These signs must be assessed when the child is calm and not crying:

1. Stridor is usually due to viral croup.
2. Indrawing of the lower chest wall may occur with most severe lower respiratory tract problems, i.e. pneumonia, stridor, bronchiolitis or asthma.
3. Wheezing suggests bronchiolitis (in an infant) or asthma (in an older child).
4. Fast breathing suggests pneumonia, bronchiolitis or asthma.

Older children with a severe lower respiratory tract problem may complain of shortness of breath. Always look for danger signs in any child with breathing difficulty.

The sudden onset of stridor or wheeze in a well child suggests a foreign body.

If any of these signs are present, the child should be carefully examined and considered for urgent transfer to hospital.