Difficulty breathing and wheeze

It is extremely scary to see your child with any sort of breathing difficulty.

Use your instincts, if your child:

  • appears well and their breathing difficultly improves after a short period, there is normally no need to worry
  • is struggling to breath and not improving after a short period, they need to be urgently seen by a medical practitioner and are likely to need treatment.
  • has croup (hoarse voice, barking cough, noisy breathing), they will also need to be seen by a medical practitioner

Wheeze is extremely common in young children and is most often triggered by a viral infection. Most pre-school 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 that usually starts as a runny nose and cough, but their breathing may get worse over the first 2-3 days
  • Children over 4 years of age with breathing difficulty may have asthma
  • Most chest infections are caused by viruses and do not usually need treatment with antibiotics

Related topics: asthmabronchiolitiscough and coldsCovid-19croup

 

 

 

When should you worry?

If your child has any of the following:

  • Breathing very fast or breathing that stops or pauses
  • Working hard to breathe, drawing in of the muscles below the rib, unable to talk or noisy breathing (grunting)
  • A harsh breath noise as they breathe in (stridor) present all of the time (even when they are not upset)
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite 10 puffs blue (salbutamol) inhaler every 4 hours via a spacer

  • Becomes pale, blue, mottled and/or unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched, continuous cry or extremely agitated
  • Has a fit (seizure)
  • A temperature less than 36oC or temperature 38oC or more if baby is less than 3 months
  • Develops a rash that does not disappear with pressure and seems unwell (see the 'Glass Test')

You need urgent help

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

If your child has any of the following:

  • Blue (salbutamol) inhaler 2-5 puffs via a spacer is not lasting 4 hours
  • Cough or wheeze/tight chest during the day and night
  • Too breathless to run/play/do normal activities
  • Breathing a bit faster than normal or working a bit harder to breathe
  • A harsh breath noise as they breathe in (stridor) present only when they are upset
  • Dry skin, lips, tongue or looking pale
  • Not had a wee or wet nappy in last 12 hours
  • Sleepy or not responding normally
  • Crying and unsettled
  • Poor feeding (babies) or not drinking(children)
  • A temperature 39oC or above in babies 3-6 months
  • Temperature of 38oC or above for more than 5 days or shivering with fever(rigors)
  • Getting worse or you are worried about them

You need to contact a doctor or nurse today

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

We recognise that during the current COVID-19 crisis, at peak times, access to a health care professional may be delayed. 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 111 staff, then consider taking them to your nearest Emergency Department

If your child has none of the above

Watch them closely for any change and look out for any red or amber symptoms

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

This guidance has been reviewed and adapted by healthcare professionals across North East and North Cumbria with consent from the Hampshire development groups.

What should you do?

  • If your child is interacting with you normally and is able to drink as normal, you can watch them closely at home. If your child is not feeding as well as normal, you should offer smaller feeds but more frequently
  • If they become more breathless or are struggling to drink, they will need to be seen urgently by a medical practitioner. Call your GP surgery or NHS 111
  • If your child has a fever, their breathing may become more rapid. You should try to lower their temperature using paracetamol
  • If your child feels or looks breathless and sounds wheezy, give up to 10 puffs of salbutamol (blue inhaler) via a spacer device. Whilst unwell, you may need to give this every 4 hours for the first few days
  • Consider contacting your child’s GP early on in the illness to see if your child would benefit from any other medicines such as a steroid (taken by mouth) to help their breathing.
  • If your child becomes too breathless to speak or drink, or they need 10 puffs of their blue inhaler more often than every 4 hours, please go directly to your nearest Hospital Emergency Department or phone 999

How long will your child’s symptoms last?

  • Although your child’s cough is likely to last for 2 to 3 weeks, they should not be breathless or wheezy for more than 3 or 4 days
  • The charts below show how long croup or bronchiolitis last in children. The faces represent 10 children who have croup or bronchiolitis. Green faces are those children who have recovered within that time period

The diagrams above are taken from www.whenshouldiworry.com

Where should you seek help?

  • If it is non-urgent, speak to your local pharmacist or health visitor
  • Follow the advice in the red, amber and green boxes above

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.

Click below to find information on your local health visiting team: 

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

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.

What the school nursing service deliver may vary depending on your local area offer. Click the link below to find information on your local school nursing team: 

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

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
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