Breathing Difficulty

Difficulty in breathing or cough is the most common reason for hospital admission in young children.

EM Curriculum: (click to view)


The most severe respiratory infections usually occur in those under 3 years. The commonest causes of breathlessness in children are asthma, croup, bronchiolitis and pneumonia. There are various guidelines available to aid with your knowledge and understanding of this topic.

Having a good grasp of these conditions is also vital if you work in paediatrics over the winter months as this forms a large proportion of presentations. Being able to identify the sick children and respond as needed is an important skill.

It is also necessary to understand which children can be safely discharged and what advice should be given to the parents about when to return.

Learning Outcomes from Completing the Tasks

  • Differentiate between the various common causes of breathing difficulty in children to include:

    • Asthma

    • Croup

    • Pneumonia

    • Bronchiolitis

  • Recognise and assess life-threatening airway obstruction and acute stridor.

  • Explain the pathophysiology of the different causes of acute stridor.

  • Recall the national guidelines for the management of various breathing difficulty problems in children.


  • Propose a management strategy for a child with airway obstruction and acute stridor

  • Recall the algorithms for age appropriate obstruction

  • Demonstrate basic airway management in children

  • Revise the causes of breathing difficulty in children


Complete the following before the face-to-face session:

TASK 1: Stridor

Duration: 60 mins

This module from the new RCEMLearning website covers this topic in great detail for the ED doctor. To access the module click on the screenshot or link below. If you haven't been to the new website it is worth taking a minute or two to look round the website.

Task 2: Difficulty in Breathing

Duration: 60 mins

This section on the Spotting the Sick Child website covers DIB in children in great detail. The particular topics of importance here are asthma, croup, bronchiolitis and pneumonia. Please note: their new website now requires you to register (for free) to access the same material.

Task 3: BTS and NICE Guidelines

Duration: 45 mins

Refresh yourselves on these vital guidelines, as well as making a common exam question they all come up frequently in clinical practice.

#EM3 Content

Lightning Learning:



We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

You are working in the paediatric department in ED when the paramedics bring in a 13 week old baby boy with his mother.
You are the senior doctor in Resus on a night shift when a mother brings in her 3 day old baby stating that he is appears blue and is not well.


Here are some extra resources to review if you want more information: UK:

BMJ learning:

Thorax article – Community Acquired Pneumonia in Children: What's new?

This article summarises the changes made to the 2011 update of the BTS CAP in Children guideline. Useful if you're a bit short on time!

Pertussis / whooping cough:

Pertussis factsheet for healthcare professionals from HPA.


RCEMLearning Croup page – this overlaps with the Acute Stridor module you completed as the first mandatory task but in simple webpage form so a good revision tool regarding acute stridor and croup.


Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: