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This is a life-threatening emergency. Call 911 immediately, then follow these steps while waiting for help.
Breathing Emergency (Respiratory Distress)
Content reviewed against published AAP, AHA, NIH guidelines
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Respiratory distress in a baby means they are struggling to breathe. This is always serious in infants because their airways are small and can become blocked quickly. Signs include nostril flaring, rib retractions, grunting, belly breathing, and color changes. Immediate action is critical.
Immediate actions
- Call 911 immediately
- Keep baby upright or in a position that seems to ease their breathing
- DO NOT: Do NOT lay baby flat — this can worsen breathing difficulty
Step-by-Step Response
Assess breathing
Count breaths per minute. Normal: newborns 30-60, infants 24-40, toddlers 20-30. Look for: nostril flaring, rib retractions (skin pulling in between/under ribs), grunting, belly breathing, head bobbing.
Check color
Look at baby's lips, tongue, and fingernails. Blue or gray color (cyanosis) is an emergency. Pale or mottled skin is also concerning.
Listen
Listen for: stridor (high-pitched sound on breathing in — may indicate croup or airway blockage), wheezing (whistling on breathing out — may indicate asthma/bronchiolitis), grunting (forceful sound with each breath — sign of severe distress).
Position for comfort
Hold baby upright against your chest or in a slightly reclined position. Do not lay flat. If baby seems to breathe better in a certain position, maintain it.
Clear the airway
Use a bulb syringe to clear mucus from nose if congestion seems to be the issue. For babies under 6 months who are obligate nose breathers, nasal congestion alone can cause significant distress.
Call 911
Call immediately if: lips/tongue are blue, baby is gasping or silent, retractions are severe, baby is limp or unresponsive, breathing rate is very fast (over 60/min in infants) or very slow.
Try cool air (for croup)
If stridor is present and you suspect croup, take baby into cool night air or run a cool mist humidifier. This can reduce airway swelling while waiting for help.
Be ready for CPR
If baby stops breathing or becomes unresponsive, begin infant CPR immediately (30 compressions, 2 breaths). Continue until help arrives.
What NOT to Do
- ✕Do NOT lay baby flat — this can worsen breathing difficulty
- ✕Do NOT give food or water if baby is in respiratory distress — aspiration risk
- ✕Do NOT put anything in baby's mouth
- ✕Do NOT try home remedies before calling for help (steam, essential oils, etc.)
- ✕Do NOT ignore "noisy breathing" in a baby — it can indicate a blocked airway
- ✕Do NOT assume it will get better on its own if baby is working hard to breathe
When to Seek Help
Call 911 if:
- Baby's lips, tongue, or face are blue or gray
- Baby is gasping for air or making no sound while trying to breathe
- Baby is unresponsive or extremely lethargic
- Severe retractions — you can see ribs and neck muscles pulling in with each breath
- Baby has completely stopped breathing
- Baby is breathing very fast (over 60 breaths per minute sustained)
- Baby cannot cry or make sounds
- Baby is drooling and unable to swallow (possible epiglottitis — do not look in throat)
Go to ER if:
- Moderate retractions (visible rib/belly pulling with each breath)
- Baby is refusing to feed because of breathing difficulty
- Wheezing that is not responding to prescribed inhaler/nebulizer
- Stridor at rest (not just when crying)
- Baby is unusually sleepy and difficult to rouse
- Premature baby or baby with known respiratory condition who is worsening
- Breathing rate persistently above 50-60 breaths per minute
Call your doctor if:
- Baby has mild nasal congestion and is feeding poorly
- Baby has a barky cough (croup) but is breathing comfortably between coughing episodes
- Mild wheezing that does not seem to be causing significant distress
- Baby is breathing faster than normal but color is good and they are alert
- Persistent cough lasting more than a week
Age-Specific Guidance
0-3 months
Newborns are obligate nose breathers — even nasal congestion can cause significant distress. RSV and whooping cough (pertussis) are particularly dangerous at this age. Any breathing difficulty in a newborn warrants immediate medical attention.
3-12 months
Bronchiolitis (usually from RSV) peaks at 3-6 months. Croup typically appears after 6 months. Watch for feeding difficulty — if baby cannot coordinate breathing and feeding, this indicates significant distress.
1-3 years
Croup is most common at ages 1-3. Asthma symptoms may begin. Toddlers are also at risk for foreign body aspiration (inhaling small objects). Sudden onset of wheezing or stridor without fever should raise suspicion for inhaled foreign body.
Prevention
- Keep baby's immunizations up to date — RSV prophylaxis (Beyfortus) if eligible
- Wash hands frequently — respiratory infections are the leading cause of breathing emergencies in babies
- Keep baby away from cigarette smoke — increases risk of respiratory illness
- Avoid sick contacts during RSV season (fall through spring)
- Keep baby's nose clear — use saline drops and bulb suction for congestion
- Do not use pillows, blankets, or soft bedding that could block airways during sleep
- Learn infant CPR — all parents and caregivers should be trained
- If baby has asthma or reactive airway disease, follow your action plan and keep medications accessible
Frequently asked questions
Should I call 911 for breathing emergency (respiratory distress)?
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What should I NOT do?
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Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Emergency Guides
Bottom line
This is a serious emergency. Always call 911 first, then follow the steps above while help is on the way.
You are doing the right thing by learning what to do in an emergency. Being prepared is one of the best things you can do for your child.