Difficulty breathing can occur when a child's lungs or heart are not working well.

Symptoms of mild difficulty breathing

The child:

• Breathes slightly faster than normal. Most healthy children breathe less than 40 times each minute.
• Uses his or her stomach muscles more than normal to help with breathing.
• Has normal skin color in his or her face, hands, and feet.

Symptoms of moderate difficulty breathing

The child:

• Breathes fast.
• Tires during feeding and may stop often to catch his or her breath. This may cause the child to lose interest in food and eat less.
• Needs to use his or her stomach muscles to help with breathing.
• Has pale, slightly gray, or blotchy skin, particularly the face, hands, and feet. The tongue, gums, and lips still look pink.

Symptoms of severe difficulty breathing

The child:

• Breathes very fast or grunts with each breath.
• Looks anxious or exhausted during feeding or is unable to nurse or take a bottle.
• Uses his or her neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
• May flare his or her nostrils when breathing in.
• May need to sit up and lean forward or tilt the nose up as if sniffing the air.
• May fight any attempt to change his or her position.
• Has pale, gray, or bluish skin (especially the tongue, lips, earlobes, and nail beds), or the skin is mottled (patchy pale and blue pattern).