Did you know that breathing issues (aka respiratory distress) are the most common reasons that young ones present to the Emergency Department?

Infants, especially newborns, have very small airways (literally the size of a drinking straw!) which make them more vulnerable to respiratory issues.

The tricky part is that infants and young children often show signs of respiratory distress different to how an older child or adult would. It's super important to be able to recognise when your baby is struggling to breathe so you can action medical help sooner. In this post, we'll have a look at some of the ways young ones can present when they have respiratory distress, tips to determine what's normal or not for your child, and when to seek medical help.

Is This Normal?

What is "normal" will often differ between babies. So honestly, the biggest advice I can give you is this:

1️⃣ Take a short video of your baby sitting just in their nappy (so you have full view of their tummy, chest and face), while they're happy and relaxed.

2️⃣ Update this video every month during the first 6 months, then every few months there-on after.

This video will be your reference guide for what your baby's "normal" is. If you are worried later on  that something's not looking or sounding right, just refer back to the video and it can really help you see if there are any changes between now and when you took the video.

Signs of Respiratory Distress in Babies:

If your baby is in respiratory distress, they may display one, or a number, of the signs below.

1. Rapid Breathing:

Rapid breathing can be a sign of breathing difficulty at any age. In the video above, you’ll see a newborn with a very fast breathing rate. You might notice that your own baby already seems to breathe quite quickly. That’s because younger children naturally breathe faster—newborns, for example, usually take about 30-60 breaths per minute, which is nearly one breath every second! 

While there are many sources online that might give you specific numbers to look for (e.g. a newborn breathing over 60 breaths a minute is often classified as having "respiratory distress"), I would prefer that you whip out the video you took and decide whether your baby is breathing a lot faster now than they are in the video. Noticing what is different for YOUR child is so much more meaningful than trying to memorise a stack of numbers.

I also want to add that rapid breathing can occur due to a number of different reasons, some of which have nothing to do with the lungs, such as anaemia or heart problems. Therefore it's important to look at other signs and symptoms your baby might have, and always reach out for help if you feel like something just isn't right.

2. Noisy Breathing:

The 2 main noises that a baby can make when they are struggling to breathe are WHEEZE and STRIDOR.

What is a wheeze?

🔸Airways are made up of tiny little pipes or tubes that air passes through. A wheeze tends to occur when there is inflammation or narrowing of the lower airways in the lungs. This causes more turbulent airflow, resulting in a high pitched whistling noises (or wheeze) as they breathe.

🔸A wheeze is usually more noticeable when a baby is BREATHING OUT. However, if the inflammation or narrowing is more severe, a wheeze will be present when your baby is breathing in too.

What causes a wheeze?

🔸While many different things can cause a wheeze, virus' would be the most common. An example of this would be bronchiolitis resulting from an RSV infection. As young ones get older, asthma is also another common cause.
🔸Wheezes can also occur if your baby has reflux, allergies, or if they've inhaled either a small object or a liquid.

🎬 Below is a video of a little one with a wheeze. Notice the high pitched sounds occurring as baby is breathing out.

What is stridor?

🔸Stridor occurs when there is inflammation or narrowing of the upper airways near the voice box. This causes more turbulent airflow, and results in a high pitched whistle noise coming from the throat.

🔸Stridor is more noticeable as baby is BREATHING IN. However, if the swelling or narrowing is more severe, stridor can be heard when baby is breathing out too.

What causes stridor?

🔸 The most common cause for stridor in an infant is croup. Croup is caused by a number of different virus' that cause inflammation of the upper airway.

🔸 Other less common causes of stridor can include airway burns, an object lodged in the upper airway, or congenital airway deformities such as laryngomalacia.

🎬 The video below shows a little one with stridor: 

3. Grunting:

Ok, I'm sure you've heard your baby grunting throughout various times of the day 💩, but prolonged grunting as they are trying to breathe is definitely not normal, and can be a sign of respiratory distress.

During grunting, babies are trying to create a pressure within their chest which prevents all their little air-sacs in their lungs from collapsing. It's usually a sign of severe respiratory distress.

🎬 The video below shows a baby grunting during respiratory distress.

4. Chest Recessions:

Chest recessions (also known as chest retractions), are when you see drawing in or sucking in of baby's chest at various places such as:

🔸Underneath the ribs (subcostal recessions)

🔸In between the ribs (intercostal recessions)

🔸Just above the collar bone (supraclavicular recessions)

🔸Just above the sternum (tracheal or suprasternal recessions)

Chest recessions happen more-so in babies/young children than in adults. This is because their chest wall isn't as rigid as ours, and their breathing muscles aren't as strong. This means that when they are struggling to breathe, their chest wall is more likely to get sucked in and around the chest bones.

🎬 The video below shows examples of chest recessions in different locations, however nearly all the video's in this entire blog post show some form of chest recession on babies. 

5. Head Bobbing:

Babies rely a lot on their diaphragm to help them breathe. If they're working really hard to breathe, their diaphragm starts getting tired and their body starts to use other muscles to help open up the rib cage. We call these muscles accessory muscles. Some of these accessory muscles run down the neck. When adults use these accessory muscles, it really helps lift and open up the rib cage. Unfortunately in babies, their neck muscles are still quite underdeveloped, so when baby uses these accessory muscles, it just makes their head bob instead.

If your baby is showing signs of head bobbing, it means that they are working REALLY hard to breathe.

🎬 The video below shows an example of head bobbing in a little baby.

6. Nasal Flaring:

Babies breathe mostly through their nose until roughly 6 months of age. Nasal flaring is when the nostrils widen with each breath, which can be a sign your baby is struggling to breathe. Since babies have smaller airways, and their respiratory muscles are still developing, they have to work harder to get enough air in during illness. 

The nasal cavity is one of the narrowest parts of a baby's airway. By increasing the diameter of the airway in this spot, nasal flaring will hopefully improve air flow. If your baby is flaring their nostrils when breathing, it is a sign (albeit very subtle!) of respiratory distress.

🎬 The video below shows a baby in respiratory distress with nasal flaring. Note how easily this little one's respiratory distress could be missed if his jacket was done up and you weren't aware of the significance of nasal flaring!

Summary:

✅ Recognising signs of respiratory distress- such as nasal flaring, grunting, or chest recessions-  is key to getting your baby the help they need sooner.

🤳A great way to stay on top of your child's "normal" is by taking a video of them while they're calm and relaxed. This provides a helpful reference to spot any changes if you're ever concerned. 

👩‍⚕️ Remember, if you notice signs of respiratory distress, or if something doesn't feel right, trust your instincts and seek medical help right away. It's always better to act early and ensure your little one gets the care they need.

Share this blog with a parent who would find this useful! 🧡