What is wheezing?
Wheezing is a high-pitched whistling sound when your child breathes out. It happens when the airways inside the lungs get narrow or swollen. Wheezing can be caused by RSV, a cold, allergies, or asthma. In children ages 0–5, wheezing is very common — but repeated wheezing episodes may be an early sign that your child is developing asthma.
What is asthma?
Asthma is a chronic condition where the airways in the lungs are sensitive and can become swollen and narrow, making it hard to breathe. Asthma cannot be cured, but it can be managed well. Alaska Native children develop asthma at higher rates than the national average. Identifying asthma early — in the 0–5 window — is one of the most important things MamaBear can help with.
Asthma risk factors — what to watch for
Your child may be at higher risk for asthma if they have:
- Repeated wheezing episodes: more than one episode of wheezing, especially with colds
- Wheezing without a cold: wheezing that happens when your child runs, plays hard, or breathes cold air
- Nighttime cough: a cough that wakes your child at night or is worse at night
- Family history: a parent or sibling has asthma, hay fever, or eczema
- Eczema (skin rashes): eczema in young children is linked to higher asthma risk
- Allergies: sneezing, watery eyes, or reactions to animals, dust, or mold
- Exposure to tobacco smoke: secondhand smoke is a major asthma trigger — inside the home or a wood-burning stove
- Indoor wood stove or oil heat: common in rural Alaska — smoke and particulates are significant asthma triggers
| Why early identification matters Children who are identified as high-risk for asthma before age 5 can receive early preventive treatment that may reduce the severity of asthma — or prevent it from becoming a chronic condition. MamaBear tracks your child’s wheezing episodes, triggers, and respiratory patterns and shares this data with your provider so they can act early. |
During a wheezing episode — what to watch for
- Breathing rate: counting breaths per minute — see fever section for normal ranges
- Chest retractions: skin pulling in between ribs or at the throat
- Color: any blue or gray color around lips or fingertips is an emergency
- Speaking: can your child speak a full sentence? Speak at all?
- Response to medicine: if your child has been prescribed a rescue inhaler (albuterol), use it and note whether it helps
What you can do during a wheezing episode
- Stay calm: anxiety makes breathing harder
- Rescue inhaler: if prescribed — give as directed and note if symptoms improve within 20 minutes
- Remove triggers: move away from smoke, animals, or anything that may have triggered the episode
- Upright position: sitting up helps
- Warm humid air can help mild wheezing: steamy bathroom
Important: Do not give antihistamines (like Benadryl) for wheezing — they can make breathing worse in young children.
| 📞 Call your provider if: First wheezing episode ever — tell your provider Wheezing that doesn’t improve with rescue inhaler Cough worse at night or with activity Repeated wheezing episodes — track and report Exposure to a new trigger (new pet, mold, smoke) | 🚨 Go to the ER immediately if: Severe difficulty breathing — retractions, grunting Blue or gray color around lips or fingertips Cannot speak or cry normally Rescue inhaler not working after 2 doses Rapidly getting worse |
7. CHEST RETRACTIONS — WHAT THEY ARE & WHY THEY MATTER
What are chest retractions?
Chest retractions happen when a child is working very hard to breathe. You can see the skin pulling in — between the ribs, under the ribs, above the collarbone, or at the throat (neck). Retractions tell you that your child’s body is using extra muscles to move air. They are always a sign that your child needs medical attention.
How to identify retractions
To check for retractions, uncover your child’s chest and watch closely while they breathe:
- Subcostal retractions: skin pulling in just below the rib cage — the belly sucks in with each breath
- Intercostal retractions: skin pulling in between the ribs — you can see the ribs clearly with each breath
- Suprasternal retractions: the skin at the base of the throat (just above the breastbone) pulls in
- Supraclavicular retractions: the skin just above the collarbone pulls in
Mild retractions may appear only when your child is breathing faster than usual. Severe retractions are visible at rest and involve multiple areas.
| Retractions always mean: contact your provider today Even mild retractions are a signal that your child is working harder than normal to breathe. Take a video using MamaBear to show your provider exactly what you are seeing — this is far more useful than a description. Severe retractions — especially with blue color or fast breathing — are a medical emergency. |
Using MamaBear to capture retractions
When you see retractions, open MamaBear and record a short video of your child’s chest. Make sure the chest is uncovered and the lighting is good. Send the video report to your provider immediately. Video is the single most useful thing you can give a provider who cannot see your child in person.
| 📞 Call your provider if: Any retractions — mild or moderate Retractions with fast breathing Retractions that come and go Retractions with wheezing or cough You are unsure what you are seeing — send a video | 🚨 Go to the ER immediately if: Severe retractions in multiple areas Retractions with blue or gray color Retractions with grunting on each breath Child appears exhausted from breathing Retractions and child is hard to wake |
8. RAPID BREATHING (TACHYPNEA)
What is rapid breathing?
