Does the child’s breathing appear to be obstructed? Look at the chest wall movement, and listen to breath sounds to determine whether there is poor air movement during breathing. Stridor indicates obstruction. Is there central cyanosis? Determine whether there is bluish or purplish discoloration of the tongue and the inside of the mouth. Is the child breathing? Look and listen to determine whether the child is breathing. Is there severe respiratory distress? The breathing is very laboured, fast or gasping, with chest indrawing, nasal fl aring, grunting or the use of auxiliary muscles for breathing (head nodding). Child is unable to feed because of respiratory distress and tires easily.