Breathing Difficulties in Children: A Parent’s Guide
There are few things more frightening for a parent than watching their child struggle to breathe. Whether it’s a strange noise, labored breathing, or a sudden change in your child’s color or alertness, breathing difficulties demand attention, and understanding.
This guide is designed to help parents recognize what normal breathing looks like, understand what can go wrong, and know when it’s time to seek specialist care.
What is the Airway?
The airway is the tube that allows air to pass in and out of the body. It begins at the voice box (larynx) and branches into progressively smaller tubes within the lungs.
Each of these tiny tubes ends in a small air sac called an alveolus, where oxygen is transferred into the bloodstream and carbon dioxide is released.
How Do We Breathe?
Breathing is the process of drawing oxygen-rich air into the lungs and releasing carbon dioxide back out. Inhaling requires the use of breathing muscles, and the oxygen taken in is transferred from the lungs into the bloodstream. We can increase oxygen intake by breathing faster or taking deeper breaths.
While we can control our breathing voluntarily, the brain also regulates it automatically through the respiratory center, which is why we continue breathing normally even while asleep.
For breathing to work properly, the brain, heart, lungs, breathing muscles, and airway must all function together. A problem with any one of these can lead to breathing difficulties.
What Can Cause Breathing Difficulties?
Breathing problems can originate from several different parts of the body:
- The brain: If the respiratory center in the brain isn’t functioning normally, breathing difficulties can occur even when everything else is working. Causes include head trauma, increased brain pressure, certain drugs, and chemical imbalances in the blood.
- The heart: If the heart has difficulty pumping blood to the lungs or throughout the body, oxygen delivery is compromised. Examples include structural heart defects, valve problems, and congestive heart failure.
- The lungs: Conditions like pneumonia or cystic fibrosis can prevent the lungs from effectively transferring oxygen into the bloodstream, even when air is reaching them.
- The breathing muscles: If the muscles used for breathing are weak or paralyzed, breathing difficulties can result. This can be caused by certain medications, nerve damage, or neurological disease.
- The airway: Anything that blocks or restricts air from reaching the lungs. Causes include infections, foreign bodies, allergic rhinitis, allergies/hay fever, and congenital abnormalities of the airway.
What Does a Child Look Like When They’re Having Trouble Breathing?
For the child, breathing difficulty is often described as feeling out of breath or needing more air. For a parent observing their child, the signs can vary depending on the cause and the child’s age.
Generally, a child having difficulty breathing will appear anxious and will be breathing faster than normal.
They may be making noises with each breath.
In severe cases, the tongue, lips, or skin may take on a bluish color and the child may become less responsive.
In younger children specifically, the ribs may become more visible with each breath, the belly may protrude, and the nostrils may flare.
If your child shows any of these signs, seek medical attention immediately.
What Does a Child Sound Like When They’re Having Trouble Breathing?
The sounds associated with breathing difficulty can actually help identify where in the airway the problem is occurring.
The airway is divided into the upper airway (which includes the nasal passages, mouth, and upper throat) and the lower airway, which includes the voice box, windpipe, and the branching airways within the lungs.
Upper Airway
Nasal passages: Obstruction here produces a congested, snoring-type sound known medically as stertor. This can be caused by a nasal obstruction, nasal deformities, and adenoid hypertrophy.
Mouth and Upper Throat
The tonsils and adenoids are located in this area. Enlargement of either can cause a muffled voice, snoring with pauses in breathing (apnea), and noisy breathing during the day.
In children under three to four years of age, a collection of pus behind the throat, called a retropharyngeal abscess, can develop and must be drained promptly to prevent the airway from becoming fully blocked.
Voice Box (Larynx)
The larynx contains the vocal cords, and problems here can produce a range of sounds depending on the exact location of the obstruction.
Above the vocal cords, blockage typically results in a muffled voice and coarse sounds during inhalation known as inspiratory stridor. The most common cause of this in infants is laryngomalacia, a condition where the tissue around the voice box is floppy.
A more serious but now rare cause is epiglottitis, a bacterial infection that can block the entire airway.
At the level of the vocal cords, the second most common cause of stridor in infants is vocal cord paralysis. If one cord is affected, the voice may sound weak or breathy. If both are paralyzed, stridor or hoarseness can be quite pronounced.
Below the vocal cords, obstruction produces a high-pitched noise on both inhaling and exhaling. One of the more common causes is croup, a viral infection identifiable by its characteristic barking cough.
Other causes include airway narrowing, tissue webs, hemangiomas, or foreign bodies.
Windpipe (Trachea)
Obstruction here tends to produce noisy breathing on exhalation. Causes include infections, foreign bodies, abnormal blood vessels wrapping around the trachea, or congenital abnormalities resulting in a floppy or narrowed windpipe.
Lower Airway
Bronchi and Bronchioles
Once obstruction moves into the smaller branching airways, the characteristic sound shifts to a musical wheeze, typically heard on exhalation. Common causes include bronchitis, asthma, bronchiolitis, and foreign bodies.
Alveoli
Obstruction at the level of these tiny air sacs produces a crackling sound heard through a stethoscope, as the sacs pop open and closed with each breath. Pneumonia is one of the more common causes, along with any condition that allows fluid to build up in the lungs.
When Would a Child Be Referred to an ENT for Breathing Difficulties?
Many causes of breathing difficulty can only be accurately diagnosed by directly examining the airway, something a pediatric ENT specialist is uniquely qualified to do.
Through a procedure called direct laryngoscopy and bronchoscopy, the entire airway can be examined, abnormalities identified, and in some cases treated in the same procedure.
Causes of stridor such as laryngomalacia and vocal cord paralysis, as well as hoarseness, can also be evaluated through flexible laryngoscopy or video stroboscopy.
Treatment for breathing difficulties is always tailored to the individual child. Every case is different, and after a thorough evaluation, your pediatric ENT surgeon will outline the most appropriate options for your child’s specific situation.
How MPENTA Can Help
At Michigan Pediatric ENT Associates (MPENTA), our team has extensive experience evaluating and treating the full range of airway and breathing conditions in children, from nasal obstruction and adenoid hypertrophy to laryngomalacia, vocal cord paralysis, and beyond.
If your child is experiencing breathing difficulties and you are looking for answers, we encourage you to reach out and schedule a consultation at a location near you.
This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
