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Most babies and older children have several mild infections of the respiratory system each year.
Upper respiratory system
The upper respiratory system includes the nose, mouth, sinuses, and throat. A child with an upper respiratory infection may feel uncomfortable and sound very congested. Other symptoms of an upper respiratory infection include:
- A runny or stuffy nose. This may lead to blockage of the nasal passages, causing the child to breathe through his or her mouth.
- Irritability, restlessness, poor appetite, and decreased activity level.
- Coughing, especially when lying down.
- Fever that occurs suddenly and may reach 105°F (41°C).
Lower respiratory system
The lower respiratory system includes the bronchial tubes and lungs. Respiratory problems are less common in the lower respiratory system than in the upper respiratory system.
Symptoms of a lower respiratory (bronchial tubes and lungs) problem usually are more severe than symptoms of an upper respiratory (mouth, nose, sinuses, and throat) problem. A child with a lower respiratory problem is more likely to require a visit to a doctor than a child with an upper respiratory problem.
Symptoms of lower respiratory system infections include:
- Shallow coughing, which continues throughout the day and night.
- Fever, which may be high with some lower respiratory system infections, such as pneumonia.
- Irritability, restlessness, poor appetite, and decreased activity level.
- Difficulty breathing. You may notice:
- Rapid breathing.
- Grunting, which is heard during the breathing out (exhaling) phase of breathing. Most babies grunt occasionally when they sleep. But grunting that occurs with rapid, shallow breathing may mean lower respiratory system infection.
- Wheezing (which is a different sound than croup).
- Flaring the nostrils and using the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs ( retractions).
Respiratory problems may have many causes.
Viral infections cause most upper respiratory infections. Sore throats, colds, croup, and influenza (flu) are common viral illnesses in babies and older children. These infections are usually mild and go away in 4 to 10 days, but they can sometimes be severe. For more information, see the topics Croup and Influenza (Seasonal Flu).
Home treatment can help relieve the child's symptoms. The infection usually improves on its own within a week and is gone within 14 days.
Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes your child to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.
Viral lower respiratory system infections may be mild, similar to upper respiratory system infections. An example of a possibly serious viral infection is bronchiolitis. Up to 10% of babies and children with viral infections of the lower respiratory system, such as those caused by respiratory syncytial virus (RSV), may develop severe blockage of the air passages and require hospitalization for treatment. For more information, see the topics Acute Bronchitis, Pneumonia, and Respiratory Syncytial Virus (RSV) Infection.
The most common sites for bacterial infections in the upper respiratory system are the sinuses and throat. A sinus infection is an example of an upper respiratory bacterial infection.
Bacterial pneumonia may follow a viral illness as a secondary infection or appear as the first sign of a lower respiratory infection. In babies and small children, the first sign of infection often is rapid breathing, irritability, decreased activity, and poor feeding. Antibiotics are effective against bacterial infections.
Tuberculosis is a less common bacterial infection of the lower respiratory system.
Allergies are a common cause of respiratory problems. Allergy symptoms in children include:
- Clear, runny drainage from the nose or a stuffy nose. Children often rub their noses by pushing the tip upward with the palm of the hand ("allergic salute").
- Sneezing and watery eyes. Often there are dark circles under the eyes ("allergic shiners").
- Irritability and loss of appetite.
Babies and small children usually do not have asthma. But the number of new cases of asthma increases with age.
- In babies and small children, a hacking cough may be the only symptom of mild asthma.
- If asthma worsens, symptoms may include wheezing and shortness of breath after exercise or at nighttime.
- In severe asthma, difficulty breathing (using the neck, chest, and abdominal muscles to breathe) and a high-pitched sound when breathing (wheezing) are the most common symptoms.
- Allergies and asthma often occur together. For more information, see the topic Asthma in Children.
Besides asthma, allergies, and infection, other possible causes of respiratory problems in children include:
- Exposure to cigarette smoke. Tobacco smoke impairs lung growth and development. Children who are exposed to tobacco smoke, even before birth (prenatal), are more likely to have asthma and other respiratory problems.
- Blockage of the airway by an inhaled object, such as food, a piece of a balloon, or a small toy. For more information, see the topic Swallowed or Inhaled Objects.
- Problems that have been present from birth (genetic causes), such as cystic fibrosis.
Babies and children younger than age 3 may have more symptoms with respiratory problems than older children, and they may become more ill. For this reason, younger children need to be watched more closely. The type and severity of the symptoms helps determine whether your child needs to see a doctor.
Check your child's symptoms to decide if and when your child should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Symptoms of serious illness in a baby may include the following:
- The baby is limp and floppy like a rag doll.
