The evaluation of a child with difficulty breathing begins with a history and physical examination.

Physical findings may include:

• Signs of severe difficulty breathing:
• Rib retractions
• Nasal flaring
• Use of accessory muscles
• Cyanosis
• Dry mucous membranes and skin, or other signs of dehydration
• Fever
• Rapid pulse
• Rapid breathing
• Wet rales and rhonchi sounds in the chest
• Wheezing

Tests are often necessary to determine the underlying cause.

Testing may include:

• Complete blood count: helps assess the severity of infection
• Chest x-ray:
• Normal chest x-ray
• Chest x-ray showing pneumonia
• Pulse oximetry: may show low oxygen levels
• Cultures of sputum (mucus) for bacteria and viruses
• Rapid influenza testing
• Pulmonary function tests