The signs of more serious breathing problems can be both obvious and subtle. These four are particularly worth noting so you can promptly take the proper steps to address them.
Blue/Gray Skin
Central cyanosis is blue or gray coloring to the skin of the face or chest. It can occur in children of all ages and may be a sign of a respiratory or cardiovascular disorder.
It is pretty obvious to most parents that if their child turns blue, they are probably having breathing problems. But central color change is the most important thing to look for, not just brief changes in fingers or toes.
What to Do
Call 911 immediately. If there is central discoloration to the child’s skin, it is not safe to drive them to an emergency room. The child could stop breathing on the way and they will get care more quickly if you call an ambulance.
Wheezing
Wheezing, or a high-pitched whistling sound made when a person exhales, is a significant sign that a child is having breathing problems. Although congestion may be heard when a person is breathing, true wheezing is a whistling noise. Wheezing in young children is most frequently caused by bronchiolitis, which is a common lung infection, or asthma.
What to Do
If your child has no history of wheezing, seek medical attention right away. Wheezing is not something that will go away on its own and it is not safe to wait several hours. Wheezing can progress quickly and your child’s oxygen levels can become dangerously low.
If your child does have a history of wheezing and you have a fast-acting inhaler or nebulizer, you may try using it as directed by your child’s doctor. If that eliminates the wheezing, you may then contact them and ask what they recommend for further treatment.
Intercostal Retracting
When looking at the chest of a child with retractions, you may notice a skeletal appearance. The skin pulls in and out between each rib with each breath and you may actually be able to count ribs. Intercostal retracting in children can be a sign of a respiratory illness or a blocked airway.
If a child is overweight, it may be difficult to determine if there is retracting around the chest wall. Another way to determine if there is retraction is to look at the neck and collarbone. If you can see the skin pulling down to the collarbone, or it looks like the child is straining their neck muscles with each breath, they are probably having significant breathing problems.
What to Do
If there is significant retracting—you can see nearly all of the child’s ribs from a few feet away—and the child is not fully alert, you should call 911. This is a sign that the child is in severe respiratory distress and making this call is the fastest and safest way to get help.
If there is minimal retracting, but your child has no history of wheezing or using inhalers or nebulizers, you should seek medical attention immediately. If the child is awake and alert, it is most likely safe to drive them yourself, but always have someone else in the car and a cell phone handy in case the situation changes.
If there is minimal retracting and your child has an inhaler or nebulizer available, giving a breathing treatment is reasonable to see if the retracting resolves. If it does, you can then call your child’s healthcare provider to get instructions for further treatment.
Nasal Flaring
When a child is congested, you may notice their nostrils flaring in and out with each breath. Nasal flaring may be seen in children with colds and may or may not be a sign that he or she is having breathing problems.
What to Do
The first thing you should do if you notice your child’s nostrils flaring is to try suctioning the nose out with saline drops and a bulb syringe. (If your child is old enough, you can alternatively just have them blow their nose.)
Using a drop or two of saline in one nostril, gently suction the congestion out, then repeat these steps in the other nostril. This may help clear up the nasal flaring. If it does not, contact your child’s doctor or seek medical attention right away.
