Difficulty breathing and wheeze

  • Wheeze is extremely common in young children. It is most often triggered by a viral infection. Most preschool children with wheeze do not have asthma.

  • Children under 2 years of age with breathing difficulty may have  bronchiolitis.  This is an extremely common condition. It usually starts with a runny nose and cough, but their breathing may get worse over the next 2 to 3 days. For those under 1 year of age, inhalers generally do not help.

  • If your child has croup (hoarse voice, barking cough, noisy breathing), they are likely to need assessment by a medical practitioner.

  • If you already have a salbutamol (blue) inhaler, please follow your treatment plan.

  • If your child has been diagnosed with asthma, please see our resources for how to manage asthma attacks.

When should you worry?

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink
  • Working hard to breathe, drawing in of the muscles below the rib, or noisy breathing (grunting)

  • Breathing that stops or pauses

  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)

  • Is pale, blue, mottled or feels unusually cold to touch

  • Difficult to wake up, very sleepy or confused

  • Weak, high-pitched cry or can’t be settled

  • Has a fit (seizure)

  • Has a rash that does not go away with pressure (the 'Glass Test')

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)

  • If you think that your child might have breathed in or sniffed up a toy or a small object that they shouldn't have, please seek emergency help.

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has a salbutamol (blue) inhaler please follow your treatment plan

If your child has any of the following:

  • Breathing a bit faster than normal or working a bit harder to breathe

  • A harsh noise as they breathe in (stridor) only when upset

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Getting worse or you are worried about them 

  • Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)

  • Temperature less than 36°C in those over 3 months

You need to contact a doctor or nurse today

Please contact your GP surgery or call NHS 111 - dial 111

If your child has a salbutamol (blue) inhaler please follow your treatment plan

If none of the above features are present

Additional advice is also available for families for help cope with crying in otherwise well babies.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

How to use your child’s salbutamol inhaler during a wheezy episode

  • See flowchart to the right or below
  • If your child is not wheezy and/or breathless, and has no increased work of breathing, there is no need for the blue inhaler.
  • If your child is wheezy and/or breathless, or has increased work of breathing, sit them upright and try to keep them calm. Give 2 puffs of blue inhaler one at a time using a spacer. Review how they respond after a few minutes. Give 2 more puffs if still concerned about breathing.
  • If your child is no longer wheezy and/or breathless, and has no increased work of breathing, there is no need for the blue inhaler.
  • If you are still concerned for their breathing and there is no other obvious reason for these symptoms, give 2 more puffs. Reassess and repeat up to a maximum of 10 puffs.
  • If you are still concerned about their breathing after this, get urgent help. Call 999 or attend the Emergency Department. Give more blue inhaler if needed.
  • If you are no longer concerned about their breathing after 10 puffs, reassess within 4 hours. Give more blue inhaler if needed. Get urgent help if a further 10 puffs is needed within 4 hours.
A flow chart. See the plain text version above or to the right.

Inhaler technique

Choose appropriate sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath).

 

  1. Shake the inhaler well and remove cap.

  2. Fit the inhaler into the opening at the end of the spacer.

  3. Place mask over the child’s face or mouthpiece in their mouth ensuring a good seal

  4. Press the inhaler once and allow the child to take 5 slow breaths between each dose or count to 10

  5. Remove the inhaler and shake between every puff. Wait 1 minute between puffs.

    Repeat steps 1 – 5 for subsequent doses
    Plastic spacers should be washed before 1st use and every month as per manufacturer’s guidelines

What should you do?

  • Keep your child well hydrated by offering them lots to drink
  • Most children with coughs and colds do not require treatment with antibiotics. 
  • If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.
  • Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help.
  • Try using saline nose drops or spray if your baby has a blocked nose. Your local pharamacist may be able to help more.

How long will your child’s symptoms last?

  • Coughs and colds can continue for weeks before they get better.

  • Do you want to know when your child should go to school or nursery? Visit our page.

  • Over the winter, children are likely to get one viral infection after another, which can make you think that they are never well. Things will get better in the summer months.

  • Having a cough for 2 or 3 weeks does not always mean that your child needs antibiotics.

  • Children under 2 years of age with breathing difficulty may have bronchiolitis. This is a common condition that usually starts as a runny nose and cough, but their breathing may get worse over the next 2-3 days.

  • If your child has noisy, harsh breathing, they might have croup.

Where should you seek help?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:-

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand – watch this video with them about going to A&E or riding in an ambulance

Page last updated on: 14th October 2024

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