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Paediatric breathing problems (asthma & wheeze)
What is paediatric breathing problems (asthma & wheeze)?
Breathing problems in children range from common, mild coughs and colds through to serious asthma attacks, bronchiolitis and other respiratory illnesses that can rapidly compromise oxygen levels. First aiders are not there to diagnose, but to spot worrying patterns of breathlessness, wheeze, recession and exhaustion that demand urgent support, and to help children use their prescribed inhalers or spacers where appropriate.
In practice that means noticing when usual reliever treatments are not working, or when a child is too breathless to speak in full sentences, feed or drink, or is becoming quiet and drowsy. Breathing problems, particularly asthma and viral-induced wheeze, can escalate quickly, so recognising increasing work of breathing and knowing when these deteriorating signs mean a 999 call is needed is central to safe paediatric first aid.
Government respiratory-disease profiles show that thousands of children in England are admitted to hospital each year with asthma, and that asthma remains a leading cause of hospitalisation in childhood despite modern treatments, so early recognition of worsening symptoms is a consistent public-health priority.
Who needs this skill?
Health & Social Care
In health and social care, community carers, children's services staff and residential teams often see children with known asthma or chronic conditions; they need confidence to support inhaler and spacer use in line with care plans, to recognise respiratory distress and to escalate through GP, 111 or 999 pathways as appropriate. Documentation of observations and actions is important when cases are reviewed or complaints arise.Licensed venues & nightlife
Licensed venues and events with physical activity, smoke effects or crowded environments can provoke breathing problems in susceptible children; a trained first aider who understands basic respiratory red flags will be quicker to move a child to fresh air, reduce triggers and call for medical support.Schools
Schools and early years providers manage a significant burden of childhood asthma and viral wheeze; staff must know where inhalers and spacers are stored, what the school asthma policy says about 'spare' inhalers, and how to recognise a child whose breathing is deteriorating despite treatment.Workplaces
In workplaces and leisure venues, staff may encounter children who have left inhalers at home or who become breathless during activity; first aiders should know how to support a child to sit upright, stay calm, use any available reliever inhaler correctly and seek urgent help if symptoms fail to improve or worsen quickly.How to manage paediatric breathing problems (asthma & wheeze)
- 1Recognise increased work of breathingLook for faster breathing than usual, flaring nostrils, chest recessions (the skin pulling in between or under the ribs), noisy breathing such as wheeze or grunting, and difficulty speaking, drinking or feeding due to breathlessness. A child who cannot complete short sentences, or an infant who cannot feed because of breathlessness, is particularly concerning.These visible signs of increased work of breathing are key red flags across paediatric guidance and should prompt urgent assessment rather than reassurance alone.
- 2Support the child's position and calm themHelp the child sit upright, perhaps leaning slightly forward with arms supported, which can make breathing easier; for infants, holding them upright against your chest may help. Speak calmly, avoid crowding them and do not force them to lie flat, as this may worsen breathlessness.Positioning and reassurance reduce the child's oxygen demand and fear, buying time for reliever medicines and emergency services to work.
- 3Help with prescribed inhalers and spacersIf the child has a reliever inhaler (usually a blue device) and spacer, support them to use it according to their asthma action plan, often as multiple separate puffs into the spacer with tidal breathing. Record how many puffs they have taken and whether there is any improvement after a few minutes.Qualsafe expects paediatric first aiders to support management of illness within their role; helping a child use their own prescribed medicines correctly can prevent deterioration while further help is arranged, provided you follow local policies and care plans.
- 4Decide when to call 999 or seek urgent adviceIf the child's breathing does not improve quickly with reliever inhaler, if they are too breathless to speak, eat or drink, if lips or face are turning blue or if they are becoming drowsy or agitated, call 999 immediately. For less severe but still worrying symptoms, NHS 111 or an urgent GP appointment may be appropriate after initial support.Clear thresholds for escalation mean staff are less likely to wait too long in deteriorating asthma or respiratory infection; calling early is safer and defensible when based on recognised red flags.
- 5Monitor continuously and be ready to start CPRStay with the child, reassessing breathing, colour and level of response while you wait for help; if breathing stops or becomes agonal, move straight into the paediatric CPR sequence. Hand over your observations, inhaler doses and timings clearly to the ambulance crew or clinical team.Continuous monitoring bridges the gap between initial support and definitive treatment and ensures any sudden deterioration is picked up rather than missed in a busy environment.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Qualsafe Level 3 Award in First Aid at Work (RQF) & Qualsafe Level 3 Award in Paediatric First Aid (RQF) - Combined
3 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about paediatric breathing problems (asthma & wheeze) training.
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You should still position, calm and monitor the child, and escalate quickly via 999 or 111 depending on severity; some schools and organisations hold emergency inhalers in line with local policy. You should not share another child’s prescription inhaler unless your policy and clinical governance explicitly allow it in life-threatening situations.