When to get help

Call emergency services now — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if your baby has any of these:

Grunting — a short sound at the end of each breath out. NICE guideline NG254 lists grunting as a high-risk criterion for severe illness or death from sepsis at any age under five.
Pauses in breathing (apnoea). Also a NICE NG254 high-risk criterion.
Blue or grey lips, tongue or skin. NICE NG254 lists cyanosis of the skin, lips or tongue as high risk; the NHS says blue or grey lips in a baby is an emergency.
A breathing rate of 60 a minute or more in a baby under one year. NICE NG254 sets exactly that number as the high-risk threshold for this age group, and NG143 lists a respiratory rate above 60 as a red feature in a child with fever.
Moderate or severe chest indrawing — the skin sucking in between or under the ribs, or at the base of the throat, with each breath. Another NG143 red feature.
Too breathless to feed, or a baby who is floppy, will not wake, or does not stay awake.

Seek urgent same-day advice — NHS 111 in the UK, your GP or GP out-of-hours service in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand — if the rate is 50 to 59 a minute in a baby under one, which NICE NG254 places in the moderate-to-high-risk group, or if you can see nasal flaring, which NG143 treats as an amber feature.

How to count a baby's breathing rate

The number is only worth having if you count it properly. Take off the vest or lift it so you can see the chest and tummy. Wait until your baby is settled, ideally asleep — a baby who has just been crying or feeding will always breathe faster, and that reading tells you nothing.

Watch one point on the chest or upper tummy and count each rise as one breath. Count for the full sixty seconds. Do not count for fifteen seconds and multiply by four. Babies breathe irregularly in short runs with brief gaps, so a fifteen-second sample can land on a fast run or a slow one and be out by twenty breaths a minute in either direction.

Count twice if the first number is near a threshold. If you get 58 and then 62, treat it as the higher one and ring for advice.

What counts as too fast

The thresholds below are the ones British clinicians actually work to, from NICE NG254 table 1. For a baby under one year, a rate of 60 breaths a minute or more is a high-risk criterion. A rate of 50 to 59 is a moderate-to-high-risk criterion. From one to two years the high-risk line moves down to 50, and from three to four years to 40.

NICE NG143 uses the same shape of rule when a child has a fever, and adds that pneumonia should be considered in a child with fever and a respiratory rate above 60 between birth and five months, above 50 from six to twelve months, or above 40 over twelve months, particularly alongside crackles in the chest, nasal flaring, chest indrawing, cyanosis, or an oxygen saturation of 95 per cent or less in air.

Notice what those numbers imply. A healthy young baby genuinely does breathe far faster than you do. The point is not that fast breathing is abnormal in itself; it is that the profession has agreed where fast stops being ordinary, and for a baby under one that place is 60.

Grunting is not just a noise

Parents often describe a baby as grunting when they mean the snuffly, rattly, wet-sounding breathing that comes with a blocked nose, or the straining noise a baby makes over a nappy. Neither of those is what clinicians mean.

Respiratory grunting is a short, low sound made at the end of each breath out, on breath after breath. The baby is closing the voice box against the outgoing air to hold pressure inside the lungs and keep the small air sacs open. It is the body compensating for lungs that are not working well, and it is why NICE puts it in the high-risk column with no rate attached. A baby who is grunting on most breaths needs assessment now, whatever the thermometer says.

Indrawing, head bobbing and flaring

Look at the whole picture rather than only the count. Chest indrawing is the soft tissue between the ribs, under the ribs, or in the notch at the base of the neck being pulled inwards with each breath, and NICE NG143 lists moderate or severe indrawing as a red feature. Nasal flaring is the nostrils widening on each breath in; NG143 treats it as amber and NG254 as moderate to high risk. Head bobbing in a young baby, where the head nods forward with each breath, is the same story told by the neck muscles.

A baby who is working that hard cannot keep it up indefinitely, which is why a tiring baby can look briefly calmer just before things get worse. Falling effort with no other improvement is not reassurance.

Fast breathing that is not an emergency

Newborns breathe in an uneven pattern with short pauses, then a run of quicker breaths. Fever itself pushes the rate up. A baby who has been screaming, or who has just finished a hungry feed, will breathe quickly for a few minutes afterwards. In every one of those cases the fix is the same: wait until your baby is genuinely settled, then count again from scratch.

Noisy breathing on its own is a different question from fast breathing. The American Academy of Pediatrics notes that stridor, a harsh sound heard when breathing in, is often caused by laryngomalacia, a floppiness of the tissue above the voice box that is usually harmless and improves as a baby grows. That is a conversation for a routine appointment, unless the rate, the effort or the colour is also wrong.

What to do while you wait

Keep your baby upright or semi-upright rather than flat, which usually makes breathing feel easier. Offer smaller, more frequent feeds, because a breathless baby cannot manage a long one, and keep count of wet nappies so you can report them. Do not put a baby with laboured breathing down for a nap unattended, and do not give any medicine to make the breathing look better.

What to say when you call

Have four things ready: your baby's age in weeks or months, the breathing rate you counted and the fact that you counted for a full minute, the temperature and how you took it, and how many wet nappies there have been in the last twelve hours. Then describe the effort in plain words — whether the ribs are sucking in, whether there is a grunt at the end of each breath out, and what colour the lips are. Those details move a call from a queue to a same-hour assessment faster than any single number.

Baby Breathing Fast