Acute respiratory distress is a condition in which respiration cannot supply the body's metabolic demand for oxygen. The etiology of acute respiratory distress in children is numerous. Respiratory distress must be promptly recognized and treated, otherwise it can result in cardiorespiratory arrest and death. The initial assessment of vital functions is made following the ABCDE algorithm (airway, breathing, circulation, disability, environment and exposure) and the key is to immediately treat the life threatening problems before moving to the next step. Only when the vital functions are assessed and stabilized, a complete physical exam is done and the definitive diagnosis is made, which is important for the proper treatment. The crucial part of the physical exam is inspection in which every abnormal pattern of respiration must be noted. Moreover, we must observe the color, temperature and humidity of the skin, listen for the breathing fenomena and make a good auscultation in a quiet room after we tranquilize the child. Furthermore, it is essential to take a good heteroanamnesis from the person of the first contact with the child. The diagnostic tests must be minimized in order not to worsen the anxiety of the child and therefore its respiratory distress as well. For this reason it is crucial to take a good heteroanamnesis and do a detailed physical exam before any diagnostic tests.