A child who is having severe difficulty breathing:

• Breathes very fast or grunts with each breath.
• Appears anxious or exhausted during feeding or is unable to nurse or take a bottle.
• Uses the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
• May flare the 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).

Call 911 or emergency services if these signs are present.