04/04/2013
It can be incredibly worrying when your little one develops a cough or any kind of breathing difficulty. While a simple cough is often a sign of a common cold, sometimes it can be accompanied by or mistaken for wheezing, a more concerning respiratory symptom. Understanding the difference between a cough and wheezing, and recognising when to seek professional help, is crucial for every parent. This article will guide you through the signs to look out for, what might be causing these symptoms, and importantly, when you should seek medical attention for your baby.
Understanding Baby Coughs and Wheezing
Babies' respiratory systems are still developing, making them more susceptible to various infections and breathing irregularities. A cough is typically a reflex action to clear the airways of mucus or irritants. It can sound dry and hacking, or wet and chesty. Wheezing, on the other hand, is a high-pitched whistling sound made when air moves through narrowed airways. This narrowing is often caused by inflammation or mucus in the smaller airways of the lungs.
Key Differences: Cough vs. Wheeze
While both can be symptoms of a cold or infection, they indicate different issues:
| Symptom | Description | Typical Cause |
|---|---|---|
| Cough | A forceful expulsion of air from the lungs. Can be dry, wet, hacking, or barking. | Common cold, post-nasal drip, irritation. |
| Wheezing | A high-pitched whistling sound, usually heard during exhalation, indicating narrowed airways. | Bronchiolitis, asthma (less common in very young children), viral infections affecting smaller airways. |
Signs Your Baby May Be Wheezing
Beyond the sound itself, there are several tell-tale signs that your baby might be struggling with their breathing due to narrowed airways. It's important to observe your baby closely:
- Breathing very fast: An increased respiratory rate is a common indicator that your baby is working harder to breathe. Newborns naturally breathe faster than older children and adults, but a sustained, rapid breathing pattern when they are unwell is a concern.
- Flaring their nostrils: When a baby struggles to get enough air, they may widen their nostrils with each breath to try and take in more oxygen.
- Grunting with the effort of trying to breathe: A grunting sound, especially when breathing out, can be a sign of respiratory distress. It's often a subconscious effort to keep the airways open.
- Drawing in the muscles below the ribs (recession): This is a significant sign of respiratory effort. You might see the skin below the ribcage pull inwards with each breath as the baby uses accessory muscles to help them breathe. This is also known as 'intercostal recession'.
- Stridor: A harsh, high-pitched noise heard when breathing in. This is different from wheezing, which is typically heard when breathing out, and indicates upper airway obstruction.
When Should You Worry?
It's natural to feel anxious when your baby is unwell. While most mild coughs and colds resolve on their own, certain symptoms warrant immediate medical attention. Trust your parental instincts; if something feels seriously wrong, it's always best to get it checked.
Red Flags: Call 999 or Go to A&E Immediately
Contact emergency services or go to the nearest Accident and Emergency department if your baby exhibits any of the following severe symptoms:
- Signs of working hard to breathe: This includes breathing very fast, nostril flaring, grunting, or recession (drawing in of muscles below the ribs or at the neck).
- Going blue around the lips: This indicates a lack of oxygen and is a critical emergency.
- Long pauses in their breathing (more than 10 seconds) or an irregular breathing pattern: While brief pauses can be normal in newborns, prolonged or irregular pauses are a serious concern.
- Stridor that is present all the time: A persistent harsh breathing sound on inhalation.
- Too breathless to talk, feed, or drink: If your baby is too unwell to maintain normal feeding, this is a significant warning sign.
- Becomes pale, mottled, and feels abnormally cold to touch: These can be signs of poor circulation or shock.
- Becomes extremely agitated (crying inconsolably), confused, floppy, or very lethargic (difficult to wake): Changes in behaviour and consciousness levels are serious indicators.
- Develops a rash that does not disappear with pressure (the ‘Glass Test’): A non-blanching rash can indicate serious infections like meningitis.
- Under 3 months of age with a temperature of 38°C / 100.4°F or above: (Unless it's a fever in the 48 hours following vaccinations with no other concerning symptoms).
When to Call 111 or Seek an Urgent GP Appointment
For less severe, but still concerning symptoms, contact NHS 111 or your GP surgery for urgent advice:
- Laboured or rapid breathing, or working hard to breathe: Look for recession (drawing in of muscles below the lower ribs, at the neck, or between the ribs).
