If your child is struggling to breathe right now, the first step is figuring out how severe it is. Look at their chest, listen to their breathing, and watch their behavior. A child who can still talk, drink, and engage with you needs different help than one who is gasping, turning blue, or going limp. The sections below walk you through recognizing an emergency, then cover the most common causes and what you can do at home for each one.
Signs That Need a 911 Call
Call emergency services immediately if your child shows any of these:
- Severe struggle with each breath, to the point they can barely speak or cry
- Blue or grayish lips or face when they’re not coughing
- Loss of consciousness or they stop breathing entirely
- Choking on an object that may be lodged in the throat
- Sudden breathing trouble after a bee sting, new medication, or a known allergen
Other warning signs that suggest a child is close to collapse include listlessness or a sudden drop in effort (they were working hard to breathe and now seem too exhausted to try), repeated pauses in breathing, and worsening confusion or sleepiness. These mean the body is running out of reserves.
How to Tell If Breathing Is Abnormal
Normal breathing rates vary a lot by age. An infant typically breathes 30 to 60 times per minute, a toddler 24 to 40, a preschooler 22 to 34, a school-age child 18 to 30, and a teenager 12 to 16. Rates consistently above these ranges, especially at rest, suggest the body is working harder than it should to get oxygen.
Beyond counting breaths, look for visual clues. Nasal flaring, where the nostrils spread wide with each breath, means the child is pulling harder to get air in. Retractions are another red flag: the skin between the ribs, below the ribcage, or at the base of the throat sucks inward visibly with each inhale. You might also hear high-pitched whistling, grunting, or a barky cough.
If you have a home pulse oximeter, place it on your child’s finger or toe. Healthy children generally read 97% or higher. Readings of 95 to 96% are associated with higher rates of hospitalization in children, so any consistent reading below 97% deserves close attention and, in most cases, a call to your pediatrician or a trip to urgent care.
Choking: What to Do by Age
If your child is coughing forcefully, let them keep coughing. A strong cough is the most effective way to clear an object. Intervene only when the cough becomes weak, silent, or the child can’t breathe, cry, or make sound.
Babies Under 1 Year
Sit down and lay the baby facedown on your forearm, resting your arm on your thigh. Support the chin and jaw with your hand and keep the baby’s head lower than their body. Using the heel of your other hand, give five firm thumps on the middle of the back between the shoulder blades. If that doesn’t clear the object, turn the baby faceup on your forearm (head still lower than the body) and give five chest compressions using two fingers in the center of the chest, just below the nipple line. Alternate between five back blows and five chest compressions until the object comes out or the baby starts breathing.
Children Over 1 Year
Stand or kneel behind the child. Give five back blows between the shoulder blades with the heel of your hand. If the object is still stuck, switch to abdominal thrusts: place a fist just above the belly button, grab it with your other hand, and press inward and upward five times. Alternate between five back blows and five abdominal thrusts until the blockage clears.
Asthma Flare-Ups
If your child has a diagnosed asthma action plan, follow it. The core tool during a flare is a rescue inhaler, and using it with a spacer makes a significant difference in how much medication actually reaches the lungs.
Shake the inhaler vigorously 10 to 15 times. Attach the spacer and have your child breathe out gently. Place the spacer mouthpiece between their teeth with lips sealed around it, then press the inhaler once while they breathe in slowly. Have them hold their breath for a count of 10 if they can, then breathe out slowly through pursed lips. Wait one to two minutes before giving a second puff if needed. For younger children who can’t coordinate this, a spacer with a face mask lets you deliver the medication while they breathe normally through the mask.
Keep the child sitting upright, as this position gives the lungs the most room to expand. If there’s no improvement after the initial doses, or if the child still can’t speak in full sentences, it’s time for emergency care.
Croup and That Barky Cough
Croup causes swelling around the vocal cords, producing a distinctive seal-like bark and sometimes stridor, a harsh sound when breathing in. It tends to flare up at night and can be frightening, but most cases are manageable at home.
Cold air is one of the most effective home measures. A 2023 randomized trial found that 30 minutes of exposure to outdoor cold air (below 50°F or 10°C) reduced croup symptoms in about half of children, compared to roughly a quarter who improved at room temperature. Children with moderate croup benefited the most, with nearly a 46 percentage point improvement over the comparison group. If it’s cold outside, bundle your child up and sit on the porch or near an open window for 15 to 30 minutes.
Keeping your child calm matters more than you might expect, because crying and agitation make the airway narrower. Hold them in your lap, speak quietly, and avoid anything that increases distress. If cold air isn’t available, some parents try steam from a hot shower, though evidence for steam is weaker than for cold air. If the stridor is present even when the child is calm and at rest, or if you see chest retractions, that warrants medical evaluation.
Bronchiolitis and Nasal Congestion in Babies
Bronchiolitis, most commonly caused by RSV, fills tiny airways with mucus and hits babies especially hard because infants are obligate nose breathers. They can’t easily switch to mouth breathing when their nose is blocked, so congestion directly affects their ability to feed and sleep.
Nasal suctioning before each feeding is one of the most practical things you can do. A suction device that maintains steady negative pressure (like a caregiver-powered nasal aspirator) tends to clear mucus more effectively than a traditional bulb syringe, which creates only a brief, weak pull. Suction gently before each feed for the first few days of illness to keep the airways as clear as possible.
Hydration is the other priority. Poor feeding is one of the top reasons babies with bronchiolitis end up hospitalized. Aim for your baby to take in at least 80% of their normal fluid intake. Offer smaller, more frequent feeds rather than waiting for full feeding sessions, since a congested baby tires quickly. If your baby is refusing feeds, producing fewer wet diapers than usual, or seems increasingly lethargic, that’s a sign they need medical attention.
Allergic Reactions and Anaphylaxis
Breathing difficulty during an allergic reaction can escalate quickly. In children experiencing anaphylaxis, noisy or difficult breathing occurs in about 83% of cases, wheezing in 59%, and coughing in 33%. These respiratory symptoms often appear alongside hives (72%) or facial swelling (55%), and sometimes vomiting or abdominal cramps.
If your child has a prescribed epinephrine auto-injector and is showing signs of anaphylaxis (breathing difficulty plus skin changes or GI symptoms, especially after a known trigger), use it immediately. Speed matters: symptoms can develop within minutes of exposure and worsen rapidly. Administer the auto-injector into the outer thigh, then call 911 even if symptoms start improving, because reactions can return. A second dose can be given if symptoms aren’t improving or start getting worse again.
Positioning Your Child for Easier Breathing
For most situations at home, keep your child sitting upright or slightly reclined. Sitting up lets gravity pull the diaphragm down, giving the lungs more room. For an older child, leaning slightly forward with hands on their knees (the “tripod” position) can also ease the work of breathing.
You may have heard that lying face-down helps breathing. Research does show that prone positioning improves oxygen levels in hospitalized infants with respiratory distress, with measurable gains in oxygen saturation and fewer episodes of low oxygen. However, this was studied only in monitored hospital settings. Because of the strong link between prone sleeping and sudden infant death syndrome, placing a baby on their stomach at home to help with breathing is not safe unless a medical professional is directly supervising. For babies at home, back-sleeping remains the safest position, with the head of the crib slightly elevated if your pediatrician advises it (though studies haven’t shown elevation alone makes a significant difference in oxygen levels).
For toddlers and older children who are awake and alert, let them find the position that feels most comfortable. Children will naturally sit up, lean forward, or ask to be held upright when they’re struggling. Follow their lead.