What are retractions in babies and what should I do if I notice them?
Quick Answer
Retractions are a sign that your baby is struggling to breathe.
It looks like the skin is being sucked in between the ribs or above the collarbone when they inhale.
If you notice retractions, it's important to stay calm, assess your baby's overall condition, and consult a doctor promptly to rule out any serious underlying issues.
Recommended Practices
Observe Your Baby's Breathing Pattern
Pay close attention to how your baby's chest and abdomen move when they breathe.
Look for any unusual sinking in of the skin between the ribs (intercostal retractions), above the collarbone (supraclavicular retractions), or below the breastbone (substernal retractions).
Note the frequency and severity of these retractions.
Count Your Baby's Breathing Rate
Count the number of breaths your baby takes in one minute while they are calm and resting.
A normal respiratory rate for newborns is typically between 40 and 60 breaths per minute, slowing to 30-40 breaths per minute by 6 months.
If your baby's breathing rate is consistently higher than this, it could indicate a problem.
Check for Other Signs of Respiratory Distress
Look for other signs that your baby is having difficulty breathing, such as nasal flaring (widening of the nostrils with each breath), grunting sounds during exhalation, or a bluish tint to the skin around the lips or fingertips (cyanosis).
Any of these signs, along with retractions, warrant immediate medical attention.
Ensure Proper Positioning
Make sure your baby is positioned in a way that allows for easy breathing.
Avoid placing them in positions that could compress their chest or abdomen.
A slightly elevated position can sometimes help.
For infants under 6 months, always place them on their back to sleep to reduce the risk of SIDS.
Keep Nasal Passages Clear
Use a bulb syringe or saline nasal drops to gently clear any nasal congestion that may be contributing to your baby's breathing difficulties.
Especially during winter or when the air is dry, maintaining clear nasal passages is important.
Consult your doctor or a trained nurse for the correct method.
Monitor Temperature and Hydration
Check your baby's temperature regularly.
Fever can increase respiratory rate.
Ensure your baby is adequately hydrated by breastfeeding or formula feeding as usual.
Dehydration can thicken mucus and make breathing more difficult.
Watch for signs of dehydration like fewer wet diapers.
What to Avoid
Ignoring Retractions
Retractions are a clear sign that your baby is working harder to breathe and should never be ignored.
It is important to seek medical advice promptly to determine the underlying cause and receive appropriate treatment.
Delaying medical attention can lead to serious complications.
Self-Treating with Over-the-Counter Medications
Avoid giving your baby any over-the-counter cough or cold medications without consulting a doctor.
These medications are often not effective for infants and can sometimes have harmful side effects.
Always seek professional medical advice before administering any medication to your baby.
Using Vapor Rubs on Infants
Avoid using vapor rubs or menthol-containing products on infants, especially those under two years of age.
These products can irritate the airways and worsen breathing difficulties.
There are safer alternatives for relieving congestion, such as saline nasal drops and a humidifier.
Smoking Around Your Baby
Never smoke around your baby.
Exposure to secondhand smoke can significantly increase the risk of respiratory infections and worsen breathing problems.
Create a smoke-free environment for your baby to protect their health.
Overdressing Your Baby
Avoid overdressing your baby, as this can lead to overheating and increased respiratory rate.
Dress your baby in lightweight, breathable clothing appropriate for the weather.
Check your baby's temperature regularly to ensure they are comfortable.
Assuming It's 'Just a Cold'
While many respiratory issues in babies are due to common colds, retractions can also indicate more serious conditions like bronchiolitis or pneumonia.
Don't assume it's just a cold; always consult a doctor to rule out other potential causes.
Common Scenarios and Solutions
Your baby has a mild cold and you notice slight retractions when they are crying or upset.
First, try to calm your baby.
Clear their nasal passages with saline drops and a bulb syringe.
Monitor their breathing closely.
If the retractions disappear when they are calm and their breathing rate is normal, it's likely just due to the cold.
However, if the retractions persist or worsen, consult a doctor.
Your baby has a fever and is breathing rapidly with noticeable retractions.
Give your baby paracetamol or ibuprofen (as directed by your doctor) to reduce the fever.
Monitor their temperature and breathing rate closely.