- The baby doesn't respond at all to being held, touched, or talked to.
- The baby is hard to wake up.
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it's hard for you to function).
- Shaking chills.
If you're not sure if a child's fever is high, moderate, or mild, think about these issues:
With a high fever:
- The child feels very hot.
- It is likely one of the highest fevers the child has ever had.
With a moderate fever:
- The child feels warm or hot.
- You are sure the child has a fever.
With a mild fever:
- The child may feel a little warm.
- You think the child might have a fever, but you're not sure.
Symptoms of difficulty breathing can range from mild to severe. For example:
- You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
- It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you're at rest (severe difficulty breathing).
Symptoms of difficulty breathing in a baby or young child can range from mild to severe. For example:
- The child may be breathing a little faster than usual (mild difficulty breathing), or the child may be having so much trouble that the nostrils are flaring and the belly is moving in and out with every breath (severe difficulty breathing).
- The child may seem a little out of breath but is still able to eat or talk (mild difficulty breathing), or the child may be breathing so hard that he or she cannot eat or talk (severe difficulty breathing).
Severe trouble breathing means:
- The child cannot eat or talk because he or she is breathing so hard.
- The child's nostrils are flaring and the belly is moving in and out with every breath.
- The child seems to be tiring out.
- The child seems very sleepy or confused.
Moderate trouble breathing means:
- The child is breathing a lot faster than usual.
- The child has to take breaks from eating or talking to breathe.
- The nostrils flare or the belly moves in and out at times when the child breathes.
Mild trouble breathing means:
- The child is breathing a little faster than usual.
- The child seems a little out of breath but can still eat or talk.
A baby that is extremely sick:
- May be limp and floppy like a rag doll.
- May not respond at all to being held, touched, or talked to.
- May be hard to wake up.
A baby that is sick (but not extremely sick):
- May be sleepier than usual.
- May not eat or drink as much as usual.
Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.
Oral (by mouth), ear, or rectal temperature
- High: 104° F (40° C) and higher
- Moderate: 100.4° F (38° C) to 103.9° F (39.9° C)
- Mild: 100.3° F (37.9° C) and lower
A forehead (temporal) scanner is usually 0.5° F (0.3° C) to 1° F (0.6° C) lower than an oral temperature.
Armpit (axillary) temperature
- High: 103° F (39.5° C) and higher
- Moderate: 99.4° F (37.4° C) to 102.9° F (39.4° C)
- Mild: 99.3° F (37.3° C) and lower
Note: For children under 5 years old, rectal temperatures are the most accurate.
You can use a small rubber bulb (called an aspirating bulb) to remove mucus from your baby's nose or mouth when a cold or allergies make it hard for the baby to eat, sleep, or breathe.
To use the bulb:
- Put a few saline nose drops in each side of the baby's nose before you start.
- Position the baby with his or her head tilted slightly back.
- Squeeze the round base of the bulb.
- Gently insert the tip of the bulb tightly inside the baby's nose.
- Release the bulb to remove (suction) mucus from the nose.
Don't do this more than 5 or 6 times a day. Doing it too often can make the congestion worse and can also cause the lining of the nose to swell or bleed.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
Sudden drooling and trouble swallowing can be signs of a serious problem called epiglottitis. This problem can happen at any age.
The epiglottis is a flap of tissue at the back of the throat that you can't see when you look in the mouth. When you swallow, it closes to keep food and fluids out of the tube (trachea) that leads to the lungs. If the epiglottis becomes inflamed or infected, it can swell and quickly block the airway. This makes it very hard to breathe.
The symptoms start suddenly. A person with epiglottitis is likely to seem very sick, have a fever, drool, and have trouble breathing, swallowing, and making sounds. In the case of a child, you may notice the child trying to sit up and lean forward with his or her jaw forward, because it's easier to breathe in this position.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Most children have 7 to 10 mild upper respiratory infections each year. Your child may feel uncomfortable and have a stuffy nose. The infection is usually better within a week and is usually gone within 14 days.
Home treatment is appropriate for mild symptoms and can help your child feel better.
- Keep the room temperature comfortable for you and your child. A hot, dry environment will increase nasal congestion.
- Raise the head of your baby's bed about 1 in. (2.5 cm) to 2 in. (5 cm) by placing blocks under the crib. Do not raise just the mattress because it may leave a gap for your baby to roll into. Do not raise the head of the bed if your baby is younger than 6 months.
- Prevent dehydration.
- Let your baby breastfeed more often or give your baby extra bottles. Liquids may help thin the mucus and also reduce fever (if present).
