor at the medical center can send the child there with a referral. Unfortunately, this isn’t the case for all health centers. If your medical center isn’t the right place for you and your child then I think you should go to a pediatrician’s office or the children’s emergency room.