Babies stop breathing for reasons that range from completely harmless to medically urgent. The most common cause is simple immaturity of the brain’s breathing-control centers, which means brief pauses in breathing are a normal part of infant sleep, especially in the first few months. But infections, structural airway problems, reflux, environmental exposures, and rare genetic conditions can also interrupt a baby’s breathing in ways that need medical attention. Understanding which pauses are normal and which warrant a call to your pediatrician or a trip to the emergency room makes all the difference.
Normal Breathing Pauses in Newborn Sleep
Newborns do not breathe with the steady rhythm adults take for granted. Their breathing during sleep follows an irregular pattern called periodic breathing, where clusters of breaths alternate with pauses of a few seconds. This is not a sign of illness. It reflects the fact that the brainstem circuits controlling respiration are still maturing. Periodic breathing is especially common during the lighter, dream-like stage of sleep and tends to be more pronounced in babies born early or at low birth weight.
1European Respiratory Review. Sleep disordered breathing at the extremes of age: infancy – Section: Normal sleep and normal sleep breathing in infancyA study that monitored healthy full-term infants at home found that the majority had some periodic breathing during sleep up to six months of age, though it accounted for less than one percent of total sleep time. No baby in the study had a breathing pause lasting 15 seconds or longer, and pauses of 10 to 12 seconds occurred only occasionally.
2PubMed. Apnea and periodic breathing in normal full-term infants during the first twelve monthsSo if you notice your baby’s chest stop moving for a handful of seconds, then start up again on its own, that is almost certainly normal periodic breathing. It becomes concerning when pauses stretch beyond about 15 to 20 seconds, when the baby’s skin turns blue or pale, when muscle tone changes, or when the baby does not restart breathing without stimulation.
Apnea of Prematurity
Babies born before about 37 weeks of gestation are far more likely to have significant breathing pauses. Their brainstems are even less mature than those of full-term newborns, and the chemical sensors that detect low oxygen and high carbon dioxide and then trigger a breath are still developing after birth.
3PubMed Central. Perinatal Hypoxemia and Oxygen SensingApnea of prematurity can involve the brain simply failing to send the “breathe” signal (central apnea), a physical blockage in the airway (obstructive apnea), or a combination of both. It is one of the most common problems managed in neonatal intensive care units. Caffeine, given as a daily medication, is the standard treatment. It stimulates the respiratory drive and has been shown to reduce the frequency of breathing pauses, episodes of low oxygen, and the need for mechanical ventilation.
4PubMed Central. Caffeine therapy in preterm infantsClinical trials have also suggested that caffeine treatment in preemies reduces the risk of chronic lung disease and certain heart complications. This is one of the better-studied interventions in neonatal medicine, and caffeine remains a cornerstone of care for premature infants with breathing instability.
5PubMed Central. Apnoea of Prematurity and Neurodevelopmental Outcomes: Current Understanding and Future Prospects for ResearchStructural Airway Problems
Some babies are born with airways that are floppy or partially obstructed. The most common example is laryngomalacia, a condition where the tissue above the vocal cords collapses inward during inhalation. The hallmark symptom is noisy, high-pitched breathing (stridor) that gets worse when the baby is on their back, feeding, or crying. The exact cause remains debated, but proposed explanations include an unusually shaped epiglottis, short tissue folds near the larynx, or bulky tissue that gets pulled into the airway with each breath.
6PubMed Central. Laryngomalacia and Obstructive Sleep Apnea in Children: From Diagnosis to Treatment – Section: Etiologic Theories and Risk FactorsIn mild cases, babies outgrow the stridor as their airway firms up over the first year or two. But more severe forms can cause real breathing disruption during sleep. One study using detailed sleep recordings found that obstructive breathing events were far worse when infants with laryngomalacia slept on their backs compared to their sides, and worse during the dream-like stage of sleep than during deeper sleep.
7Pediatric Research. Upper airway obstruction during sleep in infants with laryngomalacia is frequently sleep-position-dependentThe severity of laryngomalacia varies widely. In the mildest form, breathing events during sleep are minimal. In the most severe form, oxygen levels during sleep can drop dangerously low, and nearly all affected babies have feeding difficulties. Surgery to trim the floppy tissue (supraglottoplasty) dramatically improves breathing and oxygen levels in moderate and severe cases.
8PubMed Central. Sleep-Disordered Breathing and Clinical Presentation in Infants with Congenital Laryngomalacia: A Polysomnographic StudyInfections That Affect Breathing
Respiratory infections are one of the more common reasons an otherwise healthy baby suddenly starts having breathing pauses. RSV (respiratory syncytial virus), the common cold, and influenza can all produce enough congestion and airway swelling to trigger apnea in young infants. Whooping cough (pertussis) deserves special mention because it can cause severe and prolonged breathing pauses in very young babies, sometimes before the characteristic “whoop” even appears. The pertussis toxin contributes to a cascade of problems including high white blood cell counts and increased pressure in the lungs, making the disease especially dangerous in the first months of life.
