To check for breathing in an emergency, you place your ear close to the person’s mouth and nose, watch their chest for movement, and feel for breath on your cheek. This technique, known as “look, listen, and feel,” takes only a few seconds and tells you whether the person needs CPR or can be placed in a safe resting position until help arrives.
The 2024 American Heart Association and American Red Cross guidelines are clear: any abnormality in responsiveness or breathing should be treated as an emergency and should prompt you to call 911 immediately.
Check for Responsiveness First
Before checking breathing, you need to know if the person is conscious. Tap their shoulders firmly and ask loudly, “Are you okay?” If the person doesn’t respond, they’re unresponsive, and you should call 911 (or have someone nearby do it) before moving to the breathing check. Look quickly for medical alert jewelry on their wrist or neck, which can help you and paramedics understand what’s happening.
The Look, Listen, and Feel Method
Once you’ve confirmed the person is unresponsive, open their airway by gently tilting their head back and lifting their chin. This prevents the tongue from falling backward and blocking the throat. Then perform three checks at once:
- Look at their chest for rise and fall.
- Listen by placing your ear near their mouth and nose for the sound of air moving.
- Feel for breath against your cheek.
You should be able to tell within about 10 seconds whether the person is breathing normally. If you’re unsure, treat the situation as though they are not breathing and begin CPR.
What Normal Breathing Looks Like
A person breathing normally will have a steady, rhythmic rise and fall of the chest. In adults, this typically happens 12 to 20 times per minute. Babies under one year breathe faster, at a rate of 25 to 45 breaths per minute, and premature infants may breathe up to 60 times per minute. The breaths should be quiet and relatively effortless.
Recognizing Agonal Breathing
One of the most dangerous mistakes bystanders make is confusing agonal breathing with real breathing. Agonal breaths are gasping, irregular gulps of air that look like the person is struggling or snoring. They sound noisy, often with a gurgling quality, and come with long pauses between each one. The person may appear to be trying to breathe, but these gasps do not move enough oxygen to the brain or vital organs.
Agonal breathing is a sign of cardiac arrest, not recovery. If you see someone gasping irregularly with long gaps between breaths, treat them as though they are not breathing at all. Begin chest compressions immediately.
Signs of a Blocked Airway
Sometimes a person may be conscious but unable to breathe effectively because something is obstructing their airway. The signs differ from full respiratory arrest. With a partial blockage, you may hear wheezing, whistling, or a high-pitched sound when they try to inhale. They may struggle to speak or only get out a few words at a time.
Skin color changes are another important clue. On lighter skin, look for a bluish tint around the lips, fingertips, or nail beds. On darker skin, the lips and gums may appear gray or whitish. Agitation and confusion can also signal that the brain isn’t getting enough oxygen.
Skip the Pulse Check
You might expect that checking for a pulse is part of this process, but current guidelines actually discourage lay rescuers from trying. Research has consistently shown that untrained people, and even many trained first responders, cannot reliably determine whether a pulse is present in an emergency. Spending time searching for a pulse delays CPR and costs precious seconds. The safest approach is to focus on responsiveness and breathing. If a person is unresponsive and not breathing normally, begin CPR with chest compressions and rescue breaths right away.
What To Do If They Are Breathing
If the person is unresponsive but breathing normally, place them in the recovery position while you wait for emergency services. This keeps their airway clear by letting gravity work in their favor. Roll the person onto their side so their face angles slightly downward toward the ground. This prevents the tongue from blocking the airway and allows any fluid to drain from the mouth rather than pooling in the throat.
Position their bottom leg straight and aligned with the spine. Bend their top leg into an L-shape with the knee touching the ground, which keeps their body from rolling forward. Tuck the hand of their upper arm under their cheek as a cushion. Their head should be slightly lower than their stomach. Stay with them and keep monitoring their breathing until paramedics arrive, because a person who is breathing now can stop at any time.
Checking Breathing in Infants and Children
The look, listen, and feel approach works for children and infants too, but with a key adjustment. When opening an infant’s airway, use a much gentler head tilt. A baby’s airway is smaller and more flexible, so over-extending the neck can actually compress it. Tilt the head just enough to bring it into a neutral position, sometimes called the “sniffing position,” where the nose points slightly upward as if the baby were sniffing the air.
Because infants breathe faster than adults, don’t mistake rapid breathing for distress on its own. What matters is whether the breaths are regular and whether the chest is rising. If the baby is unresponsive and you see no chest movement or only occasional gasps, begin infant CPR immediately.