- Stridor present only when upset: Intermittent stridor might indicate a less severe upper airway irritation.
- Seems dehydrated: Signs include sunken eyes, drowsiness, or not passing urine for 12 hours.
- Becoming drowsy or irritable: Especially if this persists even when their fever comes down.
- Extreme shivering or complains of muscle pain: While less common in babies who cannot verbalise pain, signs like extreme shivering are notable.
- 3 to 6 months of age with a temperature of 39°C / 102.2°F or above: (Remember fever is common after vaccinations).
- Continues to have a fever of 38.0°C or above for more than 5 days.
- Your baby's condition is getting worse or you are simply worried.
Common Causes of Wheezing in Babies
Wheezing is quite common in young children, particularly those under two years old. The most frequent culprit is bronchiolitis, a viral infection that affects the small airways in the lungs. It typically starts with cold-like symptoms such as a runny nose and cough, and the breathing difficulties can worsen over a few days.
Other viral infections can also cause temporary wheezing. While it's scary, it's important to remember that most preschool children who wheeze do not have asthma. Asthma is a chronic condition, and while it can manifest in early childhood, it's less common as the primary cause of wheezing in infants compared to viral infections.
Croup vs. Bronchiolitis
It's also helpful to distinguish between croup and bronchiolitis, as they present differently:
| Symptom | Croup | Bronchiolitis |
|---|---|---|
| Cough Sound | Barking, seal-like cough. | Often a persistent, sometimes wet, cough. |
| Breathing Noise | Stridor (noisy, harsh sound on inhalation), often worse when crying or upset. | Wheezing (whistling sound on exhalation), sometimes crackles. |
| Onset | Can be sudden, often worse at night. | Usually follows cold-like symptoms, gradually worsening over 2-3 days. |
| Voice | Hoarse voice. | Usually normal voice. |
Both croup and bronchiolitis require medical assessment if symptoms are severe. Croup, with its characteristic barking cough and stridor, often needs to be seen by a doctor.
Home Care and Monitoring
If your baby's symptoms are mild and they are not exhibiting any of the red flags mentioned earlier, you can manage their care at home:
- Hydration: Ensure your baby stays well-hydrated by offering plenty of fluids. For babies, this means continuing with breast milk or formula. If they are not feeding as well as usual due to breathlessness, try offering smaller, more frequent feeds.
- Fever Management: If your baby has a fever, their breathing might become more rapid. You can use infant paracetamol (like Calpol) to help lower their temperature, following dosage instructions carefully.
- Rest: Ensure your baby gets plenty of rest.
- Monitor Closely: Keep a very close eye on your baby for any signs of deterioration. If they start to struggle more with breathing, feeding, or become more lethargic, seek medical advice promptly.
How Long Will Symptoms Last?
While a cough can linger for two to three weeks after a viral infection, the more concerning symptoms like breathlessness and wheezing should ideally not last more than three to four days. If these symptoms persist or worsen beyond this timeframe, it's essential to consult a healthcare professional.
The duration of conditions like croup and bronchiolitis can vary. Generally, most children recover within a week or two, but some may experience lingering symptoms.
When Antibiotics Aren't the Answer
It's important to understand that most chest infections and viral illnesses in babies and children do not require antibiotics. Antibiotics are only effective against bacterial infections. Since the vast majority of coughs, colds, and wheezing episodes in infants are caused by viruses, antibiotics will not help and can sometimes cause side effects. Always follow your doctor's advice regarding medication.
Seeking Professional Help
Navigating your baby's health can be daunting. Remember that general advice is available from the NHS website and your local pharmacy. However, when it comes to breathing difficulties, especially in infants, it's always better to err on the side of caution. If you are ever in doubt about your baby's well-being, do not hesitate to contact your GP, NHS 111, or in emergencies, call 999.
Watching your baby struggle for breath is one of the most frightening experiences a parent can have. By understanding the signs of coughing versus wheezing, recognising the red flags, and knowing when and where to seek help, you can provide the best possible care for your little one.
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