Noisy breathing occurs as a result of turbulent airflow, typically indicates some degree of airflow obstruction. Evaluating a child with noisy breathing can be challenging due to the wide range of potential cause of noise. Obtaining a comprehensive history and physical examination is critically important first step in determining possible etiology. Recognition of different types of noisy breathing and its quality or characteristics can be further evaluated through physical examination to determine either the pathology is in intrathoracic or extra thoracic. Further diagnostic evaluation such as airway endoscopy and thoracic imaging may be required to assist in diagnosis and intervention.