9PubMed Central. Caffeine to prevent respiratory failure and improve outcome in infant pertussisThe reason infections trigger apnea in babies but mostly just cause coughing and congestion in older children comes down to reflex differences. When fluid or mucus touches specialized nerve endings at the entrance to the larynx, a reflex kicks in to prevent material from getting into the lungs. In older children and adults, that reflex mainly triggers coughing. In young infants, the same reflex tends to shut breathing down entirely, close the airway, and slow the heart rate. Researchers call this the laryngeal chemoreflex, and it can be activated during infections when excess secretions reach the throat.
10PubMed. Reflux associated apnea in infants: evidence for a laryngeal chemoreflexReflux and the Laryngeal Chemoreflex
If infections can trigger that protective reflex, so can stomach contents that wash back up into the throat during gastroesophageal reflux. Parents sometimes notice their baby briefly stops breathing, turns pale, or goes limp after a feed, and reflux seems like an obvious explanation. The idea is straightforward: stomach acid reaches the larynx, the reflex fires, and the baby stops breathing temporarily.
The evidence for this link, however, is weaker than many parents and even some clinicians assume. While the reflex itself is well documented in laboratory settings, multiple studies trying to prove that reflux routinely causes apnea episodes in premature infants have produced disappointing results. A recent review noted that the current evidence for reflux as a direct cause of apnea of prematurity is poor, despite extensive research looking for a connection.
11PubMed. Gastroesophageal reflux and apnea in the preterm infantThis does not mean reflux never triggers apnea. It likely does in some individual babies, especially those with particularly severe reflux. But the blanket assumption that reflux is behind a baby’s breathing pauses often leads to unnecessary acid-suppressing medications, which carry their own risks. If your baby has both reflux and apnea, a pediatric specialist can help determine whether the two are actually connected or just happening to coexist.
Neurological, Genetic, and Metabolic Causes
In a small minority of cases, recurrent breathing pauses point to something deeper. Genetic conditions that cause low muscle tone (hypotonia), unusual facial structure, or brainstem dysfunction can produce both central apnea, where the brain fails to signal a breath, and obstructive apnea, where floppy muscles allow the airway to collapse.
12PubMed. Respiratory Involvement in HIST1H1E-Related Rahman Syndrome: A Case of Severe Mixed ApneaInborn errors of metabolism, which are inherited conditions where the body cannot properly process certain nutrients or chemicals, are another uncommon but important cause. A review of 166 infants referred for apnea evaluation found that about 4 percent had an underlying metabolic disorder, and all of those babies had experienced repeated life-threatening episodes rather than a single isolated event.
13PubMed. Recurrent apparent life-threatening events during infancy: a manifestation of inborn errors of metabolismThis is why recurrent episodes of apnea, especially when they are severe or accompanied by other symptoms like poor feeding, unusual smells, or developmental delays, warrant thorough investigation beyond the initial workup.
Environmental Risk Factors
Two environmental exposures stand out for their effect on infant breathing stability: tobacco smoke and overheating.
Prenatal exposure to cigarette smoke has a measurable impact on how premature infants breathe during sleep. One study comparing preemies whose mothers smoked during pregnancy to those whose mothers did not found that the smoking-exposed group had roughly double the rate of breathing events during active sleep, driven mainly by obstructive apnea. Even more concerning, these infants were less likely to wake up during a breathing pause. The percentage of times an apnea episode triggered an arousal was about 11 percent in the smoking-exposed group versus roughly 29 percent in the control group.
14PubMed. The effect of maternal smoking on respiratory and arousal patterns in preterm infants during sleepThat combination of more frequent breathing pauses and a blunted wake-up response is particularly dangerous. It means the baby is more likely to stop breathing and less likely to self-correct. This is one reason smoking during pregnancy and smoke exposure after birth are consistently identified as risk factors for sudden infant death.
Overheating poses a similar double threat. Excessive warmth disrupts the cardiovascular and respiratory systems, increasing the likelihood of apnea and slowed heart rate. At the same time, heat reduces the baby’s sensitivity to low oxygen and makes it harder to wake up from sleep, weakening the very defenses that would normally rescue the infant from a breathing pause.
