Respiratory Illnesses in Children Under 5

Respiratory illnesses are common in children under 5 years of age. Most children will develop three to eight colds or respiratory illnesses a year. This number may even be higher in children who attend day care or are exposed to tobacco smoke. Most cases are mild, but about one-third of all hospitalizations in this age group are due to respiratory problems, including asthma and pneumonia.

Follow this guide to recognize which respiratory symptoms are caused by illness or infection and which are caused by non-respiratory conditions—and when your child needs medical attention.

About the Respiratory System
The respiratory system has two parts: upper and lower.

The upper respiratory system includes the nose, mouth, sinuses and throat. If your child has an upper respiratory infection he or she may feel uncomfortable and sound congested, with runny nose, cough and poor appetite. Common conditions:

  • Common Cold
  • Influenza (flu)
  • Croup
  • Sinusitis

The lower respiratory system refers to the bronchial tubes and lungs. Among children under five, symptoms of a lower respiratory infection are usually more severe than those of upper respiratory illnesses and may include shortness of breath, wheezing and rapid breathing.  As a result, the child is more likely to require a visit to a healthcare provider. Common conditions:

  • RSV (respiratory syncytial virus)
  • Bronchiolitis
  • Pneumonia
  • Asthma


Common cold
What is referred to as “a cold” can be caused by 200 different viruses. These viruses spread easily from person to person both through the air and by touching germ-laden surfaces then touching your nose, mouth or eyes. That’s why hand-washing—for you and your child—is so important.

Most people are familiar with the main symptoms of colds:

  • Nasal congestion
  • Runny nose
  • Sneezing
  • Sore throat
  • Mild to moderate hacking cough
  • Possible low-grade fever for the first day or two

Influenza (flu)
Like a cold, influenza affects the upper respiratory system. Unlike a cold, though, it often causes more severe illness and complications.


  • Fever with chills
  • Body aches
  • Headache
  • Cough
  • Sore throat
  • Nasal congestion/runny nose
  • Extreme exhaustion and weakness
  • Possible stomachache or vomiting in children

The common early childhood ailment known as croup (tracheolaryngobronchitis) involves inflammation of the trachea (windpipe), the larynx (voice box) and the bronchioles (tiny airways leading to the lungs). It is recognized by a distinctive “barking cough” that usually starts suddenly and at night. Children ages 3 months to 3 years are most susceptible to croup.

Signs and symptoms:

  • Dry, barking (brassy) cough
  • Stridor – noisy, labored breathing; high-pitched noise when inhaling
  • Hoarseness
  • A tight throat

Viral infections and allergies affect sinuses the same way they affect the nasal passages, causing swelling and producing extra mucus. This makes it difficult for the sinuses to drain properly and as mucus accumulates, the sinuses become a safe haven for germs to grow. The resulting infection can cause sinus pressure and pain.

Signs and symptoms:

  • Upper respiratory tract infection symptoms lasting more than 10 days without improvement
  • Nasal congestion or discharge, any color
  • Cough, day and night
  • Facial pain or headache
  • Fatigue and irritability
  • Low-grade fever

More severe symptoms:

  • Fever (temperature above 102°F )
  • Yellow or green nasal mucus


Respiratory Syncytial Virus – RSV

While it begins in the upper respiratory system, RSV is one of the most common causes of lower respiratory tract illness in infants and young children, affecting more than 90 percent of all children before the age of 2.

For some children, RSV is a mild illness with symptoms of the common cold. However, in 20-30 percent , the infection spreads into the lower respiratory tract’s tiny airways—or bronchioles—causing them to swell, at which point the infection is known as “RSV bronchiolitis.” When there’s less room for air to pass through the airways, the child begins to wheeze and have difficulty breathing. Some research indicates that children who experience severe cases of RSV are at increased risk of developing asthma.

Signs and symptoms:

  • Upper respiratory symptoms of common cold
  • Cough
  • Fast breathing
  • Fever
  • Retractions–drawing in of muscles and skin in neck and chest with each breath
  • Irritability
  • Difficulty sleeping and signs of fatigue or lethargy

Bronchiolitis is caused by an infection that affects the tiny airways—called the bronchioles— that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making breathing difficult. This disease affects mostly infants and young children—typically during the first 2 years of life, with peak occurrence at 3 to 6 months.

