Breathing retractions are the visible sinking of the skin in the chest and neck area during inhalation. This physical sign indicates that an individual is working harder than normal to breathe. It occurs when the muscles around the ribs and in the neck are engaged to help pull air into the lungs, creating a vacuum effect. Retractions are not a standalone medical condition but rather a symptom of an underlying issue causing respiratory distress.
Types and Locations of Retractions
Breathing retractions can appear in different areas of the chest and neck, and their location can provide information about the breathing difficulty. These visual cues are important for identifying the extent of the effort being used to inhale. Understanding where to look for these signs can help in recognizing respiratory distress.
One common location is just below the rib cage, a type known as subcostal retractions, where the abdomen appears to sink in. Another type, intercostal retractions, is seen when the skin and muscles between the ribs pull inward with each breath.
Other retractions occur higher up on the body. Suprasternal retractions, sometimes called a tracheal tug, happen when the skin at the base of the neck, just above the breastbone, sinks in. Similarly, supraclavicular retractions are visible as a sinking of the skin just above the collarbone. The presence of these higher retractions often points to a more significant effort to get air into the lungs.
Underlying Causes of Retractions
Various medical conditions can obstruct the airways and lead to breathing retractions. An infection or inflammation in the airways is a frequent source of this problem.
Conditions like bronchiolitis, often caused by the respiratory syncytial virus (RSV), and pneumonia can cause inflammation and fluid in the small airways and lungs, leading to retractions. Asthma is another common cause, where the airways narrow and swell, making it difficult for air to pass through. Croup, an infection of the upper airway, obstructs breathing and causes a distinctive barking cough along with retractions.
A severe allergic reaction, known as anaphylaxis, can cause the throat and airways to swell rapidly, leading to significant breathing difficulty and retractions. In other cases, the aspiration of a foreign object can create a physical blockage in the airway.
Assessing Severity and Seeking Help
Observing retractions is a clear sign that medical evaluation is necessary, but other concurrent symptoms help determine the urgency. The severity of the respiratory distress dictates whether to seek immediate emergency care or to schedule a prompt appointment with a doctor. Certain signs, when seen with retractions, signal a critical situation.
Immediate emergency medical attention is required if retractions are accompanied by a bluish color around the mouth, on the inside of the lips, or on the fingernails, a condition known as cyanosis. Other alarming signs include grunting sounds with each exhalation, flaring of the nostrils during inhalation, and very rapid breathing. These symptoms indicate the body is not getting enough oxygen.
A child appearing unusually tired, lethargic, or having difficulty staying awake is also a reason for immediate concern. An inability to speak or cry properly further indicates severe distress. The location of the retractions matters as well; suprasternal and supraclavicular retractions generally suggest a more intense struggle to breathe. The presence of these severe signs requires calling 911 or going to the nearest emergency room.