- Do not awaken your child during naps or at night to take fluids.
- Do not force your child to take fluids, which may cause your child to vomit.
- Give your child extra cuddling and distraction.
- Let your child get extra rest to fight the infection.
- Do not give your child leftover antibiotics or antibiotics or other medicines prescribed for someone else.
- Put a vaporizer or humidifier in your child's room if he or she is breathing through the mouth.
- Lukewarm mist may help your child feel more comfortable by soothing the swollen air passages. It may also help with your child's hoarseness. But do not let your child's room get uncomfortably cold or very damp.
- Use a shallow pan of water to provide moisture in the air through evaporation if you don't have a humidifier. Place the pan where no one will trip on it or fall into it.
- If your child has a stuffy nose:
- Use saline nose drops to help with nasal congestion.
- Use a rubber bulb to suction the nose sparingly. It will help reduce nasal drainage if your baby is having difficulty breastfeeding or bottle-feeding or seems to be short of breath. Babies often do not like having their noses suctioned with a rubber bulb.
- Do not give your child oral antihistamines or decongestants unless directed to do so by your child's doctor. Antihistamines and decongestants can cause your child to behave differently, making it harder to tell how sick he or she really is. Studies show that over-the-counter cough medicines do not work very well. And some of these medicines can cause problems if you use too much of them. It is important to use medicines correctly and to keep them out of the reach of children to prevent accidental use.
- If your child has a cough:
- Honey or lemon juice in hot water or tea may help a dry cough. Do not give honey to a child younger than 1 year old. It may have bacteria that are harmful to babies.
- Be careful with cough and cold medicines. Don't give them to children younger than 6, because they don't work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included. For more information, see Quick Tips: Giving Over-the-Counter Medicines to Children.
- If your child has a barking cough during the night, you can help him or her breathe better using a humidifier or running a hot shower in the bathroom to make the air moist.
Try a nonprescription medicine to help treat your child's fever or pain:
Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your child's doctor if any of the following occur during home treatment:
- Difficulty breathing develops.
- Increased drooling develops.
- Cough gets worse or a persistent cough develops.
- Symptoms become more severe or frequent.
It is common for children to develop respiratory problems (such as viral infections) because they are often exposed to other people who have infections and have not built up immunity. There is no sure way to prevent many respiratory illnesses in babies and children. Very young babies are at greater risk for developing complications from respiratory illnesses, so it is important to do what you can to protect them from exposure. The following may help reduce your child's risk for respiratory problems:
- If you have a respiratory infection, such as a cold or the flu, or if you are caring for someone with a respiratory infection, wash your hands before caring for your child. Hand-washing eliminates the germs on your hands and the spread of germs to your child when you touch your child or touch an object he or she might touch.
- If your child goes to a day care center, ask the staff to wash their hands often to prevent the spread of infection.
- Make sure that your child gets all of his or her vaccinations, especially for diphtheria, tetanus, and pertussis (DTaP) and for Haemophilus influenzae type b (Hib). For more information, see the topic Immunizations.
- Breastfeed your baby for at least the first 6 months after birth, if possible. Breastfed children develop fewer respiratory problems than those who are not breastfed.
- If one of your children is sick, separate him or her from other children in the home, if possible. Put the child in a room alone to sleep.
- Do not smoke or use other tobacco products. If you smoke, quit. If you cannot quit, do not smoke in the house or car. Secondhand smoke irritates the mucous membranes in your child's nose, sinuses, and lungs and increases his or her risk for respiratory infections. For more information, see the topic Quitting Smoking.
- Avoid giving young children food or objects that may be improperly swallowed and inhaled, such as nuts, popcorn, small candies, or small toys. An inhaled object can lead to a respiratory infection. For more information, see the topic Swallowed or Inhaled Objects.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your child's doctor diagnose and treat your child's condition by being prepared to answer the following questions:
- Did the symptoms start as a cold but now appear to be worse than you would expect from a cold?
- What home treatment have you tried? Did it help?
- What nonprescription medicines have you used? Did they help?
- What prescription and nonprescription medicines does your child take?
- Does your child seem to have any symptoms that indicate an infection in one area, such as pain in one ear?
- Has your child had any other recent illnesses?
- Has your child had his or her routine immunizations?
- Does another member of your family have similar symptoms?
- Has your child been eating, sleeping, and playing normally?
- Have you, your child, or another member of your family recently traveled, either inside or outside of the country?
- Does your child have any health risks?
Current as of: June 25, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
John Pope MD - Pediatrics
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine