Noisy Breathing in Children
Noisy breathing is a common concern in babies and young children. While it can be completely normal in some cases, it can also be a sign of an underlying airway or lung condition that may require medical assessment. Understanding what noisy breathing sounds like, the different types, and when to seek help is important for all parents and carers.
What Is Noisy Breathing?
Noisy breathing refers to any unusual or loud sound made when a child breathes. It usually occurs due to a narrowing or blockage in some part of the airway—from the nose and mouth down to the lungs—causing turbulent airflow.
Some children may have noisy breathing only during colds or viral infections, while others may have persistent symptoms related to an underlying condition.
Common Types of Noisy Breathing
1. Stertor
- A low-pitched, snoring-like sound
- Originates from the nose or back of the throat
- Common in babies and toddlers, especially when they have a cold
- Often confused with snoring, but can occur during both wakefulness and sleep
2. Stridor
- A high-pitched, harsh sound heard most often on breathing in (inspiration), but sometimes on breathing out (expiration)
- Caused by a partial blockage in or just below the voice box (larynx) or in the upper trachea
- May be due to conditions like laryngomalacia, croup, vocal cord problems, or airway narrowing
3. Wheeze
- A high-pitched whistling sound, typically heard during exhalation
- Indicates narrowing or inflammation in the lower airways (bronchi), as seen in asthma or viral infections like bronchiolitis
- Often mistaken for other upper airway sounds, especially in young children
Common Causes of Noisy Breathing
- Viral infections (e.g., colds, croup, bronchiolitis)
- Allergies or asthma
- Floppy airways (e.g., laryngomalacia, tracheomalacia, bronchomalacia)
- Congenital airway narrowing (e.g., subglottic stenosis)
- Enlarged adenoids or tonsils
- Foreign body aspiration
- Vocal cord paralysis or dysfunction
- Airway obstruction from swelling, scarring, or tumours
- External compression from a vessel or mass pressing on the airway
Some children, especially those aged 6 months to 2 years, may experience a persistent bubbling or rattling sound, which is often mistaken for a wheeze. This may feel like “crackles” when placing a hand on the chest, but it is not caused by lung disease. It is usually benign and improves with time.
When Should I Be Concerned?
Seek medical attention if your child has noisy breathing and any of the following:
- Fast or laboured breathing
- Pulling in of the skin between the ribs or under the chest
- Flaring of the nostrils with each breath
- Bluish discolouration of the lips, face, or hands
- Pauses in breathing (apnoeas)
- Lethargy or unusual sleepiness
- Difficulty feeding or poor weight gain
How Is Noisy Breathing Diagnosed?
A careful history and physical examination is often the most useful starting point. Important questions include:
- Was the noisy breathing present since birth or did it develop later?
- Is it constant or does it come and go?
- Does it worsen during sleep, feeding, or illness?
Depending on the findings, your doctor may recommend one or more of the following investigations:
- Flexible laryngoscopy or bronchoscopy – to view the airway directly
- Chest or neck X-rays
- High-resolution CT scan
- Sleep study (if obstructive sleep apnoea is suspected)
- Swallowing assessment (to assess for aspiration)
- Pulmonary function tests (in older children)
Treatment Options
Treatment depends on the cause and severity of your child’s symptoms:
- Observation and reassurance – many mild causes resolve as your child grows
- Medication – such as bronchodilators for asthma or steroids for airway swelling
- Airway clearance therapy – for children with recurrent mucus build-up
- Surgery – for structural abnormalities or severe narrowing
- Ongoing monitoring – to track your child’s breathing and growth
Summary
Noisy breathing is a common condition that can be caused by a wide range of factors, from simple congestion to more serious airway issues. If your child experiences persistent noisy breathing, is working harder to breathe, or exhibits any red flag signs, they should be evaluated by a specialist for further assessment.
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