Difficulty breathing and wheeze
Wheeze is extremely common in young children. It is most often triggered by a viral infection. Most preschool 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. It usually starts with a runny nose and
cough, but their breathing may get worse over the next 2 to 3 days.
For those under 1 year of age, inhalers generally do not help.
If your child has croup (hoarse voice, barking cough, noisy breathing),
they are likely to need assessment by a medical practitioner.
If you already have a salbutamol (blue) inhaler, please follow your
treatment plan.
If your child has been diagnosed with asthma, please see our resources
for how to manage asthma attacks
When should you worry?
If your child has any of the following:
- Is going blue around the lips
- Has pauses in their breathing (apnoeas) or has an irregular breathing pattern or starts grunting
- A harsh breath noise as they breathe in (stridor) present all of the time (even when they are not upset)
- Too breathless to talk / eat or drink
- Becomes pale, mottled and feels abnormally cold to touch
- Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
- Develops a rash that does not disappear with pressure (the ‘Glass Test’)
- Is under 1 month of age with a temperature of 38°C / 100.4°F or above
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has any of the following:
Breathing a bit faster than normal or working a bit harder to breathe
● A harsh noise as they breathe in (stridor) only when upset
● Dry skin, lips or tongue
● Not had a wee or wet nappy in last 8 hours
● Poor feeding in babies (less than half of their usual amount)
● Irritable (Unable to settle them with toys, TV, food or hugs even after their
fever has come down)
● Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
● Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
● Temperature less than 36°C in those over 3 months
● Getting worse and I am still worried
You need to contact a doctor or nurse today.
Please ring your GP surgery or call NHS 111 Wales - dial 111
If symptoms persist and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.
If none of the above features are present
Watch them closely for any change and look out for any red or amber symptoms
● If your child has any other symptoms associated with their fever, you may want to look at the information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache or our other pathways.
Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 Wales– dial 111
What should you do?
How to use your child’s salbutamol inhaler during a wheezy episode:
Help them to sit up. Do not let them lie down. Try to keep them calm.
Help them take one puff of their reliever inhaler (with their spacer, if they use one) every 30 to 60 seconds, up to a total of 10 puffs.
If they do not have their reliever inhaler, or it’s not helping, or if you are worried at any time, call 999 for an ambulance.
If the ambulance has not arrived after 10 minutes and their symptoms are not improving, repeat step 2.
If their symptoms are no better after repeating step 2, and the ambulance has still not arrived, contact 999 again immediately.
Inhaler technique
Click here for videos on inhaler technique.
What else should you do?
• Keep your child well hydrated by offering them lots to drink
• Most children with coughs and colds do not require treatment with antibiotics.
• If your child seems to be in pain or discomfort, you can give your child
Paracetamol or Ibuprofen, following the instructions on the container.
• Do not give cough syrup. It is not recommended for children under 6 years. It
can make children sleepy and does not help.
• Try using saline nose drops or spray if your baby has a blocked nose
• For children over 2 years, vapour rubs (containing camphor, menthol and/or
eucalyptus) may help children sleep better
How long will your child’s symptoms last?
Coughs and colds can continue for weeks before they get better.
• Over the winter, children are likely to get one viral infection after another,
which can make you think that they are never well. Things will get better in the
summer months.
• Having a cough for 2 or 3 weeks does not mean that your child needs
antibiotics
• Children under 2 years of age with breathing difficulty may have bronchiolitis
( This is a common condition that usually starts as a runny nose and
cough, but their breathing may get worse over the next 2-3 days
• If your child has noisy breathing, they might have croup.
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.
- If your child has any of the above features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111 Wales.
- You should only call 999 or go your nearest A&E department in critical or life threatening situations.
For wear and tear, minor trips and everything in between.
Self-care
You can treat your child's very minor illnesses and injuries at home.
Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.
Sound advice
Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.
For information on common childhood illnesses go to What is wrong with my child?
For wear and tear, minor trips and everything in between.
Self-care
You can treat your child's very minor illnesses and injuries at home.
Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.
Sound advice
Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.
For information on common childhood illnesses go to What is wrong with my child?
Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.
Sound advice
- Visit a pharmacy if your child is ill, but does not need to see a GP.
- Remember that if your child's condition gets worse, you should seek further medical advice immediately.
- Help your child to understand - watch this video with them about going to the pharmacy.
For information on common childhood illnesses go to What is wrong with my child?
Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.
Sound advice
- Visit a pharmacy if your child is ill, but does not need to see a GP.
- Remember that if your child's condition gets worse, you should seek further medical advice immediately.
- Help your child to understand - watch this video with them about going to the pharmacy.
For information on common childhood illnesses go to What is wrong with my child?
Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Wales 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.
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?
Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Wales 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.
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.
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.
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.
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.
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.
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 Wales, 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?
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 Wales, 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
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
