The heart and lungs work very closely together. When the heart is not working as it should, it can cause trouble breathing.

Quickly recognizing signs of trouble breathing is very important — it allows your child to get the treatment they need before it becomes more serious.

Here's how to care for your child.

• If your child develops trouble breathing, your child's cardiologist (heart specialist) may recommend that you:
  • Give medicines, breathing treatments, or oxygen at home.
  • Bring your child into the office to be checked by someone on the cardiology care team.
  • Take your child to the ER or call 911.

Call your cardiology care team if your child has any signs of trouble breathing.

If you can't get in touch with your care team within a few minutes or if you are very worried about your child, call 911 or take your child to the ER.

Signs of trouble breathing include:

• Fast breathing (To count your child’s breathing rate, count how many times their chest rises and falls in one minute. One rise and fall counts as one breath. See table below for normal rates.)
• Noisy breathing, such as grunting, wheezing, or other new breathing sounds
• Nostrils opening wide with each breath
• Skin pulling in around the ribs, collarbone, or neck with each breath (called retractions)
• Sweating, especially if the skin feels cool or clammy
• Eating less, stopping often during feeding, or getting tired while eating
• A heartbeat that is pounding or feels faster than usual when you put your hand on your child's chest
• A change in oxygen level (if you are using a pulse oximeter at home)
• Pale, gray, or blue skin, lips, mouth, or nails
• Head bobbing with breathing
• Sitting or leaning forward, or tilting the head back, to breathe more easily

How do I check my child's breathing rate? Check your child's breathing rate when they are calm and resting, not crying, playing, or just after exercise.

1. Watch your child's chest or belly.
2. Count each time the chest or belly rises and falls. One rise and one fall equals one breath.
3. Use a timer or clock and count the breaths for one minute (60 seconds).
4. Write down the number of breaths you counted.

Compare your child's breathing rate to the chart below. Call your cardiology care team if your child's heart rate is slower or faster than the normal rate for their age.

How many times does a child breathe in 1 minute? When they're calm or asleep, the number of times kids breathe in a minute is:

Why do children with heart problems have trouble breathing? Kids with heart problems can develop breathing problems because the heart and lungs work very closely together. Trouble breathing can be caused by too much blood flow or extra fluid in the lungs or high pressure in the blood vessels of the lungs. Kids with heart problems are also more likely to develop breathing problems from respiratory infections like colds.

How can we help prevent trouble breathing? It's important to:

• Keep your child away from people who are smoking or vaping. Make your home and car smoke and vapor free. For help quitting, call 800-QUIT-NOW (800-784-8669) or visit smokefree.gov.
• Keep your child strong by making sure they get the nutrition they need.
• Make sure your child takes the medicines that your cardiologist recommends.
• Ask the cardiologist what physical activity is safe for your child.

Also, kids with heart problems are more likely to have trouble breathing when they are sick. To help your child avoid getting sick:

• Get all vaccines for your child and family members as recommended by your healthcare provider or cardiologist.
• Keep your child away from people who are sick whenever possible.
• Teach everyone in the family to wash hands well and often.
• Help your child take good care of their teeth and gums. Good dental care helps lower the chance that germs from the mouth can cause infection. Ask the cardiologist if your child needs antibiotics before dental visits.