Seesaw breathing, medically known as paradoxical respiration, is a dramatic visual cue that signals severe difficulty in breathing. This pattern occurs when the chest and abdomen move in opposite directions instead of rising and falling together. It is a sign of significant respiratory distress, particularly concerning in infants and young children whose respiratory systems have less reserve. This labored breathing indicates a failure of the normal mechanics of respiration and warrants immediate medical attention.
Understanding the Mechanics of Seesaw Breathing
Normal breathing involves the diaphragm contracting and moving downward during inhalation, causing both the chest and the abdomen to expand outward simultaneously. In seesaw breathing, this synchronized movement is lost, creating a rocking motion across the torso. When a person attempts to inhale, the chest may sink inward while the abdomen pushes outward, a reversal of the expected motion. The paradoxical pattern then flips during exhalation, with the chest moving outward as the abdomen collapses inward.
This action is a sign of extreme fatigue or inefficiency in the primary breathing muscles, often due to airway obstruction or severe lung disease. The body is attempting to overcome massive resistance to airflow. When the airways are significantly blocked, the diaphragm’s contraction generates a strong negative pressure inside the chest cavity. This negative pressure physically pulls the compliant chest wall inward, even as the diaphragm pushes the abdominal contents down.
The paradoxical movement suggests a failure to move air effectively and is a strong indicator of impending respiratory failure. The accessory muscles of breathing, such as those in the neck and between the ribs, are overworked to compensate for the primary muscles. This strenuous effort consumes a great deal of energy, which an already ill patient may not be able to sustain for long.
Recognizing Other Physical Signs of Respiratory Distress
Seesaw breathing is rarely an isolated sign and is usually accompanied by other visible markers of increased respiratory effort. One of the most common is retractions, where the skin visibly pulls inward with each breath, indicating the use of accessory muscles. These retractions can be seen above the collarbone (suprasternal), between the ribs (intercostal), or just below the rib cage (subcostal). The sharp inward movement shows the intense force required to overcome blocked or stiff airways.
Another sign is nasal flaring, which is the widening of the nostrils during inhalation. This reflex is the body’s attempt to reduce resistance and increase the volume of air entering the upper airway. The flaring action slightly increases the diameter of the nasal passages.
An audible sign that often accompanies severe distress is grunting, a short, low-pitched sound heard during exhalation. This noise is created when the body unconsciously attempts to keep air in the lungs by partially closing the vocal cords. This maneuver generates pressure that prevents the tiny air sacs in the lungs from collapsing entirely, maintaining lung volume for gas exchange.
The most alarming sign of inadequate oxygen delivery is a change in skin color, known as cyanosis. This appears as a blue or grayish tint, most noticeable around the lips, inside the mouth, and on the nail beds. Cyanosis is a late and concerning finding, signifying that blood oxygen saturation has dropped significantly.
Triage: When Seesaw Breathing Requires Emergency Intervention
Seesaw breathing is a distinct sign of severe respiratory distress and should always be treated as a medical emergency, especially in children. This paradoxical pattern suggests the respiratory system is on the verge of failure. The most important immediate action is to contact emergency medical services by calling 911 or the local emergency number without delay.
While waiting for help, the emergency status is cemented if seesaw breathing is present alongside blue or gray discoloration of the skin, particularly around the mouth or fingertips. If the person becomes unresponsive, is unable to speak or cry, or if their breathing effort suddenly slows down or stops, the situation has become immediately life-threatening.
Maintaining a calm presence and providing comfort to the person is important while emergency services are en route. If the patient is an infant or child, place them in the position they find most comfortable, often sitting up or leaning forward, as this can ease the work of breathing. Do not attempt to give food or drink, as the priority is to maintain an open airway.