Newborn breathing is naturally sensitive, and parents often feel anxious about whether their baby is getting enough air. “Labored breathing” refers to an increase in the effort or work required for a baby to move air in and out of their lungs. Because newborns cannot communicate discomfort, caregivers must quickly recognize the visual and auditory signs indicating this increased effort. Identifying these physical signs early ensures the baby receives appropriate medical attention.
Understanding Normal Newborn Breathing Patterns
Newborns naturally breathe faster than older children and adults, with a typical resting rate ranging from 40 to 60 breaths per minute. This rate can slow down slightly, often to 30 to 40 breaths per minute, when the baby is sleeping. A common characteristic of healthy newborn respiration is “periodic breathing,” where the baby breathes rapidly for a short time, followed by a brief pause that lasts less than 10 seconds, before breathing quickly again.
This periodic pattern is considered normal, particularly during sleep, and does not involve changes in the baby’s skin color or heart rate. Another normal pattern is “belly breathing,” where the abdomen rises and falls prominently because newborns primarily use their diaphragm to breathe. This prominent abdominal movement can be alarming but is not a sign of distress if the baby appears comfortable and the pauses are brief.
Key Visual Indicators of Respiratory Distress
When a newborn’s breathing becomes labored, they use extra effort, resulting in several visible indicators. One of the earliest signs is nasal flaring, the widening of the nostrils with each inhalation. This widens the nasal passage to decrease resistance and increase the amount of air taken in. Persistent nasal flaring indicates the baby is working harder to breathe.
A visual sign is retracting, where the skin visibly pulls inward during inspiration. This happens because the baby is using accessory muscles instead of the diaphragm to draw air into the lungs. Retractions can be seen in different areas of the chest and neck.
Types of Retractions
Retractions are categorized by location:
- Intercostal retractions occur when the skin sinks in between the ribs.
- Subcostal retractions are visible under the rib cage.
- Suprasternal retractions involve the skin pulling in above the breastbone.
- Supraclavicular retractions appear above the collarbones.
The presence of retractions, especially those higher up, signals moderate to severe respiratory distress.
The coordinated movement of the chest and abdomen can appear abnormal, sometimes presenting as “seesaw breathing,” where the chest sinks as the abdomen rises. Another concerning sign is head bobbing, where the head moves forward and backward in rhythm with each breath. This motion indicates the newborn is using neck muscles to assist with breathing, suggesting significant respiratory distress and requiring immediate medical attention.
Changes in skin color, known as cyanosis, are a late-stage indicator that the baby is not receiving enough oxygen. This appears as a bluish or dusky tone, often noticeable around the lips, tongue, or nail beds. For babies with darker skin tones, this change may appear as a grayish or whitish color, especially around the mouth. A bluish tint, particularly when centered around the mouth, is a medical emergency because it signifies dangerously low oxygen levels.
Auditory Cues and When to Seek Immediate Medical Help
Beyond visual signs, certain sounds confirm that a newborn is struggling to breathe effectively. Grunting is a short, low moan or sigh made on exhalation that indicates labored breathing. The baby grunts to keep the small air sacs in the lungs open by maintaining pressure, which helps to optimize oxygen absorption.
Other concerning sounds include wheezing and stridor. Wheezing is a whistling or musical noise typically heard as the baby breathes out, suggesting air is passing through narrowed lower air passages. Stridor is a high-pitched, harsh sound usually heard when the baby breathes in, signaling a potential blockage or narrowing in the upper airway, such as the voice box or trachea.
Recognizing any of these visual or auditory signs means the baby is experiencing a medical emergency. If a newborn exhibits signs of truly labored breathing, such as severe retractions, persistent nasal flaring, head bobbing, grunting, or any change in skin color, do not wait for the symptoms to improve. Caregivers should contact their local emergency services, such as 911, or proceed directly to the nearest emergency department. Labored breathing requires urgent medical evaluation and intervention.