Chest retractions are an involuntary inward pulling of the skin and soft tissue on the chest or around the neck during inhalation. This visual sign indicates respiratory distress, meaning the body is struggling to move air into the lungs. Recognizing retractions is important because they signal that the person, often an infant or child due to their more flexible anatomy, is working much harder than normal to breathe. This symptom requires prompt medical evaluation.
Identifying the Different Types of Chest Retractions
Retractions are classified by their location, which indicates the severity of the breathing difficulty.
Low-Level Retractions
The first and most common signs appear low on the chest. Subcostal retractions occur below the ribs, often seen as a subtle scooping motion beneath the rib cage. Substernal retractions pull the skin in beneath the breastbone (sternum).
Mid-Level Retractions
As the effort to breathe intensifies, signs become more pronounced and move higher up the chest. Intercostal retractions are the most easily identifiable type, appearing as the skin and muscles between the ribs are visibly sucked inward with each breath. This creates a dented appearance of the ribs and shows that accessory muscles are being recruited forcefully.
High-Level Retractions
The most concerning retractions occur high on the chest and neck, signaling severe airway obstruction and significant respiratory effort. Suprasternal retractions cause the tissue above the breastbone to be drawn inward, sometimes referred to as a tracheal tug. Supraclavicular retractions pull the skin in above the collarbones (clavicles). The presence of these retractions means the breathing problem is serious.
The Physiology Behind Respiratory Distress
Retractions occur because the body is attempting to overcome an obstruction or narrowing in the airways, requiring a greater force to inhale. Normally, the diaphragm contracts and moves downward, creating a gentle negative pressure inside the chest cavity that naturally draws air into the lungs. This process is effortless during normal breathing.
When the airways are partially blocked, the diaphragm and other chest muscles must pull harder to generate enough negative pressure to move air past the obstruction. This intense, suction-like negative pressure physically pulls the softer, more flexible tissues of the chest wall inward. The result is the visible “caving in” of the skin and muscle in areas not supported by rigid bone, which is the characteristic look of a retraction.
Common Conditions That Cause Retractions
A variety of medical conditions can cause the airway narrowing that leads to the increased breathing effort and subsequent retractions.
In infants and young children, viral infections are a frequent cause, such as bronchiolitis (often caused by Respiratory Syncytial Virus or RSV) or croup, which causes swelling in the upper airway. These infections inflame and narrow the small air passages.
Chronic conditions like asthma can also lead to retractions during an exacerbation, as the airways constrict and swell. Pneumonia, an infection causing inflammation in the lung tissue, can also lead to visible retractions if the resulting breathing difficulty is severe. A foreign body lodged in the airway, which is common in toddlers, is a sudden and severe obstruction that immediately triggers retractions.
Immediate Emergency Response
The presence of chest retractions is a definite sign of respiratory distress and should never be ignored or dismissed. Regardless of the location or severity, retractions indicate that the individual is not breathing effectively and needs prompt medical attention. Seek emergency medical services, such as calling 911, immediately upon noticing this symptom.
Do not attempt to wait for the retractions to resolve on their own or try any home remedies, as the underlying cause requires medical intervention to resolve the airway compromise. While awaiting professional help, observe for other signs of distress, such as rapid breathing, a bluish tint to the lips or skin (cyanosis), or a change in alertness, which signal the situation is worsening. Medical professionals will assess the oxygen saturation, breathing rate, and overall level of consciousness to stabilize breathing and then treat the specific cause.