15PubMed Central. Hyperthermia and Heat Stress as Risk Factors for Sudden Infant Death Syndrome: A Narrative ReviewThe Brainstem and SIDS
Sudden infant death syndrome remains the most feared outcome linked to infant breathing. SIDS is defined as the unexplained death of an infant during sleep, typically between one and twelve months of age. For decades, the leading theory has centered on a brainstem defect that compromises the baby’s ability to respond to a breathing or cardiovascular crisis during sleep.
Research has increasingly pointed to serotonin, a chemical messenger with critical roles in breathing regulation and the ability to arouse from sleep. A study examining brainstem tissue from SIDS cases in a high-risk population found defects in the serotonin system of affected infants. The defect appeared to be strongly associated with premature birth and was proposed to underlie the failure to wake up and resume breathing during a dangerous event in sleep.
16PubMed Central. Serotonergic receptor binding in the brainstem in the Sudden Infant Death Syndrome in a high-risk populationThis does not mean that every baby who has a breathing pause is at risk for SIDS. Most apnea episodes resolve on their own or with gentle stimulation. The serotonin hypothesis helps explain why some babies, when placed in a risky sleep environment, fail to mount the protective response that would save them. It is a vulnerability that only becomes lethal in the presence of other stressors like prone sleeping, overheating, or smoke exposure.
What Doctors Look For After a Breathing Episode
If your baby has an episode where they stop breathing, turn blue or pale, go limp, or become unresponsive, and then return to normal on their own, doctors now use the term Brief Resolved Unexplained Event, or BRUE, to describe what happened. The word “unexplained” is key: the label only applies after a doctor has done a thorough history and physical exam and found no obvious cause.
17Pediatrics. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants – Section: BRUE DefinitionBabies who meet the BRUE criteria are then sorted into lower-risk and higher-risk categories. Current guidelines classify a large proportion of babies as higher risk, partly because being under 60 days old is treated as a risk factor. A recent study found that more than three-quarters of BRUE infants were flagged as higher risk under current rules, but when the age-under-60-days criterion was removed, only about a quarter were classified as higher risk, and no infants with serious diagnoses were missed. This suggests the criteria may undergo revision in the future to avoid unnecessary hospitalizations and testing in very young but otherwise healthy babies.
18PubMed Central. Etiology of apneic episodes in infants aged <1 year and validation of brief resolved unexplained events risk-stratification criteria without age as a risk factorWhat to Do If Your Baby Stops Breathing
If your baby has a brief pause and then starts breathing again with normal color and tone, this is almost certainly periodic breathing. Keep an eye on them, but you do not need to rush to the emergency room for a five-second pause during sleep.
If the pause lasts more than about 15 to 20 seconds, if the baby turns blue or pale, if they become limp or stiff, or if they do not restart breathing on their own, act immediately. Try gentle stimulation first: flick the soles of their feet, rub their back, or gently blow on their face. If they do not respond, call emergency services and begin infant CPR.
Infant CPR differs from adult CPR in important ways. For chest compressions, guidelines recommend the two-thumb technique, where you wrap both hands around the baby’s chest and press on the breastbone with your thumbs, compressing to a depth of about 4 centimeters at a rate of 100 to 120 compressions per minute.
19PubMed Central. 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 7. Pediatric basic life supportFor rescue breaths, cover both the baby’s mouth and nose with your mouth to create a seal. Research on facial measurements has shown that by the time a baby is three to six months old, many adults, especially women, physically cannot form a good seal over just the baby’s nose and open mouth. Covering both the nose and mouth together is more reliable.
20PubMed. Assessment of infant cardiopulmonary resuscitation rescue breathing technique: relationship of infant and caregiver facial measurementsIf you have not taken an infant CPR class, consider it a priority. Many hospitals, fire stations, and community centers offer them. The hands-on practice matters far more than reading about technique.
Safe Sleep Practices That Reduce Risk
The American Academy of Pediatrics regularly updates its safe sleep guidelines based on the best available evidence. The current recommendations are designed to reduce the risk of all sleep-related infant deaths, which account for more than 4,000 deaths per year in the United States.
21PubMed Central. Safe Infant Sleep Interventions: What is the Evidence for Successful Behavior Change?The core recommendations include:
- Back sleeping: Always place babies on their backs for every sleep, even naps.
- Firm, flat surface: Use a firm mattress with a fitted sheet and nothing else in the crib. No pillows, blankets, bumper pads, or stuffed animals.
- Room sharing: Keep the baby’s sleep space in your room for at least the first six months, but do not share your bed.
- Avoid overheating: Dress the baby in one layer more than you would wear, and keep the room at a comfortable temperature.
- No smoke exposure: Avoid smoking during pregnancy and keep the baby’s environment smoke-free after birth.
- Breastfeeding: Human milk feeding is associated with reduced risk.
