Retracted breathing in infants is a visible sign of respiratory distress, indicating a struggle to pull air into the lungs. This pattern of breathing is a serious medical concern because the child is working much harder than normal to get sufficient oxygen. Recognizing this struggle quickly is vital for timely medical intervention. Retractions involve a noticeable inward pulling of the soft tissues of the chest wall with each inhalation.
The Physiology Behind Retracted Breathing
Retractions occur because the infant’s primary breathing muscle, the diaphragm, contracts with excessive force to overcome resistance in the airways or stiffness in the lungs. When the diaphragm pulls down to draw air in, it creates negative pressure inside the chest cavity. In a healthy lung, air rushes in easily to equalize this pressure.
If the airways are narrowed or the lungs are not expanding correctly, the diaphragm continues to pull harder, generating a much stronger negative pressure. This heightened internal suction then pulls the pliable, soft areas of the infant’s chest wall inward. Unlike adults, an infant’s chest wall is less rigid due to immature bone structure and cartilage, making it more susceptible to this inward movement. The visible sinking of the chest tissue is a direct consequence of this extreme effort.
Visual Identification of Retraction Locations
The appearance of retracted breathing depends on where the chest wall visibly sinks inward during inhalation. Retractions are categorized by their location on the body.
Lower chest retractions are often the first to appear as a baby begins to struggle:
- Intercostal retractions are the pulling in of skin and muscles between the ribs.
- Subcostal retractions involve the inward movement of the abdominal area just below the lower edge of the ribcage.
- Substernal retractions are located at the bottom tip of the sternum, where the tissue pulls in toward the spine.
Retractions that appear higher on the body generally indicate a more severe level of respiratory distress. These include:
- Suprasternal retractions, visible as an indentation in the soft tissue above the sternum, at the base of the neck.
- Supraclavicular retractions, seen as the skin pulling in above the collarbones.
In the most severe cases, the entire sternum may move inward, known as a sternal retraction, demonstrating extreme breathing difficulty.
Underlying Conditions Causing Infant Respiratory Distress
Retracted breathing is caused by underlying medical conditions that impair normal lung function. Respiratory Syncytial Virus (RSV) is a frequent cause, often leading to bronchiolitis, which is inflammation and narrowing of the small airways.
Pneumonia, a lung infection causing inflammation and fluid buildup in the air sacs, also obstructs gas exchange and lung expansion. Conditions present at birth, such as Respiratory Distress Syndrome (RDS), affect premature infants whose lungs lack surfactant, a substance that helps air sacs stay open. Without surfactant, the lungs become stiff, requiring excessive force to inflate them.
Transient tachypnea of the newborn (TTN) is a temporary condition where fluid in the lungs is not cleared quickly enough, often seen after a fast delivery or C-section. Although TTN usually resolves within a few days, the fluid causes labored breathing and retractions. Other causes include asthma, upper airway obstruction like croup, and the aspiration of foreign objects.
Recognizing Severity and Seeking Emergency Care
Observing the location and depth of retractions helps determine the severity of the infant’s breathing difficulty. When retractions progress from the lower chest up to the neck and throat, it indicates a rapidly worsening situation and requires immediate medical intervention. Parents should also look for other physical signs that accompany the retractions, signaling a serious emergency.
Nostril flaring, where the baby’s nostrils widen with each breath in an attempt to pull in more air, is a sign of serious respiratory effort. A grunting sound heard when the baby breathes out is another indicator, as it represents the body trying to keep the air sacs open. Cyanosis, a bluish tint around the lips, on the fingertips, or on the skin, is an urgent sign that oxygen levels are dangerously low.
A significant increase in breathing rate, or a sudden decrease, indicates a problem. If the baby appears lethargic, unresponsive, or is struggling to feed, it is a sign of respiratory fatigue. Any observation of deep retractions, blue coloring, or a concerning change in alertness warrants an immediate call to emergency services.