When to take your child to the ER for changes in breathing

Abnormal breathing can be troubling for any parent to witness in his or her child. While some changes in breathing are temporary and relatively harmless, other abnormal breathing episodes may indicate a larger problem.

A variety of pediatric respiratory conditions can affect your child's breathing. If you notice chronic breathing concerns, visit a pediatric pulmonologist to determine if it may be due to chronic childhood allergies or pediatric asthma.

Irregular breathing in newborns

Newborns will often begin breathing faster for a few seconds and then slow down their breathing, especially when sleeping. This type of irregular breathing is normal and does not require treatment. If irregular breathing persists past the age of six months, call your pediatrician to ensure your child’s breathing is healthy. If your infant displays any of the symptoms listed below, immediately seek emergency care. 

If your child stops breathing

If your child has stopped breathing and is not responsive, immediately begin CPR and call 911. 

If your child ceases breathing for 15 seconds or more, and then resumes breathing, visit the pediatric ER. Even if your child seems fine, it is important to make sure the underlying reason for the episode has been resolved.  

Many children between the age of six months and six years will experience breath-holding spells, involuntary breath holding that usually occurs when the child is crying or upset. Children who experience these spells do not need to seek emergency care unless the incident results in unconsciousness or a seizure. In these cases, it is best to visit the pediatric ER to make sure there are no other reasons for the seizure or unconsciousness. 

Changes in breathing

If your child seems to be having a hard time breathing, or you notice abnormal behaviors or actions, it may be time to seek emergency care. Visit the pediatric ER if you notice these symptoms:

• Breathing that is faster than normal
• Breathing harder than usual without exertion
• Chest and abdomen look like a seesaw (one goes up while the other goes down)
• Bluish hue to the lips or skin
• Persistent barking cough or wheezing
• High-pitched squeaky sound in the upper airway
• Placing weight on the hands in a tripod position while hyperextending the neck

If your child is recovering from a choking episode in which he or she turned blue but returned to normal, it is still a good idea to visit the pediatric ER to ensure there are no longer-term consequences.

Pneumonia in children

Pneumonia is a common lung infection that can be life-threatening. Children with asthma, have recently been hospitalized, use antibiotics frequently or have another chronic condition are at a higher risk for developing pneumonia. If your child has had an upper respiratory condition for more than five days and is not getting better, visit your doctor — even if they just seem congested. If you are concerned your child is not eating or drinking enough, or going to the bathroom regularly, seek medical attention. Visit the ER immediately if your child:

• flares the nostrils when breathing
• has retractions: working too hard to breathe, shown in the areas below the ribs, between the ribs, and in the neck sinking in with each attempt to inhale

When to go to the ER if your child has asthma

When your child is diagnosed with asthma, work with your child's physician (pediatric pulmonologist) to create a plan that lists specific symptoms to trigger a call to your doctor or a trip to the ER. These should be early warning signs of a flare up and may include:

• wheezing
• tightness in chest
• inability to stand or sit still
• restless sleep
• throat clearing
• rapid or irregular breathing
• coughing not due to cold or persistent cough
• unusual fatigue

Visit the ER immediately if your asthmatic child experiences:

• constant wheezing
• repeated severe flare-up symptoms that are not relieved with rescue or fast-acting medicine
• blue or gray lips and fingernails
• difficulty talking
• retractions: working too hard to breathe, shown in the areas below the ribs, between the ribs, and in the neck sinking in with each attempt to inhale
• a peak flow reading below 50% and doesn't improve after using medicine
• if your child's peak flow reading falls below 50% (which is in the red zone of the peak flow) and doesn't improve after using medicine

Learn more about pediatric ER care at Rocky Mountain Hospital for Children.