Observing a baby sleep often brings peace, but parents frequently notice their baby’s breathing patterns differ from adults. This can lead to concerns about normal variations. Infant breathing during sleep is commonly irregular and usually not serious, reflecting a baby’s developing respiratory system.
Understanding Normal Infant Breathing
Infants exhibit unique breathing patterns during sleep due to their still-developing respiratory systems. A newborn’s breathing rate is typically faster than an adult’s (30-60 breaths/minute awake, 30-40 asleep). Their breathing can also appear irregular, with periods of rapid breathing followed by brief pauses.
This pattern is known as periodic breathing: a baby takes several quick breaths, pauses for 5 to 10 seconds, then resumes breathing rapidly before returning to a regular rhythm. Periodic breathing is normal in healthy infants, especially during sleep, and is usually outgrown by six months of age. Unlike concerning pauses, it does not typically cause changes in the baby’s skin color.
Babies primarily use their diaphragm for breathing, which is why their abdomen visibly moves up and down with each breath. This “belly breathing” is normal and expected. The variations observed in infant breathing, including shallow breaths and occasional sighs, are part of this developmental process.
Identifying Concerning Breathing Patterns
While some irregularities are normal, certain breathing patterns indicate difficulty and require immediate attention. A pause lasting 20 seconds or longer is defined as apnea. Shorter pauses combined with symptoms like a slow heart rate or reduced blood oxygen are also problematic.
Changes in a baby’s skin color, such as a bluish tint around the mouth or face, or a pale, mottled, or gray appearance, suggest insufficient oxygen. Other signs include labored breathing, manifesting as flaring nostrils that widen with each inhaled breath. Chest retractions, where skin pulls in at the ribs, below the breastbone, or above the collarbones with each breath, also indicate increased breathing effort.
Unusual sounds during breathing, such as grunting, wheezing, or gasping, can also be red flags. Grunting is a sound a baby makes to try to keep air in the lungs and build up oxygen levels. Persistent or rapid breathing that remains fast even after the baby calms down, especially if it exceeds 60 breaths per minute, warrants immediate evaluation.
Common Reasons for Breathing Irregularities
Infant breathing irregularities stem from various causes. Nasal congestion from a common cold can lead to noisy or labored breathing, as babies are obligate nose breathers. While often transient, significant congestion can impede airflow. Gastroesophageal reflux disease (GERD), where stomach contents flow back into the esophagus, may cause breathing problems like wheezing, coughing, or even pauses.
Infant sleep apnea is a condition where breathing repeatedly slows or stops during sleep. Two main types exist: obstructive sleep apnea (OSA), caused by a physical airway blockage, and central sleep apnea, occurring when the brain fails to send breathing signals. Central sleep apnea is more common in infants, especially premature babies, whose central nervous systems are still developing.
Sudden Infant Death Syndrome (SIDS) is a serious concern related to sleep and breathing, representing a leading cause of death in infancy. While its exact cause is not fully understood, SIDS is linked to sleep-related factors and highlights the importance of safe sleep practices. SIDS rates significantly declined after the American Academy of Pediatrics (AAP) recommended placing babies on their backs to sleep.
Creating a Safe Sleep Environment
Establishing a safe sleep environment is a key measure to reduce risks associated with infant breathing during sleep, including SIDS. The American Academy of Pediatrics (AAP) recommends placing infants on their back for all sleep, until they reach one year of age. This position significantly reduces the risk of sleep-related infant deaths.
Babies should sleep on a firm, flat surface, such as a crib, bassinet, or portable play yard, with a fitted sheet. The sleep surface should not indent when the baby is lying on it. Keep the sleep area clear of soft bedding (loose blankets, pillows, bumper pads, soft toys), as these pose a suffocation hazard. The crib should be bare except for the baby.
Room-sharing, where the baby sleeps in the same room as parents but on a separate surface, is recommended for at least the first six months, ideally the first year. This practice can decrease the risk of SIDS by as much as 50%. Bed-sharing is not recommended due to increased risks of suffocation, strangulation, and entrapment.
When to Contact a Healthcare Professional
Contact a healthcare professional for any concerning changes in your baby’s breathing. If a baby stops breathing for 20 seconds or longer, or if shorter pauses are accompanied by a slow heart rate or bluish skin color, immediate medical attention is necessary. If a baby is unresponsive, turns blue, or becomes limp, call emergency services immediately and begin infant CPR if trained.
For other worrisome signs, contact a pediatrician. These include persistent rapid breathing, flaring nostrils, chest retractions, or grunting noises with each breath. Unusually loud breathing, persistent coughing, or wheezing also warrant evaluation. If a baby is too breathless to feed, seek urgent medical attention.