Why Is My Child Having Trouble Breathing?

For the approximately 4 million young people with asthma or another respiratory condition, breathing challenges can be severe, persistent or even life-threatening.

Asthma is the most common chronic childhood disease, according to the National Institutes of Health. Children with pediatric asthma might have intense coughing episodes that land them in the hospital and cost weeks of missed school. It also may hurt every time they take a deep breath, said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children’s.

Respiratory illnesses also can limit young people’s ability to do things they love and impact their quality of life.

We can improve a child’s endurance and ability to breathe so they can exercise safely, improve lung function and have better lung health in the long term.

The devastating 2025 Palisades and Eaton fires left many Los Angeles children struggling with breathing complications, bringing the bigger picture of lung health into sharper focus.

“The toll is huge,” Dralyuk said, and it is likely underestimated.

“Breathing issues frequently go unrecognized, because people get used to it,” she added. “Parents don’t always notice or feel like they know what to do with it.”

Common Breathing Problems in Children

Here are tips and treatments for the most common breathing problems in children.

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Childhood Asthma

This chronic inflammatory disease causes the lining around a child’s respiratory system to swell when triggered and the muscles and airways to constrict (bronchospasm)—restricting airflow. Asthma can show up as wheezing, whistling or noisy breathing; chest tightness; a constant or returning cough; and breathlessness, especially when young people are active.

It’s linked to environmental factors such as air pollution, smoke exposure and chemical disinfectants, as well as hereditary factors. Pests, pets, dust and mold can also trigger attacks.

Treatments for pediatric asthma include continuous inhaled or oral corticosteroids, often alongside bronchodilators that open tight airways. Lifestyle changes, such as identifying and avoiding triggers, also can be part of your child’s asthma action plan. The Centers for Disease Control and Prevention defines asthma control as lessening symptoms and interruptions to your child’s life, with just one or no asthma attacks each year.

Young people can develop serious complications if asthma is poorly controlled, Dralyuk warned. One in 20 children is hospitalized annually due to asthma. A severe asthma attack can cut off oxygen and cause brain injury, which can be deadly. Over time, asthma can permanently damage lungs.

Allergies

Allergic rhinitis, either seasonal or year-round, is the body’s reaction to an allergen that it thinks is dangerous and tries to fight off. Pollen from trees, grass or weeds is often to blame, as well as dust mites, mold, cockroach waste or animal dander.

During an allergic reaction, the immune system releases histamine, which irritates the nose, eyes, throat and sometimes lungs. This causes sneezing, a stuffy or runny nose, itching, nosebleeds and/or wheezing. Allergies affect about 19% of children, and there’s a strong overlap with asthma. Eight in 10 asthmatic children also have allergies, making symptoms worse.

Breathing issues frequently go unrecognized, because people get used to it.

To treat your child’s allergies, your pediatrician might prescribe antihistamines, nasal sprays and other decongestants that open up blood vessels in the nose to relieve congestion. They may also refer you to an allergist. Allergy treatment has vastly improved, including immunotherapies and allergy shots that can rewire the body’s reactions to triggers.

Allergists recommend young people with a history of seasonal allergies start treatments two weeks before the expected onset of symptoms. They also should shower after playing outside to get rid of pollen or other dust triggers.

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Infections

Viral illnesses such as croup or respiratory syncytial virus (RSV) spread through direct contact with an infected person’s bodily fluids and can cause swelling in the small airways inthe lungs. Croup’s telltale sign is a barking cough, but children might also have stuffy or runny noses, run a fever or lose their voice.

Babies and young children between 3 months and 5 years old are most susceptible. Because their airways are so small, breathing can take much more effort for sick children than it does for sick adults. Some children may get repeat infections in the winter.

Inhaled medicines and steroids prescribed by your child’s doctor can help, as well as at-home care with a humidifier, washcloth or steam.

Illnesses such as the flu, COVID-19 and RSV can leave behind a lingering cough after the illness has passed. If your child’s cough won’t go away after four weeks, see their pediatrician.

Congenital or Structural Problems

Cystic fibrosis is a complex genetic condition that causes mucus to thicken and stick in the lungs of the nearly 40,000 children who have it, according to the Cystic Fibrosis Foundation, weakening the lungs over time. Revolutionary treatments are extending life, including those that edit a child’s genetic code. Preventive daily treatments such as breathing vests help breakup mucus to clear the airways.

Other children are born with or develop chronic lung disease from lesions, scarring or swelling. These patients—who can have fast, shallow breathing all the way to more severe lung collapse—might need anti-inflammatory steroids, needle decompression, surgery to remove rare congenital malformations or immune suppressants.

Smoke and Wildfires Can Worsen Children’s Lung Health

Avoid triggers for any child with breathing problems—especially smoking or vaping, Dralyuk stressed. Triggers also can include candles, incense, heavy dust, or high air pollution or active wildfires in the area.

You can monitor air quality to limit your child’s exposure to potential triggers. The Air Quality Index (AQI) is measured on a scale of 0 to 500, and parents can implement precautions such as masking with fitted N95 respirators and keeping children indoors on days with potentially hazardous air (AQI over 150).

The American Academy of Pediatrics also recommends using high-efficiency particulate air (HEPA) filters in the home, which can help clear the air of hidden substances by as much as 25% to 50%.

Consult with your child’s pediatrician if you notice your child has a cough, congestion, faster breathing or decreased energy levels, Dralyuk recommended.

Watch out for nasal flaring, belly breathing or if your child can’t speak in full sentences, which signals moderate to severe respiratory distress.

When to Seek Emergency Care for a Child’s Chest Tightness or Breathing Difficulty

Visit your nearest emergency room if you notice your child has a fast heart rate or blue skin, Dralyuk said, or if they’re gasping for air. Children with severe infections or asthma attacks might need oxygen.

If your child has had trouble breathing more than once or twice, seek out a pediatric pulmonologist for an exam. Depending on the cause, they might loop in an ear, nose and throat (ENT) doctor.

It’s also not normal for a child’s breathing to be strained regularly while exercising, Dralyuk added. If this is a concern for your child, a pulmonologist can prescribe an albuterol inhaler and spacer. Your child can inhale the medicine 15 to 20 minutes before physical activity.

“We can improve a child's endurance and ability to breathe, so they can exercise safely, improve lung function and have better lung health in the long term,” she said.