Newborn breathing often seems erratic and noisy, causing concern for parents. In the womb, the fetus receives oxygen via the placenta, and the lungs are filled with fluid. When the baby takes its first breath, the lungs must clear this fluid and begin independent gas exchange. This immediate transition results in a highly sensitive and uncoordinated respiratory system, explaining why newborn breathing differs significantly from an adult’s.
The Peculiar Rhythm and Rate of Newborn Breathing
A newborn’s respiratory rate is significantly faster than an adult’s. When awake, the rate typically ranges from 40 to 60 breaths per minute, slowing to 30 to 40 breaths per minute during sleep. Counting the breaths for a full 60 seconds provides the most accurate assessment.
The most distinctive characteristic is periodic breathing. This involves the baby breathing rapidly, followed by a brief pause lasting five to ten seconds, before quickly resuming fast breaths. This irregularity is a normal sign of an immature nervous system, common during sleep. The pattern should not cause a change in the baby’s skin color or heart rate during these pauses.
Normal Sounds and Movements
Newborns use a mechanical motion for breathing that differs visibly from older children and adults. Infants primarily rely on the diaphragm, the large muscle beneath the lungs, to pull air in. This results in abdominal respiration, or “belly breathing,” where the abdomen noticeably rises and falls with each breath while chest movement is less pronounced.
The small, narrow nasal passages contribute to a variety of normal sounds. Occasional snorts, gentle whistling, or soft gurgling noises are common as air moves past mucus or dried milk in the airway. Since newborns are obligate nose-breathers for the first few months, tiny blockages create noisy breathing. An occasional sigh is a normal reflex that helps the baby fully inflate the lungs.
Distinguishing Normal from Signs of Distress
While irregular and noisy breathing is normal, certain signs indicate the baby is exerting too much effort and needs immediate medical evaluation. Respiratory distress is often signaled by retractions, where the flexible skin and muscles are visibly pulled inward with each breath. This sucking-in action may be seen between the ribs (intercostal), beneath the rib cage (subcostal), or at the base of the neck and collarbone (suprasternal).
Another indicator of increased work of breathing is nasal flaring, where the nostrils widen significantly as the baby attempts to take in more air. A continuous respiratory rate above 60 breaths per minute, known as tachypnea, is a sign of trouble, especially if the baby is calm and resting. True apnea, a pause lasting 20 seconds or longer, or a shorter pause accompanied by a color change, requires immediate attention.
Color changes, particularly a dusky or blue tint around the lips, tongue, or torso (central cyanosis), signal a lack of oxygen and constitute a medical emergency. A grunting sound heard consistently at the end of every exhale indicates the baby is trying to keep the air sacs in the lungs open. Any persistent abnormal noises, such as high-pitched wheezing or stridor, combined with an inability to feed or lethargy, should prompt an immediate call to a healthcare provider.