Bronchiolitis is usually caused by RSV (Respiratory Syncytial Virus) It can be also caused by colds, influenza (flu) and human metapneumovirus (hMPV, which may also cause pneumonia).

Signs and symptoms:

  • Cough
  • Fever
  • Rapid heartbeat
  • Rapid, shallow breathing
  • Retractions—drawing in of muscles and skin around neck and chest with each breath
  • Flaring of the nostrils

Pneumonia is a bacterial or viral infection of the lung that causes the lungs’ airpockets (alveoli) to become inflamed. Lungs may produce extra fluid, which can accumulate in the airways. Healthcare providers often use x-rays to diagnose pneumonia.


  • Fever
  • Cough
  • Rapid breathing
  • A distinct rattling that can be heard with a stethoscope
  • Decreased activity and poor eating
  • A grunting sound when your child exhales
  • Retractions— drawing in of muscles and skin around neck and chest with each breath

Children with asthma have sensitive, easily irritated airways in their lungs. When exposed to certain triggers – like viruses, allergens, secondhand smoke, chemical irritants, cold air or pollution – the airways become more inflamed, producing increased mucus, mucosal swelling and muscle contraction. This results in airway obstruction, chest tightness, coughing, shortness of breath and wheezing.

Asthma in children varies by age group, and infants, toddlers and 4-year-olds are diagnosed and treated differently than teens and adults. The way asthma affects a child also varies from person to person, and symptoms may get better or worse at certain times. In some children, asthma symptoms get better as the child grows. While asthma can’t be cured, symptoms can be managed by following the treatment plan you develop with your child’s healthcare provider.


  • Coughing on expiration (breathing out), especially at night
  • Wheezing on expiration
  • Difficulty breathing
  • Shortness of breath when exercising or playing
  • Rapid heart rate


GERD (Gastroesophageal Reflux Disease)
The opening between the esophagus (food pipe) and the stomach is guarded by a small muscle. When this muscle relaxes and opens up at the wrong time, small amounts of food or gastric acid can splash up from the stomach into the esophagus, causing a burning sensation and irritation of the lining of the esophagus.

Common symptoms in infants and young children:

  • Frequent spitting up or vomiting
  • Frequent or persistent cough
  • Refusing to eat or difficulty eating (choking or gagging with feeding)
  • Chest pain
  • Hoarseness

Parents often report that teething causes respiratory symptoms such as runny nose or coughing in their young child. In fact, the symptoms may be a matter of timing rather than a direct effect of cutting a tooth.

Infants have a natural immunity to germs and allergens in the environment. However, most of this natural immunity is gone by the age of 6 months – just the time when most children begin to get their teeth. As a result, the child suddenly becomes more susceptible to common germs in the environment and minor illnesses that bring nasal congestion, cough and fever. Even though symptoms may appear at the same time as new teeth, studies have shown they are more likely due to an illness or infection than to the teething process.

Signs and symptoms:

  • Sore gums
  • Fussiness; irritability
  • Excessive drooling (caused by the body making more  saliva than they can swallow)
  • Possible runny nose

Respiratory allergies
Allergies are frequently to blame for breathing problems, especially during a pollen-heavy springtime or fall. Common year-round allergens include mold, dust mites, cockroaches and furry pets.

Signs and symptoms:

  • Nasal congestion
  • Runny nose
  • Sneezing
  • Red, itchy eyes

Food allergies
If your child has food allergies, coming into contact with the allergen can lead to a wide range of signs and symptoms that typically involve the three major organ systems in the body:

  • Skin, such as hives or eczema
  • Gastrointestinal tract, including nausea, stomach upset and diarrhea
  • Respiratory tract, including sneezing, runny nose (rhinitis) and difficulty breathing (asthma)

Some allergies – including insect sting, latex, medication and some foods – can cause a life-threatening reaction called anaphylaxis, which can lead to death in a matter of minutes if not treated. If your child is diagnosed with a life-threatening allergy, you should always carry two epinephrine auto-injectors to use in case of emergency.


  • Mouth: itching, swelling of lips and/or tongue
  • Throat: itching, tightness/closure, hoarseness, difficulty swallowing
  • Skin: itching, hives, flushing (redness) and swelling of face
  • Gut: vomiting, diarrhea, cramps
  • Lung: shortness of breath, cough, wheeze
  • Heart: weak pulse, dizziness, passing out, loss of consciousness