Coughs, Colds and Breathing: When to Seek Care

An independent educational resource prepared by Mark M. Simonian, MD, FAAP

Sources checked: August 2, 2026     |     Medical review completed: August 2, 2026

This page is for general education only and does not replace individualized medical advice. This resource does not establish a doctor-patient relationship. For questions about your own child, contact your child's current healthcare professional.

Magnolia Pediatrics, Valley Children's Healthcare

2497 E. Herndon Avenue, Suite 101, Clovis, CA 93611     |     559-538-3070

Families do not need to identify the exact virus before deciding what to do. Focus first on how hard the child is breathing, alertness, drinking and urination, age, medical risks, and whether symptoms are improving or worsening.

Urgent Warning Signs — Check This First

When in doubt about a life-threatening breathing emergency, call 911.

CALL 911 NOW

  • Severe trouble breathing: struggling for each breath, gasping, barely able to speak or cry, or becoming too tired to keep breathing normally

  • Blue or gray lips or face, a child who is limp or unresponsive, or breathing that has stopped or has repeated long pauses

  • Sudden choking or coughing with inability to breathe, speak, cry, or cough effectively

  • Sudden breathing trouble with swelling of the lips, tongue, or throat, widespread hives, collapse, or another sign of a severe allergic reaction

GET EMERGENCY MEDICAL CARE NOW

  • Ribs, the breastbone, or the area above the collarbones pull in with each breath; persistent grunting; head bobbing in an infant; or very fast or labored breathing

  • Stridor—a harsh or high-pitched sound while breathing in—when the child is resting, or stridor with increasing effort, drooling, or difficulty swallowing

  • Pauses in breathing, pale or gray color, markedly decreased activity, confusion, or difficulty waking the child

  • Breathing difficulty that prevents feeding or drinking, or signs of significant dehydration such as no urine for about 8 hours, a very dry mouth, no tears, or unusual drowsiness

  • The child has an asthma action plan, emergency medicine is not helping as directed, or symptoms have reached the emergency level in that plan

CONTACT YOUR CHILD'S HEALTHCARE PROFESSIONAL TODAY

  • A baby 3 months old or younger has any new cold, cough, feeding, or breathing symptoms, even without fever

  • New wheezing, stridor, breathing much faster than usual, or breathing that looks harder than normal but is not severe

  • Coughing repeatedly interferes with sleep, feeding, drinking, speaking, play, or normal activity

  • The child drinks substantially less, urinates less, vomits repeatedly with coughing, has ear or chest pain, or looks increasingly ill

  • Symptoms improve and then return or worsen, or are not beginning to improve after about 10 days

  • The child was born prematurely or has chronic lung or heart disease, asthma, a weakened immune system, a neuromuscular condition, or another high-risk medical condition

  • You are worried or uncertain about the child's breathing, color, hydration, or overall condition

For temperature thresholds and fever-specific warning signs, also see Fever and Illness: When to Seek Care.

Sources and medical review

Recognizing Breathing Difficulty

Watch the child when calm. Crying, fever, activity, and a blocked nose can briefly make breathing faster, but persistent work or noisy breathing needs attention.

Signs a child is working too hard to breathe

  • Retractions: the skin pulls inward between or under the ribs, above the breastbone, or near the collarbones

  • Nostrils flare, the belly moves more than usual, the head bobs with breaths, or the child grunts

  • Breathing is much faster than usual, the child cannot feed comfortably, or an older child cannot speak in normal phrases

  • The child becomes exhausted, less alert, pale, gray, or blue around the lips or face

Different breathing sounds

  • Stridor is a harsh, high-pitched sound mainly while breathing in. It often occurs with croup, but stridor at rest or with drooling or swallowing difficulty is urgent.

  • Wheezing is a musical or whistling sound, usually while breathing out. It can occur with bronchiolitis, asthma, or other airway narrowing and may need examination.

  • Grunting is a short sound at the end of a breath. Persistent grunting can signal serious breathing difficulty.

  • A wet or rattly sound from the nose or throat may be mucus, but the child's breathing effort, color, feeding, and alertness are more important than the sound alone.

Common Patterns Families May Notice

These descriptions can help families communicate what they see. They are not a substitute for an examination and should not be used to diagnose a child at home.

Cold or upper respiratory infection

A cold commonly causes a runny or blocked nose, sneezing, sore throat, hoarse voice, and cough. Most are caused by viruses and improve without antibiotics. Many children improve within 7 to 10 days, although a cough may last longer. Worsening after improvement, persistent pain, breathing difficulty, or poor hydration deserves medical guidance.

Croup

Croup usually causes a barky cough and hoarse voice. Some children develop stridor, a harsh sound while breathing in. Keep the child calm and watch breathing closely. Stridor only while crying is less concerning than stridor while resting, but any worsening breathing effort needs prompt assessment. Do not delay care while trying steam or outdoor air; evidence that these treatments help is limited, and hot water or steam can burn a child.

