Difficulty Breathing

The main concern is in watching for signs of difficult breathing:

Mild difficulty breathing is noted when a child is breathing a little faster than usual, but is able to eat and talk normally. Babies are able to take a bottle or nurse comfortably and are able to smile and coo. The stomach muscles may be moving in and out very slightly when the child breathes. This visible movement of extra muscles to breathe is called retractions. Places to look for retractions include the muscles in the neck, the muscles in between or below the ribs and the stomach muscles.

Moderate difficulty breathing is noted when a child is breathing with more effort normal, has retractions of the muscles of the stomach and possibly between the ribs. He may appear pale, but not blue. He will interact and talk in short phrases, but maybe not in complete sentences and may play for brief periods. A baby taking the bottle or nursing may need to pause more frequently, but is able to feed.

Severe difficulty breathing is noted when a child is struggling to take each breath. Retractions are seen of the stomach muscles, the muscles between the ribs and those above the collarbone. Audible grunting may be noted. He may need to sit up and lean forward just to breathe. The child will appear agitated or frantic. The child will not make good eye contact, interact and there is obvious difficulty getting a word out. A baby may appear listless and is unable to suck a bottle or nurse effectively. The tongue, lips and possibly nailbeds will appear blue. This is a real emergency and it must be decided if it is quicker to take the child immediately to the emergency room or call 911.