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Respiratory Problems, Age 11 and Younger

Topic Overview

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

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.

Bacterial infections

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

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.

Asthma

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.

Other causes

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 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

Home Treatment

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 breast-feed 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 breast-feeding 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, including any products with menthol. They may not be safe for young children, so check the label first. If you do give these medicines to a child, always follow the directions about how much to give based on the child's age and weight. 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 by following the home treatment for a barking cough.
Medicine you can buy without a prescription
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.
Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all labels on the medicine bottle and box.
  • Give, but do not exceed, the maximum recommended doses.
  • Do not give your child a medicine if he or she has had an allergic reaction to it in the past.
  • Do not give aspirin to anyone younger than age 20 unless directed to do so by your child's doctor.
  • Do not give naproxen (such as Aleve) to children younger than age 12 unless your child's doctor tells you to.

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.

Prevention

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.
  • Breast-feed your baby for at least the first 6 months after birth, if possible. Breast-fed children develop fewer respiratory problems than those who are not breast-fed.
  • 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 Objects.
  • For information on preventing allergies or asthma, see the topic Allergic Rhinitis or Asthma in Children.

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?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer David Messenger, MD
Last Revised May 4, 2012

Last Revised: May 4, 2012

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Messenger, MD

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