Newborns often have irregular breathing patterns that concern new parents, from breathing fast to taking long pauses between breaths. By learning what’s normal and what isn’t, you’ll have a better idea of when to reach out to your pediatrician – and hopefully, breathe a bit easier.
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Newborns breathe differently than adults
As you lovingly watch your newborn breathe, it’s easy to go from wonder to worry very quickly. Is your newborn breathing fast? Breathing too slowly? Making unusual noises? Whether you’re a first-time parent or a more experienced one, fears about your baby’s breathing are common – perhaps because it’s so different from what adults are used to.
Consider this:
Your baby may still have amniotic fluid and meconium in their airways after birth.
Your baby has yet to learn how to use their lungs and breathing muscles.
Your baby’s airways are much smaller and easier to obstruct.
Your baby’s chest wall is mostly made of cartilage, making it more pliable.
Usually, there is often nothing to worry about – but parents often worry anyway. One of the best things you can do is to pay close attention to your newborn’s typical breathing pattern. Once you know what’s normal for them, it becomes easier to tell if something is different.
Understanding infant respiratory rates
Diaphragmatic breathing in infants – also known as belly breathing – uses their diaphragm (the large muscle below their lungs) to breathe, causing their belly to rise and fall. Diaphragmatic breathing is the normal, natural way that all babies breathe.
However, newborns breathe faster than older babies, typically at a rate of 40-60 breaths per minute when awake (20-40 breaths per minute when asleep). By 6 months of age, their normal breathing rate will slow to 25-40 breaths per minute.
Your newborn may also breathe faster when they are angry, crying, or upset. As long as they get back to 60 breaths per minute or less after they settle down, there’s no cause for concern. Within a few months, most of the irregularities of newborn breathing resolve themselves.
Periodic breathing in infants
Periodic breathing is when a newborn takes rapid, shallow breaths for 10 seconds, then pauses briefly for 5-10 seconds. Again, this is very different from adult breathing patterns, which is why many parents become alarmed – but periodic breathing is also normal for newborns.
Your baby might repeat this cycle (a pause in breathing followed by rapid breathing) three or more times in a row, then settle back into a steady rhythm. Periodic breathing typically happens when your baby is sleeping. As they grow, their body learns how to regulate their breathing, and the periodic breathing cycles stop.
What other breathing noises mean
From hiccups to snorts, newborns often make interesting noises as they breathe. Here’s what some of those noises could mean:
Hiccups – Hiccups can happen at any age. Eating too quickly and swallowing air while feeding are two frequent causes of hiccups in newborns.
Sneezing – Frequent sneezing is common in newborns as they learn to breathe, due to their small nasal passages.
Snorting – Because newborns breathe more through their nostrils than their mouths, snorting is also common.
Snoring – Snoring is usually due to clogged mucus in a newborn’s nostrils.
Grunting (a deep, guttural sound made by the throat) is often harmless and related to digestion, as newborns learn how to move gas and stool through their immature digestive systems. Newborns may also grunt because their nostrils are blocked with mucus. However, persistent grunting as they breathe is another story.
When to worry about newborn breathing
Now that we have covered what’s usually normal, let’s review the newborn breathing issues that require medical care – sometimes immediately.
More than 60 breaths per minute
More than 60 breaths per minute is too fast and signals that your newborn’s body is working harder to breathe. If your baby consistently takes more than 60 breaths per minute for an extended period of time – especially when they are sleeping, calm, or happy – it could be a sign of a medical emergency.
Possible conditions include:
Transient tachypnea of the newborn (TTN) – This temporary respiratory condition in newborns is caused by a delay in clearing fluid from the lungs, resulting in rapid breathing for the first few hours of life. Most babies recover completely within 24-72 hours.
Respiratory distress syndrome (RDS) – Respiratory distress syndrome is caused by a lack of surfactant, a substance that prevents air sacs in the lungs from collapsing. Premature newborns are more likely to have RDS.
Persistent pulmonary hypertension of the newborn (PPHN) – This serious condition occurs when blood is not being properly oxygenated by a newborn’s lungs.
