An 8-month-old has a cold and is making a noisy, rattly sound when breathing. After nasal suctioning the sound goes away. What was this?
Wheezing During a Cold in Babies
A cold can cause wheezing in babies when viruses swell the small airways and fill them with mucus. Noisy rattly breathing that clears after nasal suction is usually congestion, not wheezing. True wheezing is a musical whistle from the chest during breathing out that continues even after the nose is cleared.
Cold-Related Wheezing vs. Nasal Congestion
- Noisy breathing from a stuffy nose is not wheezing — congestion sounds wet and rattly and comes from the nose, while true wheezing is a musical whistle from the chest during breathing out.
- A helpful test: if the noisy breathing clears when the nose is suctioned, it was likely nasal congestion. If the whistling continues after clearing the nose, it is more likely true wheezing from the lungs.
- The two most common causes in children under six years old are bronchiolitis — a viral infection of the small airways, most common in babies under 12 months — and asthma, more common in toddlers and older children.
- Viral infections — especially RSV, rhinovirus, and influenza — cause swelling and extra mucus inside the small airways, narrowing them and creating the whistling sound.
- Wheezing that only happens during colds and goes away completely between illnesses is called episodic viral wheeze. Wheezing that also occurs between illnesses — during exercise, laughing, or at night — may suggest asthma.
When to Worry
- Call the pediatrician if wheezing is new and persistent, if the child is feeding less than half of normal amounts, or if wet diapers have decreased noticeably.
- Seek emergency care immediately if the child shows blue or gray color around the lips, tongue, or fingertips, or if the child is limp, unusually sleepy, or very difficult to wake.
- Seek urgent care if breathing rate is consistently fast and the child appears to be working hard with each breath — skin pulling in at the neck, ribs, or belly.
- A high-pitched whistling sound from the chest during breathing out combined with nasal flaring is true wheezing with signs of increased breathing effort — do not wait for color changes.
- If the child has a known asthma condition and the prescribed inhaler is not providing relief within the expected time frame, contact the pediatrician or seek emergency care.
Knowledge Check
Tap the answer that best fits each scenario.
A 14-month-old has had a cold for 3 days and a high-pitched whistling sound is heard from the chest when the child breathes out. The nostrils are also flaring. What is the appropriate response?
A 2-year-old suddenly starts wheezing with no cold symptoms after playing on the floor with small toys. What should be considered?