- Pacifier use: Offering a pacifier at sleep time is associated with lower risk, though the mechanism is not fully understood.
These guidelines sometimes conflict with what seems practical in the moment, especially bed-sharing during nighttime breastfeeding or using an inclined sleeper that seems to help with reflux. But the evidence behind these recommendations is substantial, and deviation from them consistently shows up as a risk factor in studies of infant deaths.
Home Monitors and Their Limits
Consumer-grade baby monitors that track heart rate and oxygen levels have become increasingly popular. Parents understandably find comfort in having an alarm that will sound if something goes wrong. But there is a meaningful gap between what these devices promise and what they deliver.
A study testing a popular over-the-counter infant pulse oximeter against hospital-grade monitoring equipment found troubling sensitivity numbers. For detecting dangerously low heart rates, the device caught only about 6 percent of events using its standard display and about 39 percent when raw data was analyzed. For detecting significant drops in blood oxygen, it caught about 14 percent of events on its smoothed display and 74 percent using raw data. Specificity was excellent, meaning the device rarely alarmed when nothing was wrong, but a device that misses the majority of real events provides a false sense of security.
23PubMed Central. Diagnostic accuracy of an over-the-counter infant pulse oximeter for cardiorespiratory eventsDetection improved for longer and more severe events, which is somewhat reassuring since a prolonged drop in oxygen is more dangerous than a brief blip. But no major medical organization currently recommends home apnea monitors for healthy infants as a strategy to prevent SIDS. If your baby has a diagnosed condition that requires monitoring, your medical team will prescribe a medical-grade device, not a consumer wearable.
Long-Term Effects of Repeated Breathing Pauses
For premature infants who experience frequent apnea and the oxygen drops that accompany it, there is genuine concern about effects on brain development. Repeated episodes of low oxygen have been linked to language and cognitive delays, motor problems, and eye damage (retinopathy of prematurity).
24Experimental Neurology. The relationship between intermittent hypoxemia events and neural outcomes in neonatesOne study found that the amount of time preterm infants spent having breathing events and periodic breathing around their expected due date predicted poorer language and motor scores at six months of corrected age.
25Journal of Perinatology. Developmental consequences of short apneas and periodic breathing in preterm infantsAn important caveat: it remains unclear whether the apnea itself is causing the developmental delays or whether both the apnea and the delays are consequences of the same underlying prematurity-related brain immaturity. Caffeine therapy in preemies has been shown to improve long-term neurodevelopmental outcomes, but disentangling the direct contribution of apnea from all the other challenges of premature birth is an ongoing research question.
5PubMed Central. Apnoea of Prematurity and Neurodevelopmental Outcomes: Current Understanding and Future Prospects for ResearchThe Emotional Impact on Parents
Witnessing your baby stop breathing, even briefly, is terrifying. The psychological toll on parents who experience a serious infant breathing episode is real and underappreciated. A meta-analysis looking at parents whose children experienced a single traumatic event found that roughly 17 percent of parents met criteria for post-traumatic stress disorder afterward.
26PubMed Central. Post-traumatic Stress Disorder in Parents Following Their Child’s Single-Event Trauma: A Meta-Analysis of Prevalence Rates and Risk Factor CorrelatesParents of babies who have been through NICU stays for apnea of prematurity, or who have experienced a BRUE at home, often describe ongoing hypervigilance, sleep disruption, and anxiety that persists long after the baby’s breathing has stabilized. If you find that the fear of your baby not breathing is dominating your daily life, interfering with your sleep when the baby is sleeping peacefully, or making you unable to let anyone else care for your infant, those are signs worth discussing with your own doctor. Parental mental health after a frightening infant event is a legitimate medical concern, not something to push through on willpower alone.
Disparities in Sleep-Related Infant Deaths
Not all families face the same level of risk. In the United States, rates of sudden unexpected infant death are substantially higher in Black and Indigenous communities compared to white communities. This disparity is not explained by biology. Research in cities like Chicago has found that infant mortality clusters in neighborhoods marked by racial segregation and economic marginalization, where families face compounding barriers to healthcare access, safe housing, and economic stability.
27PubMed Central. Racial and ethnic disparities of sudden unexpected infant death in large US cities: a descriptive epidemiological studySafe sleep messaging that focuses solely on individual behavior, such as telling parents to put the baby on their back, misses the structural factors that shape sleep environments. A family living in overcrowded housing with no crib, working night shifts, or lacking access to prenatal care faces a different landscape of risk than the one most safe-sleep pamphlets assume. Effective prevention efforts increasingly recognize that partnering with affected communities to address these underlying conditions matters as much as distributing educational materials.