Call911or other emergency services immediately if your child is having difficulty breathing, indicated by:

• Breathing very fast (more than 60 times a minute).
• Making a grunting noise.
• Being unable to speak, cry, or make sounds, sometimes with drooling.
• Flaring nostrils or lifting the shoulders when inhaling.
• Having a gray, mottled, or blue color to the skin (look for skin color changes in the fingernail beds, lips, or earlobes).
• Wheezing that lasts over 1 hour in a baby younger than 3 months old who also appears sick.
• Breathing that stops for longer than 15 to 20 seconds.

See your doctor immediately if your baby or child has moderate difficulty breathing, indicated by:

• Breathing 40 to 60 times a minute.
• Tiring quickly during feeding. The child either stops eating or sucks in air to catch a breath. The child loses interest in eating because of the effort involved.
• Using the stomach muscles when breathing.
• Having unusual color. The child's face, hands, and feet are pale to slightly gray or lacelike purple and pale (mottled), but the tongue, gums, and lips remain pink.

See your doctor if your child shows signs of a lower respiratory infection, indicated by:

• Breathing rapidly-although keep in mind that the normal breathing rate for children is faster than for adults.
• Having difficulty breathing. Children may use muscles in the neck, chest, and stomach when taking in air. This causes the skin to retract between the ribs with each breath, making the ribs more defined than usual, a condition known as retractions. Retractions get worse (the ribs become more defined) as the degree of difficulty in breathing increases.
• Wheezing.
• Appearing extremely tired.
• Showing little interest in food or surroundings.
• Showing signs of an ear infection, such as irritability, difficulty sleeping, and tugging on or rubbing the ear. For more information, see the topic Ear Infections.
• Having a fever greater than 100.4F when younger than 3 months old.

Call a doctor if your child is:

• Breathing slightly faster than normal and seems to be getting worse. Most healthy children breathe less than 40 times a minute.
• Having cold symptoms that become severe or other problems are developing, such as signs of an ear infection.

Watchful Waiting

For an otherwise healthy child who has symptoms of an upper respiratory infection, such as a cough or runny nose, home treatment usually is all that is needed. But it is important to watch for signs and symptoms of complications, such as dehydration. For more information, see the Check Your Symptoms section of the topic Respiratory Problems, Age 11 and Younger.

Watchful waiting may not be appropriate when your child with an upper respiratory infection has an increased risk for complications. Watch your child closely if he or she has symptoms of an upper respiratory infection. If symptoms get worse or new symptoms develop, see a doctor right away.

Who To See

Respiratory syncytial virus (RSV) infection can be diagnosed and treated by a health professional such as a:

• Family physician.
• Pediatrician.
• Nurse practitioner.
• Physician assistant.

To prepare for your appointment, see the topic Making the Most of Your Appointment.