Red flags to look out for when baby is sick

Baby’s first sickness can be super stressful!  Charlotte and Teresa from & Breathe First Aid walk us through how to manage.

It’s totally normal to feel a bit on edge if your baby is unwell, especially if this is your first time navigating it. One day your little one has a dribbly nose, and the next they’re coughing, off their feeds, and breathing in a way that just doesn’t feel right.

A really common question we get from families in our first aid courses, especially when we’re talking about red flag signs of sickness is “how do I know if this is normal or if I’m overreacting?”

Baby breathing, even when they are fine, can look (and sound) a bit strange, especially when they are little. But sometimes, those small changes are actually very important clues that your baby needs help.

So, let’s walk through what normal infant breathing looks like, what changes to keep an eye out for, and what common winter bugs can affect your baby’s breathing.

WHAT DOES NORMAL BABY BREATHING LOOK LIKE?

Babies breathe faster than adults, around 30 to 60 breaths a minute and they mostly breathe through their nose. You’ll often see their tummy rise and fall with each breath. This is totally normal, especially in younger babies who use lots of tummy muscles to breathe. Your baby should look relaxed with no skin pulling in around their ribs, neck, or under their chest.

You might also hear snuffling, light grunts, or notice their breathing changes slightly when they’re sleeping or dreaming, that can all be okay too.

Tip: Take a short video of your baby breathing when they’re calm, settled, and well. It’s an amazing reference to help you notice changes when they’re sick and it can be really helpful to show a doctor or nurse if you’re unsure.

WHEN TO WORRY: SPOTTING THE SIGNS YOUR BABY IS WORKING TOO HARD TO BREATHE

Sometimes, babies who are unwell, especially with a cold or respiratory virus, have to work a lot harder to breathe. Here’s how to spot some of the signs we teach in our first aid courses:

+  Retractions: Look for the skin pulling in between or under your baby’s ribs when they breathe in, especially if their chest or tummy seems to be sucking in with each breath.

+  Tracheal tug: Watch just above the collarbones. If the skin dips in or pulls downward with each breath, that’s a tracheal tug.

+  Flaring nostrils: Your baby’s nostrils widen or flare with each breath, even when they’re calm or resting.

+  Grunting sounds: You’ll hear a soft grunt, croaky noise, or “ugh” sound when your baby breathes out, often with each breath.

+  Feeding less or no energy to feed: Your baby might take only a few sucks, fall asleep quickly during feeds, or not want to feed at all.

+  Blue or grey lips or fingertips: Their lips, tongue, or the skin under their nails may look bluish, dusky, or grey instead of pink.

+  Fast or shallow breathing: Their breathing looks quicker than usual, or the breaths seem short, uneven, or harder to count.

If you notice any of these signs, or if your gut says something’s not right, trust yourself. You know your baby. Get help early, whether that’s a call to Healthline, your GP – or heading to the emergency department if it feels urgent.

COMMON RESPIRATORY ILLNESSES IN BABIES

It’s no secret that babies get sick more often in the colder seasons. Their airways are small, and their immune systems are still learning how to respond to bugs, so what starts off as a sniffle can sometimes turn into something a bit more serious.

We often talk about these common respiratory illnesses in our first aid courses because they’re the ones that crop up year after year, and knowing which age groups are more vulnerable can help you feel more prepared if something crops up in your whānau.

RSV and other common cold viruses

RSV (Respiratory Syncytial Virus) is one of the most common causes of illness in babies during colder months. It spreads easily through droplets (coughs, sneezes, toys, surfaces, basically anything). In young babies this can cause bronchiolitis, this is when the little airways in their lungs become inflamed and fill with mucus, making it harder to breathe. Other viruses like rhinovirus and parainfluenza can cause very similar symptoms.

+  Higher-risk age: Babies under 12 months (especially under 6 months) and premature babies are most vulnerable to complications and hospitalisation.

Influenza (the flu)

Flu isn’t just a bad cold, it can hit babies hard and fast, sometimes making them very unwell in a short space of time. Unlike a cold, flu often brings high fevers, body aches, and exhaustion, which babies can’t tell you about so it often shows up as extreme tiredness, poor feeding, or fast breathing.

+  Higher-risk age: Babies and toddlers under two are most at risk, especially if they haven’t had the flu vaccine. The risk is higher again for those under 12 months.

Pneumonia

Pneumonia is an infection in the lungs that causes inflammation and can make it very difficult for babies to breathe. It might start off looking like a cold but then worsen quickly, or it can come on suddenly with fever and breathing changes. It’s less common, but it’s one of the conditions we take very seriously in babies.

+  Higher-risk age: Under one (particularly under six months) and any little ones with an underlying medical condition such as heart issues and long term respiratory issues.

Croup

Croup causes swelling in the upper airway and is known for its barking seal-like cough. It can sound alarming, especially when it happens at night or suddenly. Most cases are mild and can be managed at home, but occasionally the swelling can affect breathing.

+  Higher-risk age: Most common between six months and three years (it’s uncommon in little ones under six months). Younger babies are more affected by even small amounts of swelling due to their narrow airways.

WHAT YOU CAN DO AT HOME

If your baby comes down with a mild cold or viral bug, there’s often a lot you can do at home to help them feel more comfortable and support their breathing. It’s all about keeping their airways as clear as possible, helping them stay calm and rested, and knowing when things might need a second look.

Here are a few simple, gentle things that can really make a difference:

+  Saline drops or spray: a couple of saline drops in each nostril can help loosen dry or thick mucus, especially before feeds or naps. This makes it easier for your baby to breathe through their nose, which is their preferred way of breathing, particularly while feeding.

+  Try a nasal aspirator: after using saline, you can use a bulb syringe or a gentle suction aspirator to remove any mucus sitting near the front of the nostrils. This can help relieve congestion and make breathing easier, especially in younger babies who can't blow their noses yet.

+  Use a cool-mist humidifier: winter air and heaters can dry out the air, which can irritate the nose and throat. A cool-mist humidifier adds moisture to the air and can help ease stuffy noses and coughs. Aim for the humidity in your baby’s room to sit between 40-60%, which is ideal for respiratory comfort. Just make sure the humidifier is cleaned regularly to avoid bacteria or mould building up.

+  Keep their fluids up: offer your baby more frequent feeds to keep them hydrated and help thin out mucus. Even small amounts more often can make a big difference, especially if they’re a bit off their usual feeding pattern.

+  Watch out for red flags: even with a mild illness, keep an eye out for signs that your baby may be starting to struggle, like fast or laboured breathing, retractions, flaring nostrils, poor feeding, or any of the other red flags mentioned earlier. If something feels off or even if you just want reassurance, it’s always okay to ask for help. Call Healthline. Feeling really worried is a valid reason to take your baby to a doctor urgently.

Bugs and sickness can be overwhelming, especially when your baby is not acting like themselves and you're trying to work out what's normal. Knowing what to watch for, like changes in breathing, signs of working harder to breathe, or feeding difficulties can help you feel more prepared and less unsure in the moment. Most of the time, it’s nothing super serious, but if something feels off, always trust your gut. It’s always okay to seek help when you feel worried about your sick baby this winter.

Charlotte and Teresa are senior clinical paediatric ICU nurses and owners of & Breathe First Aid, teaching immersive baby and child first aid courses to families. Motivated by seeing poor outcomes and preventable injuries in the PICU, they have a shared has a passion for helping families learn effective CPR and how to keep their little ones safe. Visit andbreathefirstaid.co.nz to book a course online or in person.