Seek immediate medical attention, as the fever and retractions could indicate a more serious infection.
Your baby is feeding poorly and has retractions, along with a bluish tint around their lips.
This is a sign of severe respiratory distress. Call for an ambulance or take your baby to the nearest emergency room immediately. The bluish tint indicates that they are not getting enough oxygen.
You live in a highly polluted area and your baby has frequent respiratory issues, including retractions.
Try to minimize your baby's exposure to air pollution.
Keep windows closed during peak pollution times.
Use an air purifier with a HEPA filter in your home.
Consult your doctor about whether a nebulizer or other respiratory support devices might be helpful.
Similar Questions Parents Ask
What is a normal breathing rate for a baby?
A normal breathing rate for a newborn is between 40 and 60 breaths per minute, decreasing to 30-40 breaths per minute by 6 months.
What are the signs of respiratory distress in a baby?
Signs of respiratory distress include retractions, rapid breathing, nasal flaring, grunting, and a bluish tint to the skin.
When should I take my baby to the doctor for a cough?
You should take your baby to the doctor for a cough if they have difficulty breathing, a fever, are feeding poorly, or if the cough persists for more than a few days.
Can air pollution cause breathing problems in babies?
Yes, air pollution can irritate a baby's airways and increase the risk of respiratory infections and breathing problems.
Signs to Consult Immediately
Severe retractions (skin pulling in deeply with each breath)
Rapid breathing rate (over 60 breaths per minute)
Nasal flaring (widening of the nostrils with each breath)
Grunting sounds during exhalation
Bluish tint to the skin around the lips or fingertips (cyanosis)
Lethargy or decreased responsiveness
Difficulty feeding or refusing to eat
High fever (over 100.4°F or 38°C)
Seizures
Detailed Explanation
Retractions occur when a baby is having difficulty getting enough air into their lungs.
Normally, when a baby inhales, the diaphragm and chest muscles work together to create a vacuum that draws air into the lungs.
However, if there is an obstruction or inflammation in the airways, the baby has to work harder to breathe, causing the muscles between the ribs, above the collarbone, and below the breastbone to pull inward.
It's important to differentiate between normal breathing patterns and retractions.
All babies have slightly different breathing patterns, and some may breathe faster or more shallowly than others.
However, retractions are a clear sign of increased effort and should not be considered normal.
Occasional, very mild retractions during crying might be normal, but persistent or worsening retractions always warrant medical evaluation.
Warning signs that require immediate medical attention include severe retractions, a rapid breathing rate (over 60 breaths per minute), nasal flaring, grunting sounds, a bluish tint to the skin (cyanosis), lethargy, or difficulty feeding.
These signs indicate that your baby is in significant respiratory distress and needs urgent medical intervention.
The guidance on retractions doesn't drastically change based on the baby's age within the first year.
However, the possible causes of retractions may vary.
In newborns (0-3 months), common causes include respiratory syncytial virus (RSV) and congenital abnormalities.
In older infants (6-12 months), bronchiolitis and pneumonia become more common.
Premature babies are at higher risk for respiratory problems due to their underdeveloped lungs.
They may be more prone to retractions and require closer monitoring.
Babies with underlying health conditions, such as congenital heart defects or chronic lung disease, are also at increased risk and may need specialized care.
In India, seasonal changes can impact respiratory health.
During the winter months, increased air pollution and cold temperatures can exacerbate respiratory problems.
In the monsoon season, humidity can promote the growth of mold and other allergens that can trigger respiratory issues.
During the summer, dehydration can thicken mucus and make breathing more difficult.
It's important to take appropriate precautions to protect your baby's respiratory health during each season.
Sources
Indian Sources
Refer to the IAP guidelines for the latest recommendations on the diagnosis and management of pneumonia in children. (Note: You'll need to navigate their website to find the specific pneumonia guidelines document.)
Search the Indian Pediatrics journal for recent articles on respiratory infections in children in India. (Note: You'll need to search their archives for relevant articles.)
International Sources
WHO's fact sheet on pneumonia, including information on causes, symptoms, and treatment.
AAP's information page on RSV, a common cause of respiratory illness in infants.
Recommended Reading for Parents
A comprehensive guide to infant and child care, available in many bookstores in India or online.