Difficulty Breathing / Noisy Breathing

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Noisy breathing is very common in young children. It is most often caused by a viral infection.

Your child might have symptoms of a cold such as a blocked or runny nose, a cough, and a slightly high temperature (fever) first.

Children under 2 years of age with breathing difficulty may have bronchiolitis. This is an very common condition that starts as a cold. Their breathing may get worse over the next 2-3 days. Your child may look like this.

Your child might have symptoms of a hoarse voice, barking cough and noisy breathy like this.

When should I get help?

Use the traffic light table to know what to do if your child is unwell.


If your child has any of the following: Has blue lips Has pauses in their breathing (apnoeas) or has an irregular breathing pattern or starts grunting Has a harsh noise as they breathe in (stridor) present all of the time (even when they are not upset) Is too breathless to talk / eat or drink Is pale, mottled (blotchy rash) and feels cold to touch Is agitated (crying inconsolably despite distraction), confused or very hard to wake Has a rash that does not go away when you press on it (the ‘Glass Test’) Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless within 48 hours of having their vaccinations)	You need help now Go to the nearest Hospital Emergency Department or phone 999

If your child has any of the following:

Has blue lips
Has pauses in their breathing (apnoeas) or has an irregular breathing pattern or starts grunting
Has a harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
Is too breathless to talk / eat or drink
Is pale, mottled (blotchy rash) and feels cold to touch
Is agitated (crying inconsolably despite distraction), confused or very hard to wake
Has a rash that does not go away when you press on it (the ‘Glass Test’)
Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless within 48 hours of having their vaccinations)

You need help now

Go to the nearest Hospital Emergency Department or phone 999


If your child has any of the following: Has fast breathing or they are working hard to breathe – pulling in below their lower ribs, at their neck or between their ribs (recession). A harsh noise as they breathe in (stridor) you only hear when they are upset Seems dehydrated (has sunken eyes, a dry mouth, hard to wake or not had a wee for 12 hours) Is very sleepy or irritable (you are unable to settle them with toys, TV, food or by picking them up) – especially if they are still drowsy or irritable after their fever has come down Has extreme shivering or complains of muscle pain Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (fever is common in babies up to 2 days after they have had their vaccinations) Has a fever of 38.0°C or above for 5 or more days Is getting worse or if you are worried	You need to see a doctor or nurse today. Please ring your GP surgery or call NHS 24 - dial 111 If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 24 staff, then consider taking them to your nearest ED.

If your child has any of the following:

Has fast breathing or they are working hard to breathe – pulling in below their lower ribs, at their neck or between their ribs (recession).
A harsh noise as they breathe in (stridor) you only hear when they are upset
Seems dehydrated (has sunken eyes, a dry mouth, hard to wake or not had a wee for 12 hours)
Is very sleepy or irritable (you are unable to settle them with toys, TV, food or by picking them up) – especially if they are still drowsy or irritable after their fever has come down
Has extreme shivering or complains of muscle pain
Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (fever is common in babies up to 2 days after they have had their vaccinations)
Has a fever of 38.0°C or above for 5 or more days
Is getting worse or if you are worried

You need to see a doctor or nurse today.

Please ring your GP surgery or call NHS 24 - dial 111

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 24 staff, then consider taking them to your nearest ED.


If your child has none of the red or amber features	Self care You can keep looking after them at home. If you are still concerned about your child, call NHS 111 – dial 111

If your child has none of the red or amber features

Self care

You can keep looking after them at home. If you are still concerned about your child, call NHS 111 – dial 111

What should I do?

Offer smaller feeds more often. If your child is under 6 months of age keep giving them milk. If your child is over 6 months old and is not eating make sure that they are having some sugary fluids or milk
Keep them upright and comfortable
Offer them paracetamol and / or ibuprofen if they are in distress
Follow the instructions on the medicine for how much to give and how often. Both are very safe when used in the right way. If your child has too much medicine or takes it too often it can be harmful.
If you think your child has taken too much medicine phone NHS 111
Ask your local pharmacist if you want more advice about medicines for your child

How long will my child's symptoms last?

Most children with bronchiolitis will seem to get worse during the first 1-3 days of the illness. They often begin to improve over the next two weeks. The cough may go on for a few more weeks.
If your child has croup the barking cough should settle in 1-3 days
Noisy breathing from a cough or cold with a blocked nose might may last 1-2 weeks
Your child can go back to nursery or day care as soon as he or she is well enough. (feeding as normal and with no difficulty in breathing)
If you are worried your child is unwell or is not getting better see your doctor

Where should I get help?

If it is non urgent, speak to your local pharmacist or health visitor.
If your child has any of the above red or amber features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111.
You should only call 999 or go your nearest emergency department in critical or life threatening situations.

Self Care
For wear and tear, minor trips and everything in between. Self-care You can treat your child's very minor illnesses and injuries at home. Some illnesses can be treated in your own home with support and advice from the services listed when needed. Use any medicines recommended by your pharmacist or doctor. Make sure your child gets plenty of rest.	Sound advice Children can get better from illness quickly but also can become more poorly quickly. it is important to get further advice if your child's condition gets worse. More information on common childhood illnesses.
Local Pharmacist
Pharmacists are experts in many aspects of healthcare. They are the first port of call for minor ailments and can provide advice and medication (if needed) for a wide range of long term conditions and common ailments including coughs and colds. Pharmacy First is a free service. You do not need an appointment and many pharmacies have a private consultation area. Your pharmacist will let you know if you need further medical attention.	Sound advice Visit a pharmacy if your child is ill, but does not need to see a GP. Remember that if your child's condition gets worse, you should seek further medical advice immediately. Help your child to understand - watch this video with them about going to the pharmacy.
Health Visitor
Health visitors are nurses or midwives who are passionate about promoting healthy lifestyle and preventing illness through the Universal Health Visiting Pathway. They work with you through your pregnancy up until your child is ready to start school. Your health visitor may be able to refer you on to other health professionals, for example if there are hearing or vision concerns. Contact them by phoning your local health visiting team.	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?
GP (General Practitioner)
GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.	Sound advice You have a choice of service: Doctors/GPs can treat many illnesses that do not warrant a visit to the Emergency Department. For minor injuries such as cuts that need stitches, broken bones, sprains and minor burns in children aged 5 or over, go to one of our Minor Injury Units (MIU).
NHS 24
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 24 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.
Emergency Department
Emergency 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 Many visits to the Emergency Department and calls to 999 could be resolved by any other NHS services. If your child's condition is not critical, choose another service to get them the best possible treatment. Help your child to understand – watch this video with them about going to the Emergency Departmen t or riding in an ambulance