Rapid breathing — or tachypnea — means your child is breathing faster than normal for their age. It can be a sign of pneumonia, RSV, asthma, fever, or other illness. Fast breathing on its own, even without other symptoms, always warrants attention.
How to count breathing rate
Count breaths when your child is calm and at rest — not crying, feeding, or active. Watch the belly or chest rise and fall. Count for a FULL 60 seconds.
| Normal breathing rates by age Under 2 months: up to 60 breaths per minute is normal 2–12 months: up to 50 breaths per minute is normal 1–5 years: up to 40 breaths per minute is normal Above these numbers when calm = rapid breathing. Log it in MamaBear and contact your provider. |
Log the exact count in MamaBear. If you count it three times and get a similar number each time, that count is reliable. Include the time you counted.
| 📞 Call your provider if: Breathing faster than normal for their age at rest Fast breathing that has lasted more than a few hours Fast breathing with fever Fast breathing with decreased activity or feeding You’ve counted and it’s above normal — always call | 🚨 Go to the ER immediately if: Fast breathing AND retractions (working hard to breathe) Fast breathing AND blue or gray color Breathing rate above 70 per minute at any age Fast breathing AND child is hard to wake Breathing appears to stop briefly (apnea) |
9. FAST HEART RATE (TACHYCARDIA)
What is a fast heart rate?
A fast heart rate in children can happen with fever, dehydration, pain, respiratory distress, or illness. The heart beats faster to pump more oxygen when the body is under stress. In most cases, treating the underlying cause — reducing fever, giving fluids — will bring the heart rate down. But a very fast heart rate, or a fast heart rate that doesn’t improve, needs medical attention.
Normal heart rates by age
- Newborn (0–1 month): 100–160 beats per minute
- 1–12 months: 100–160 beats per minute
- 1–2 years: 90–150 beats per minute
- 2–5 years: 80–140 beats per minute
Heart rates are naturally higher in babies and young children than in adults. A child’s heart rate also goes up when they cry, are active, or have a fever. Count heart rate when your child is calm and at rest.
How to check heart rate at home
- Place two fingers gently on the inside of the wrist just below the thumb
- Or feel the pulse on the left side of the chest
- Count beats for 60 seconds — or count for 15 seconds and multiply by 4
- Log the count and time in MamaBear
| 📞 Call your provider if: Heart rate above normal for age when calm Fast heart rate that doesn’t slow down after fever is treated Fast heart rate with decreased wet diapers (dehydration) Fast heart rate with fast breathing Your child seems very tired or pale | 🚨 Go to the ER immediately if: Heart rate above 200 beats per minute Fast heart rate with blue or gray color Chest pain with fast heart rate Child is limp, pale, or unresponsive Heart rate AND severe difficulty breathing |
10. COLD EXPOSURE & ALLERGEN TRIGGERS
Cold exposure and respiratory symptoms
In Alaska, cold air is a year-round reality — and for children with sensitive airways or early asthma, cold air can trigger wheezing, coughing, and breathing difficulty. This is especially relevant in rural Alaska where children may spend time outdoors in extreme cold or in unheated spaces. Cold air causes the airways to narrow, which can trigger symptoms in children who would otherwise be well.
Cold exposure — what to watch for
- Coughing that starts or gets worse after being outside in cold air
- Wheezing after cold air exposure
- Breathing harder than normal after coming in from outside
- Runny nose and congestion triggered by cold
Protecting children from cold-triggered symptoms
- Cover the nose and mouth: a loose scarf or face covering over the nose and mouth when going outside warms the air before it reaches the lungs
- Breathe through the nose: nasal passages warm air before it reaches the airways — encourage nasal breathing
- Limit cold exposure for children with known wheezing or asthma
- Warm up gradually: bring children in from the cold gradually — sudden temperature changes can also trigger symptoms
Allergen triggers
Allergens are things in the environment that cause an immune reaction. In rural Alaska, common allergen triggers for young children include:
- Wood smoke: from wood stoves — one of the most significant indoor triggers in rural Alaska
- Mold: common in homes with moisture issues — often associated with lack of running water or poor ventilation
- Dust mites: in bedding and carpets
- Animal dander: dogs, cats, and other animals in the home
- Oil fumes: from oil-burning heaters
- Outdoor allergens: grasses, tree pollen — more relevant in spring and summer
Reducing allergen exposure at home
- Wood stove: burn dry wood only — wet wood produces more smoke. Ensure good ventilation. Keep children away from smoke
- Mold: fix moisture sources. Use ventilation fans. Check for visible mold under sinks and in corners
- Bedding: wash bedding weekly in hot water. Encase mattress and pillows in allergen-proof covers if possible
- Pets: if pets trigger symptoms, keep them out of the bedroom
- No smoking indoors: tobacco smoke and cannabis smoke are major triggers — always smoke outside and away from the home
Log allergen exposures in MamaBear whenever your child has a symptom episode. Over time, patterns will emerge that help your provider identify your child’s specific triggers.
