1 Have your child's breathing problems started within the last few minutes?

2 Are any of the danger signs in the warning box present?

3 Is your child less than 1 year old?

4 Does your child have harsh, noisy breathing and/or a barking cough?

5 Is your child dribbling or unable to swallow?

6 Is your child's breathing abnormally rapid ()?

7 Is your child also wheezing?

8 Has your child been diagnosed as having asthma in the past?

9 Does your child have a temperature of 38°C (100°F) or above?

10 Has your child had episodes of any of the following?

• Wheezing
• Coughing at night
• Coughing after exercise
• Coughing when out in the cold

11 Is your child wheezing now?

12 Emergency! Call an ambulance

Possible cause Your child may be choking on an inhaled foreign body, such as a piece of food or a small object, particularly if the problem started while he or she was eating.

Action While waiting for help to arrive, follow the first-aid measures for choking. In hospital, your child will be examined and any foreign body removed.

13 Emergency! Call an ambulance

Possible cause Your child's breathing problems may be due to a serious condition that needs urgent medical attention.

Action Your child will be examined in hospital and may have tests such as a chest X-ray and tests for measuring blood oxygen. The underlying cause will be treated, and oxygen may be given to ease breathing.

14 Call your doctor now

Possible cause and action Bronchiolitis, a viral lung infection, is a possible cause. Your child may be admitted to hospital for tests including a chest X-ray. Treatment for the condition may include giving oxygen and bronchodilator drugs.

15 Emergency! Call an ambulance

Possible cause Epiglottitis, inflammation and swelling of the cartilage flap that prevents food entering the main airway, may have resulted in blockage of the airway. This condition is now rare because of routine immunization against the Haemophilus influenzae type b (Hib) bacterium, which is the cause.

Action Your child will need emergency admission to hospital for treatment with oxygen and antibiotics.

16 Call your doctor now

Possible cause and action Croup, in which the throat becomes swollen and narrowed due to a viral infection, is the likely cause. Your doctor may give your child corticosteroid drugs. Self-help measures for relieving a cough may also help.

17 Emergency! Call an ambulance

Possible cause A severe attack of asthma is a possibility.

Action While waiting for help, give your child the number of puffs of his or her relieving inhaler or nebulizer according to his or her treatment plan and carry out the self-help measures for easing breathing in an asthma attack. In hospital, your child will be examined and his or her blood oxygen levels measured (see Measuring blood oxygen). He or she may be given oxygen and bronchodilator drugs as well as corticosteroids to ease his or her breathing.

18 Emergency! Call an ambulance

Possible cause Your child may be having a first asthma attack.

Action While waiting for help, carry out self-help measures for easing breathing in an asthma attack. Once in hospital, your child will be examined. If the diagnosis of asthma is confirmed, your child will be prescribed bronchodilator drugs and corticosteroids to ease his or her breathing.

19 Call your doctor now

Possible cause A chest infection such as pneumonia (infection of the air spaces in the lungs) is a possible cause of these symptoms.

Action If your doctor confirms the diagnosis, he or she will probably prescribe antibiotics and may arrange for a chest X-ray. Take steps to reduce your child's temperature (see Bringing down a fever), and make sure he or she drinks plenty of fluids. Occasionally, hospital admission is necessary so that a child's blood oxygen levels can be measured ( Measuring blood oxygen) and physiotherapy provided.

20 Call your doctor now

Possible causes Rapid breathing may be due to a serious heart or lung disorder or, in some cases, it may be caused by anxiety.

Action Your doctor will examine your child and will probably arrange for tests, such as a chest X-ray, to determine the cause of his or her rapid breathing and the appropriate treatment.

21 Call your doctor now

Possible cause Your child may have asthma. It will be easier for your doctor to make a diagnosis if he or she sees your child when the symptoms are present.

Action Your doctor will examine your child and may measure his or her peak flow rate (see Measuring peak flow rate). If the results indicate that your child has asthma, he or she may initially be prescribed bronchodilator drugs. If the cough or intermittent wheezing persists, your doctor may also prescribe inhaled corticosteroids. In some cases, small children may be given the drugs through a face mask.

22

Possible cause and action These symptoms may be due to mild asthma. Consult your doctor, who will examine your child and measure his or her peak flow. If your doctor suspects asthma, he or she may suggest treatment with inhaled bronchodilator drugs to relieve the symptoms and may also prescribe inhaled corticosteroids.

23

Call your doctor now if your child has a breathing problem not dealt with in this chart.