Breathing pauses of 15-20 seconds
The breathing pauses associated with periodic breathing last 5-10 seconds. If your newborn stops breathing for 15-20 seconds, they could have infant apnea – a condition that causes their heart rate to drop at the same time.
Infant apnea is more common in premature babies born before 37 weeks, but it can also be caused by factors like airway obstruction, infections, heart or blood vessel problems, and more. If your baby takes breathing pauses of 15-20 seconds or more, especially when they are sleeping, contact your pediatrician right away.
Retractions in infants
Infant retractions are a visible sign of respiratory distress, where the skin around their neck or windpipe, in between or under their ribs, or around their belly pulls inward with each breath. When this happens, your newborn is using extra muscles in their neck, chest, and/or abdomen to get enough air into their lungs – also known as accessory muscles for respiration.
Infant retractions can be caused by conditions like:
Respiratory infections, such as bronchiolitis, pneumonia, or RSV
Asthma or other airway diseases
A foreign object in the newborn’s airway
Inflammation of the epiglottis (the flap of cartilage at the base of the tongue that prevents food and liquids from entering the lungs)
Respiratory distress syndrome
Other visible signs of respiratory distress
If your newborn is working harder than normal to breathe, you may also notice:
Head bobbing – Your newborn must use their neck muscles to breathe, causing their head to move up and down with each breath.
Nasal flaring – Nasal flaring is a sign that your newborn’s body is trying to pull in more air.
Changes in skin color – If your newborn’s skin, lips, or fingertips have a bluish tone, that means they are not getting enough oxygen as they breathe.
Sweating – Newborns sweat for many reasons. But if any of these other signs are visible, the sweating is likely due to respiratory distress.
Lethargy – If your newborn is unusually difficult to wake, sleeps more than usual, or is less responsive, they may be struggling to breathe.
Audible signs of respiratory distress
Sometimes it’s not just what you see, but also what you can hear. Listen carefully for any of these audible signs of respiratory distress:
Wheezing – You may hear high-pitched wheezing from your newborn’s chest as they inhale, exhale, or both.
Whistling – Whistling (also called stridor) is a high-pitched, harsher sound caused by an obstruction in the upper airway. It is often loudest in the neck area.
Grunting or moaning – Persistent grunting or moaning could indicate that your newborn is trying to get more air into their lungs.
Gasping – Your newborn may gasp for air due to laryngomalacia (a harmless condition where soft cartilage in their voice box collapses as they inhale, particularly during feeding) or respiratory conditions like TTN, RDS, and more.
Never hesitate to reach out to your pediatrician if you are concerned about your newborn’s breathing, especially if it seems like they are in distress.
Some newborn breathing tips for parents
Are you concerned about your baby’s breathing? These tips can help you prevent breathing issues and keep your baby safe and healthy.
Know what’s normal – As mentioned above, it’s an excellent idea to learn your newborn’s typical breathing patterns, so you have a better chance of noticing what isn’t typical if it occurs.
Take a video – When in doubt, take a video of your baby’s breathing to show to your pediatrician or doctor, whether you schedule an in-person appointment or a virtual telehealth visit.
Always put your baby to sleep on their back – If your baby has a respiratory infection and/or nasal congestion and isn’t sleeping well, it’s still not safe to prop them up or put their crib mattress on an incline. Sleeping on their back also lowers your baby’s risk of sudden infant death syndrome (SIDS). Ask your pediatrician for alternative ways to help them breathe better, such as saline nasal spray and steam baths. Both can help loosen mucus in your newborn’s nasal passages and airways.
Dress your newborn appropriately – Babies tend to breathe faster when they are overheated, so be sure to dress your baby in breathable fabrics like cotton vs. synthetic fabrics like polyester that trap heat inside. And don’t bundle your baby up too much, even in cold weather – you should only add one layer more than what you are wearing yourself.
We understand how scary breathing issues can be, especially when a tiny newborn is involved. The pediatric care experts at Pediatric Associates are here to provide you with answers and assurance, with same-day care and after-hours and weekend care available at most locations.