| 📞 Call your provider if: Wheezing or coughing triggered by cold air or allergens Symptoms that follow a clear pattern (same trigger, same response) Symptoms improving when away from home environment Skin rash or hives after exposure Repeated episodes — log and report to provider | 🚨 Go to the ER immediately if: Severe wheezing or difficulty breathing after exposure Throat swelling or difficulty swallowing Hives spreading rapidly across the body Child is pale, limp, or unresponsive after exposure Any signs of anaphylaxis — call 911 |
11. DEHYDRATION
What is dehydration?
Dehydration happens when a child loses more fluid than they take in. It can happen with fever, vomiting, diarrhea, or any illness where your child isn’t drinking well. Young children get dehydrated faster than older children or adults. Dehydration makes every illness worse.
Signs of dehydration to watch for
- Fewer wet diapers: normal is 6 or more wet diapers per day for infants. Fewer than 4 is concerning
- No tears when crying
- Dry mouth and lips
- Sunken eyes
- Sunken fontanelle: the soft spot on a baby’s head sinking in
- Very dark yellow urine: or no urine for 8+ hours in older toddlers
- Skin that stays ‘tented’: pinch the skin on the belly gently — if it stays tented instead of snapping back, dehydration may be significant
Keeping your child hydrated
- Infants under 6 months: breast milk or formula only — offer more frequently in smaller amounts
- Infants over 6 months: breast milk, formula, or small amounts of water. Oral rehydration solution (like Pedialyte) for active dehydration
- Toddlers: water, diluted juice, broth, popsicles, oral rehydration solution
- Small and often: if your child is vomiting, try 1–2 teaspoons every 5 minutes — small amounts more likely to stay down
- Avoid: sugary drinks, full-strength juice, sports drinks — these can make diarrhea worse
| 📞 Call your provider if: Fewer than 4 wet diapers in 24 hours No urine for 6–8 hours in a toddler Dry mouth, no tears Not keeping any fluids down for more than a few hours Child seems very tired or less active than usual | 🚨 Go to the ER immediately if: Sunken eyes, sunken fontanelle Limp, very difficult to wake No wet diaper for more than 12 hours Skin that stays tented Lips and mouth very dry, child not responding normally |
UNIVERSAL EMERGENCY REFERENCE — ALWAYS SEEK CARE FOR THESE SIGNS
Regardless of what illness your child has, these signs always mean seek emergency care immediately. Do not wait to see if they improve.
| 🚨 GO TO THE ER OR CALL FOR EMERGENCY HELP IMMEDIATELY FOR: Blue, gray, or white color around the lips, fingertips, or face Struggling to breathe — retractions, grunting, nostrils flaring Very difficult or impossible to wake up Limp, floppy, not responding to you Seizure (shaking, stiffening, eyes rolling back) Breathing has stopped or is stopping Severe allergic reaction — throat swelling, hives spreading rapidly, difficulty breathing Your instinct tells you something is seriously wrong — trust it |
DEV NOTE: Add local emergency contact info field here — community health aide number, regional hospital, medevac line. This should be configurable per clinic deployment.
In rural Alaska, emergency transport takes time. If you are seeing any of the signs above, contact your community health aide or emergency services immediately — do not wait. While waiting for help, keep your child as calm and upright as possible, and continue monitoring.
NOTES FOR CLINICAL REVIEW & LOCALIZATION
The following items are flagged for clinical review before deployment and for Alaska-specific localization in partnership with tribal health organizations:
- Medication dosing: all dosing references currently point to package instructions by weight — consider adding a weight-based dosing table for acetaminophen and ibuprofen
- Oral rehydration: confirm availability of Pedialyte or equivalent in rural Alaska communities — note alternatives if unavailable
- Community health aide routing: add configurable field for local CHA contact information per deployment region
- Language: content is written in plain English. Prioritize translation into Yup’ik for YK Delta deployment — work with YKHC or ANTHC language team
- Cultural review: all content should be reviewed by Alaska Native community health representatives before deployment to ensure cultural appropriateness and trust
- Breathing rate chart: consider adding a visual graphic for breath-counting — helpful for low-health-literacy families
- Video guidance: add in-app prompts for how to capture good retraction and breathing videos — lighting, distance, duration
- Asthma risk scoring: consider integrating a validated asthma predictive index (API) score into the asthma/wheezing module — discuss with clinical advisors