Nasal flaring, the widening of the nostrils with each inhalation, is a physical sign that an infant is working harder than normal to pull air into their lungs. While a momentary flutter might occur during crying or excitement, persistent or pronounced nasal flaring in a newborn is generally not normal. It indicates respiratory difficulty and signals that the baby’s breathing is labored, requiring prompt attention and medical evaluation. Recognizing this sign early is fundamental to addressing potential underlying respiratory distress.
Defining Nasal Flaring and Its Severity
Nasal flaring is the visible expansion of the external openings of the nose, known as the alae nasi, during inhalation. To observe it clearly, look for the nostrils pulling open and stretching wider with every breath inward. This physical manifestation is the body’s involuntary attempt to decrease resistance in the upper airway and maximize the volume of air entering the lungs.
A fleeting, minimal widening of the nostrils during fussing or vigorous feeding may be benign, especially if the infant is calm and pink when resting. However, pronounced, continuous flaring while the newborn is at rest is a concerning symptom of respiratory compromise. The degree of nasal flaring often correlates with the severity of the breathing problem, suggesting a greater struggle for air.
The Underlying Cause: Increased Work of Breathing
Nasal flaring is a direct result of the body’s compensatory mechanism for increased work of breathing. Newborns are obligate nasal breathers, meaning they primarily breathe through their nose. Any restriction in this pathway immediately affects their ability to get sufficient oxygen. When an infant’s lungs or airways face resistance (such as from mucus or inflammation), the infant must increase the force of their respiratory muscles to maintain adequate airflow.
The small muscles attached to the nostrils, which are usually passive, become actively engaged to pull the nasal passages wider open. This action lowers resistance to airflow by increasing the diameter of the upper airway, allowing more air to be drawn in. Nasal flaring is a physical manifestation of the effort to overcome pulmonary issues. It indicates that the infant is struggling to meet oxygen demands or effectively expel carbon dioxide.
Recognizing Other Critical Signs of Distress
Nasal flaring rarely occurs in isolation when a true respiratory problem is present; it is usually accompanied by other signs indicating a severe emergency. One common sign is retractions, where the skin pulls inward between the ribs, below the breastbone (sternum), or above the collarbone during inhalation. Retractions happen when the infant uses accessory muscles to force air into the lungs, demonstrating the extent of the respiratory struggle.
Another serious sign is grunting, a short, low-pitched sound heard at the end of exhalation. The infant makes this sound by partially closing the vocal cords to trap air in the lungs, a maneuver intended to keep the small air sacs (alveoli) from collapsing. Tachypnea, an abnormally rapid breathing rate, is also observed. A rate exceeding 60 breaths per minute often signals distress in a newborn.
The most alarming sign is cyanosis, a blue or dusky discoloration, particularly noticeable around the lips, tongue, or nail beds. This color change is a sign of dangerously low oxygen levels in the blood, indicating that the baby is not getting enough oxygen to the central organs. Behavioral changes, such as unusual lethargy, difficulty waking, or excessive irritability, can also signal that breathing difficulty is impacting the baby’s overall well-being. Observing nasal flaring combined with any of these symptoms signifies a rapidly escalating situation requiring immediate medical intervention.
Immediate Action: When to Contact a Healthcare Provider
The presence of persistent nasal flaring warrants a medical evaluation, but the required action depends on other symptoms. If flaring is accompanied by severe signs like central cyanosis (blue lips or tongue), a limp or unresponsive state, or severe retractions, immediately call emergency medical services. These combinations suggest a life-threatening lack of oxygen and represent a medical emergency.
If the flaring is continuous but isolated, without blue coloring or lethargy, contact the baby’s pediatrician or healthcare provider urgently. Before calling, gather specific details, such as the baby’s estimated breathing rate, temperature, and recent feeding and diaper output. Providing the healthcare team with a clear description of the breathing pattern and behavioral changes will help them determine the necessary next steps. Seeking medical attention is always appropriate when concerned about a newborn’s breathing, as early intervention can significantly improve outcomes.