Bronchiolitis and RSV (respiratory syncytial virus)

Bronchiolitis is swelling of the small airways, most often caused by RSV (respiratory syncytial virus) or another virus in infants and young children. It may begin like a cold and progress over several days to fast breathing, wheezing, retractions, poor feeding, or pauses in breathing. Very young infants may have decreased activity or feeding and may not have a fever. Treatment is usually supportive, but oxygen, fluids, or hospital care may be needed when breathing or hydration is affected.

Wheezing or an asthma flare

A viral illness can trigger wheezing in a child with asthma, and a first episode of wheezing may resemble bronchiolitis. If the child has a written asthma action plan, follow it. A child without an asthma diagnosis should not be treated with another person's inhaler or leftover medicine; new or worsening wheezing needs professional guidance.

Sudden cough or choking

A cough that begins suddenly while eating or playing with a small object is different from a gradual viral cough. If the child cannot breathe, speak, cry, or cough effectively, call 911 and begin age-appropriate choking first aid. Even after apparent improvement, persistent cough, wheeze, or one-sided noisy breathing after a choking event needs prompt evaluation.

Sources and medical review

Safe Home Care When No Warning Signs Are Present

  • Offer fluids frequently. Continue breast milk or formula for infants. Smaller, more frequent feedings may be easier when the nose is blocked.

  • Use plain saline nose drops or spray, then gentle suction for infants or nose blowing for older children. Suction before feeding or sleep when congestion interferes, and avoid repeatedly irritating the nose.

  • A clean cool-mist humidifier may ease nasal congestion. Follow cleaning directions carefully; do not use a hot-steam vaporizer around children.

  • For children 1 year and older, a small amount of honey may soothe a cough. Never give honey to an infant younger than 1 year because of the risk of infant botulism.

  • Allow rest and quiet activity. A cough helps clear mucus; the goal is comfort, hydration, and easier breathing rather than eliminating every cough.

  • Keep sleep safe: infants should sleep flat on their backs on a firm, level surface without pillows, wedges, positioners, or an inclined sleep product, even when congested.

  • Keep the home and car free of cigarette smoke, marijuana smoke, and vaping aerosol. Opening a window, using a fan, or smoking in another room does not remove secondhand smoke exposure.

Sources and medical review

Medicines and Treatments: Safety First

  • The FDA does not recommend over-the-counter cough and cold medicines for children younger than 2 years. Manufacturers label these products 'Do not use in children under 4 years of age.' For an older child, read the label and ask a pharmacist or healthcare professional when uncertain.

  • Do not give a child an adult cough or cold product. Do not combine products without checking active ingredients; many contain the same fever reducer, antihistamine, decongestant, or cough medicine.

  • Use only the measuring device supplied with a medicine. Never use a kitchen spoon.

  • Antibiotics do not treat ordinary viral colds, viral croup, RSV, or most bronchiolitis. They are used only when a healthcare professional diagnoses or strongly suspects a bacterial infection.

  • Do not start leftover antibiotics, steroids, albuterol, or another child's prescription medicine. Children with asthma should use only the medicines and steps in their own current asthma action plan.

  • Flu and COVID-19 can resemble a cold. Testing or prescription antiviral treatment may matter for some children, especially those at higher risk, and works best when discussed early in the illness.

Sources and medical review

Reducing Spread and Respiratory Irritants

  • Wash hands often, cover coughs and sneezes, clean frequently touched surfaces, and avoid sharing cups and utensils during illness.

  • Keep children away from tobacco smoke and vaping aerosol. A fully smoke-free and vape-free home and car provide the best protection.

  • Ask the child's current healthcare professional which seasonal immunizations and preventive products are recommended for the child's age and risks. Options may include influenza and COVID-19 vaccines and, for eligible infants, protection against severe RSV illness through maternal vaccination or an infant preventive antibody.

  • Use extra caution around young infants and medically high-risk children. Avoid close contact when sick and seek guidance early if they develop symptoms.

Sources and medical review

Preparing to Contact a Healthcare Professional

Have the following information ready when possible:

  • The child's age, current weight, medical conditions, medicines, allergies, prematurity, and immune-system or heart/lung risks

  • When symptoms began and whether they are improving, worsening, or returned after improvement

  • What the breathing looks and sounds like when the child is calm; a short video may help if it can be recorded without delaying care

  • Temperature, how it was measured, alertness, fluid intake, urine or wet diapers, vomiting, and pain

  • Whether the cough is barky, sudden after choking, associated with wheezing or stridor, or causing vomiting, sleep loss, or feeding difficulty

  • Any medicines already given, including product, concentration, amount, and time; and, for asthma, the action-plan zone and response to prescribed rescue medicine

  • Known exposure to flu, COVID-19, RSV, pertussis, smoke, vaping aerosol, allergens, or a possible swallowed or inhaled object

Do not delay emergency care to make a video, take repeated temperature readings, try a home remedy, or wait for a callback when the child has a severe warning sign.