Retracted breathing, or retractions, is a visible sign that an infant is struggling to inhale enough air. This occurs when the soft tissues and muscles of the chest wall visibly sink inward during inspiration, indicating the baby is working much harder than normal to breathe. This increased effort is caused by the muscles pulling against a blocked or stiff airway, which creates lower pressure inside the chest cavity. Recognizing this pattern is a strong indicator of respiratory distress and signals an immediate need for concern.
Identifying Retractions by Location
The location of the visible sinking offers clues about the severity of the respiratory effort. One of the first places retractions appear is just beneath the rib cage, known as subcostal retractions. The indentation is seen where the abdomen meets the lower margin of the bony ribs as the baby attempts to expand the lungs. This lower-chest movement is a sign of mild to moderate difficulty breathing.
As the effort increases, indentations become visible between the ribs themselves, called intercostal retractions. The skin and soft tissue visibly suck inward between the bony ridges of the ribs with every breath. This pattern suggests a more significant level of respiratory distress, indicating the baby is using more accessory muscles to overcome airway resistance.
The most concerning retractions occur higher up on the chest and neck, signaling severe distress. Suprasternal retractions appear as a deep indentation in the soft notch above the breastbone, at the base of the neck. Closely related are supraclavicular retractions, where the skin sinks in just above the collarbones. These upper-airway retractions indicate an extremely high level of effort and suggest a potential obstruction in the trachea or upper respiratory tract.
Other Visual and Auditory Signs of Distress
Retractions rarely occur in isolation and are usually accompanied by other compensatory efforts. A common visual sign is nasal flaring, where the baby’s nostrils widen significantly with each inhalation. This action attempts to reduce airway resistance and maximize the amount of air drawn into the lungs. Since infant airways are prone to obstruction, this widening of the nasal passage is an important compensation mechanism.
Parents may also hear grunting, which is a short, low-pitched sound heard as the baby exhales. This noise is the body’s way of trying to keep the small air sacs in the lungs from collapsing. By exhaling against a partially closed vocal cord, the baby creates positive pressure in the chest, helping to keep the air passages open for better oxygen exchange. In severe cases, the baby may exhibit head bobbing, where the head moves forward and down with each inhalation. This motion indicates the baby is actively using neck muscles to assist breathing, often seen in infants due to their underdeveloped neck strength.
A change in skin color is a late and serious indicator of insufficient oxygen. Cyanosis presents as a bluish or grayish discoloration of the skin, particularly visible around the lips, tongue, or nail beds. This color change signals hypoxemia, or low oxygen saturation in the blood, and mandates immediate medical intervention.
Common Conditions Causing Retractions
Retracted breathing is a symptom, not a diagnosis, and it can be triggered by conditions that cause airway obstruction or lung stiffness. Viral infections are the most frequent culprits, especially those targeting the lower respiratory tract. Respiratory Syncytial Virus (RSV) is a common cause, often leading to bronchiolitis, which is the inflammation of the lung’s smallest airways.
Bronchiolitis typically affects children under two years old and is a leading cause of hospitalization in infants during the winter months. Other infections like pneumonia or croup, which affects the windpipe and voice box, can also result in retractions. Caregivers should focus on recognizing retractions as a sign that the baby’s respiratory system is compromised. The difficulty in breathing occurs because inflamed, mucus-filled airways become narrow, making it difficult for the baby to draw air in and out.
Urgent Next Steps for Caregivers
Upon observing any sign of retracted breathing, a caregiver’s immediate response should be calm assessment and prompt action. If the retractions are severe, such as suprasternal, or if the baby’s lips or skin color appear bluish or gray, immediate emergency medical services should be contacted. These signs suggest the baby is in significant respiratory failure and requires urgent stabilization.
If the retractions are mild but persistent, or if they are accompanied by other signs like a fever, reduced feeding, or unusual lethargy, the pediatrician or local emergency department should be contacted right away. Monitoring the baby’s alertness and feeding habits is important, as a tired or unresponsive baby may be nearing respiratory exhaustion. While awaiting help, keeping the baby calm and in an upright position can sometimes ease the breathing effort. Never delay seeking professional medical attention, as retractions are always a serious finding in an infant.