Overview

Most babies and older children have several mild infections of the respiratory system each year.

Upper respiratory system

The upper respiratory system includes the nose, mouth, sinuses, and throat. A child with an upper respiratory infection may feel uncomfortable and sound very congested. Other symptoms include:

• A runny or stuffy nose. It may lead to blocked nasal passages that cause the child to breathe through the mouth.
• Feeling cranky or restless, having a poor appetite, and being less active than usual.
• Coughing, especially when lying down.
• Fever.

Lower respiratory system

The lower respiratory system includes the bronchial tubes and lungs. These types of problems are less common than ones in the upper respiratory system. But they are usually more severe. They are more likely to need a doctor's care.

Symptoms of lower respiratory system infections include:

• Coughing that lasts through the day and night.
• Fever. It may be high with some infections, such as pneumonia.
• Feeling cranky or restless, having a poor appetite, and being less active than usual.
• Difficulty breathing. You may notice:
  • Rapid breathing.
  • Grunting, which is heard when the child breathes out (exhales). Most babies grunt now and then when they sleep. But grunting that occurs with rapid, shallow breathing may mean a lower respiratory system infection.
  • Wheezing. (This is a different sound than croup.)
  • Using the neck, chest, and belly muscles to breathe. This causes a "sucking in" between or under the ribs (retractions).
  • Flaring the nostrils when breathing.

Respiratory problems may have many causes.

Viral infections

Viral infections cause most upper respiratory infections. Sore throats, colds, croup, and influenza (flu) are common viral illnesses in babies and older children. These infections are usually mild and go away in 4 to 10 days. But sometimes they can be severe.

Home treatment can help relieve the child's symptoms. The infection usually improves on its own within a week and is gone within 14 days.

Antibiotics aren't used to treat viral illnesses. They don't change the course of viral infections. Using an antibiotic when it's not needed exposes your child to the risks of an allergic reaction and antibiotic side effects. These side effects include nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill helpful bacteria and encourage the growth of dangerous antibiotic-resistant bacteria.

Viral lower respiratory system infections may be mild, similar to upper respiratory system infections. An example of a possibly serious viral infection is bronchiolitis. Up to 10% of babies and children with viral infections of the lower respiratory system, such as those caused by respiratory syncytial virus (RSV), may have severe blockage of the air passages. They need treatment in a hospital.

Bacterial infections

The most common sites for bacterial infections in the upper respiratory system are the sinuses and throat.

Bacterial pneumonia may follow a viral illness as a secondary infection. Or it can appear as the first sign of a lower respiratory infection. In babies and small children, the first sign of infection often is rapid breathing, crankiness, being less active than usual, and poor feeding. Antibiotics work well against bacterial infections.

Allergies

Allergies are a common cause of respiratory problems. The symptoms in children include:

• Clear, runny drainage from the nose or a stuffy nose. Children often rub their noses by pushing the tip upward with the palm of the hand ("allergic salute").
• Sneezing and watery eyes. Often there are dark circles under the eyes ("allergic shiners").
• Crankiness and loss of appetite.

Asthma

Babies and small children usually don't have asthma. But the number of new cases of asthma increases with age.

• In babies and small children, a hacking cough may be the only symptom of mild asthma.
• If asthma gets worse, symptoms may include wheezing and shortness of breath after exercise or at nighttime.
• In severe asthma, the most common symptoms are trouble breathing (using the neck, chest, and belly muscles to breathe) and a high-pitched sound when breathing (wheezing).
• Allergies and asthma often occur together.

Other causes

Besides asthma, allergies, and infection, other possible causes of respiratory problems in children include:

• Exposure to cigarette smoke. Tobacco smoke impairs lung growth and development. Children who are exposed to this smoke, even before birth (prenatal), are more likely to have asthma and other respiratory problems.
• Blockage of the airway by an inhaled object, such as food, a piece of a balloon, or a small toy.
• Problems that have been present from birth (genetic causes), such as cystic fibrosis.

Babies and children younger than age 3 may have more symptoms with respiratory problems than older children. And they may become more ill. For this reason, younger children need to be watched more closely. What type of symptoms your child has and how severe they are will help you know if your child needs to see a doctor.

Self-Care

Most children have 7 to 10 mild upper respiratory infections each year. Your child may feel uncomfortable and have a stuffy nose. The infection is usually better within a week and is usually gone within 14 days.

Here are some things you can do to ease mild symptoms and help your child feel better.

• Be safe with medicines. Read and follow all instructions on the label.
  • Ask your doctor if you can give your child acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Do not use ibuprofen if your child is less than 6 months old unless the doctor gave you instructions to use it.
  • Do not give aspirin to anyone younger than 20. It has been linked to Reye syndrome, a serious illness.
  • Be careful with cough and cold medicines. Don't give them to children younger than 6, because they don't work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included.
  • Be careful when giving your child over-the-counter cold or flu medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. Read the labels to make sure that you are not giving your child more than the recommended dose. Too much acetaminophen (Tylenol) can be harmful.
  • Don't give your child leftover antibiotics. And don't give your child antibiotics or other medicines prescribed for someone else.
• Have your child drink plenty of water and other fluids.

  This may help soothe a dry or sore throat. Honey or lemon juice in hot water or tea may ease a dry cough. Do not give honey to a child younger than 1 year old. It may contain bacteria that are harmful to infants.

• Try moist air.

  Place a cool-mist humidifier by your child's bed or close to your child. This may make it easier for your child to breathe. Follow the directions for cleaning the machine.

• Treat a stuffy nose.
  • If your child has problems breathing because of a stuffy nose, squirt a few saline (saltwater) nasal drops in one nostril. Then have your child blow their nose. Repeat for the other nostril. Do not do this more than 5 or 6 times a day.
  • For babies and children who aren't able to blow their nose, put a few saline drops in one nostril. Using a soft rubber suction bulb, squeeze air out of the bulb and gently place the tip of the bulb inside the baby's nose. Relax your hand to suck the mucus from the nose. Repeat in the other nostril.
• Make sure your child rests.

  Keep your child at home if they have a fever.

• Keep your child away from smoke.

  Do not smoke or let anyone else smoke around your child or in your home.

Using decongestants

Here are some precautions to take when using decongestants.

• Be safe with medicines. Read and follow all instructions on the label.
• Decongestants may not be safe for young children. The U.S. Food and Drug Administration (FDA) recommends not using over-the-counter cough and cold medicines in children younger than age 2. The FDA also recommends avoiding these medicines for children younger than age 4.^{footnote 1} If you use these medicines, always follow the directions about how much to use based on age and in some cases weight. Not everyone needs the same amount of medicine.
• Decongestants can cause problems for people who have certain health problems, such as heart disease, high blood pressure, glaucoma, diabetes, or an overactive thyroid. Decongestants may also interact with some drugs, such as certain antidepressants and high blood pressure medicines. Read the package carefully or ask your pharmacist or doctor to help you choose the best decongestant for you.
• Drink extra fluids when you are taking cold and allergy medicines.
• Don't use decongestant nasal sprays, drops, or gels more times in one day or for more days in a row than the label says. Overuse can cause rebound congestion. It makes your mucous membranes swell up more than before you used the spray.
• If you are pregnant or breastfeeding, check with your doctor or pharmacist before using a decongestant.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse trouble breathing.
• New wheezing.
• New or worse cough.
• Symptoms occur more often or are more severe.

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