New Born Breathing
NEW BORN BREATHING
RAPID BREATHING IN NEWBORNS
To the parents of newborns, any changes in a baby’s respiratory pattern may seem alarming. Although many babies experience brief episodes of rapid breathing, a condition clinically known as tachypnea, this symptom is only rarely a sign of a medical problem. If you have any concerns regarding your baby’s respiratory health, consult his pediatrician. A medical evaluation can rule out the possibility of an underlying illness.
Babies naturally breathe faster than toddlers, children and adults. According to the National Institutes of Health, a newborn typically takes 40 to 60 breaths per minute. If your baby persistently breathes more than 60 times per minute, his pediatrician may diagnose him with tachypnea. Brief episodes of tachypnea are normal and ultimately harmless for most newborns.
According to renowned pediatrician Dr. William Sears, rapid breathing and panting are extremely common in newborns. As a baby adjusts to life outside the womb, his body gradually acclimates to a comfortable breathing pattern. Sears states that, as long as the baby is comfortable most of the time and shows no other worrisome symptoms, rapid breathing is not a cause for concern. Some medical problems may also cause a baby to breathe rapidly, including respiratory infections and complications from childbirth.
IS IT STRANGE THAT I OFTEN FEEL THE NEED TO CHECK MY BABY’S BREATHING?
No, and you’re not alone. Check on your child as often as you feel you need to. If your baby is premature or has a chronic lung disease or another condition, such as sleep apnea, you may have to monitor your baby’s breathing, at least for a while. But even if your baby doesn’t have a medical problem, you may worry that he could develop one, such as sudden infant death syndrome (SIDS).
It may help to keep in mind that babies have various stages of slumber – sometimes deep and still, sometimes active and noisy. Your comfort level should grow with your experience as a parent, but it’s okay if you continue to visit your child’s bedroom nightly, just to check on his breathing, for years to come.
HOW CAN I TELL IF MY BABY HAS STOPPED BREATHING, AND WHAT SHOULD I DO ABOUT IT?
In most cases, babies’ irregular breathing habits are nothing to worry about. While sleeping, newborns may do what’s called periodic breathing: They breathe progressively more quickly and deeply, then more slowly and shallowly, then pause for up to 15 seconds. They start up again with progressively deeper breaths.
This is common – especially among preemies – and will evolve into a more mature pattern of breathing, with occasional sighs, in the first few months of life.
It’s also not unusual for a baby’s hands and feet to be mildly bluish. But if his lips, tongue, whole face, or the trunk of his body turns dark or distinctly blue, it’s a sign that he may be in danger.
If you suspect that your baby has stopped breathing or simply want to reassure yourself, lightly touch or rouse him to see whether he responds. If he doesn’t, rub his back vigorously or slap his feet. If he still doesn’t respond, he may be experiencing something called apnea. Call 911 or your local emergency number right away.
If this happens and you know how to administer infant CPR, begin emergency treatment right away and have someone else call for emergency help. If you’re alone with your baby, administer CPR for two minutes, then call for help and resume CPR until help arrives or your baby starts breathing again.
About 1 percent of babies have what is called an apparent life-threatening event (ALTE). These episodes can be frightening to parents and need prompt medical attention. Call 911 right away if your baby suddenly shows some or all of the following symptoms during sleep:
- stops breathing for 20 seconds or more
- becomes limp or rigid
- turns blue or pale, or sometimes red
- chokes or gags and becomes unresponsive
Children who have an ALTE will need to undergo tests to figure out the cause of these symptoms. In some cases of ALTE, a doctor will recommend using an apnea monitor at home for a while to keep track of your baby’s breathing and heart rate. (These monitors can be useful with babies who have had an ALTE, but don’t rely on one to prevent SIDS. SIDS is different than an ALTE.)
NOISY BABY BREATHING
Breathe in, breathe out. It seems so simple when you do it, doesn’t it? And so…quiet? Well, your little one doesn’t have it quite so easy: Remember that his tiny lungs and nose were just introduced to the concept of inhaling air mere weeks ago. And since you’re perched in the front row (or listening to it piped-in on your baby monitor!), you can hear every whine, whistle, or wheeze his wind section makes as it’s tuning up.
Overhearing a shifting repertoire of baby sneezes, squeaks, and snorts is par for the course when it comes to a newborn baby — and not an indication of anything to be concerned about. Your baby’s symphonic breathing is perfectly fine.
So try taking a deep “om” inhalation yourself, and learn the lowdown when it comes to baby breathing:
If you pay close attention, you’ll probably notice that your baby’s breathing is as variable as your own — slower when he’s relaxed, faster when he’s excited.
When a baby’s awake, he can take over 60 breaths a minute — especially if he’s coming off a crying jag. That’s a lot faster than grown-ups — and it’s perfectly normal.
If you watch your babe’s chest go up and down while he’s sleeping (of course, you know there’s no need to do that), you may notice that his breathing stops altogether for a few seconds. Not to worry. A sleeping newborn often holds his breath for five to ten seconds, and then starts right up again (without a care in the world — unaware that, panic-stricken, you’ve been holding your breath).
All those snorts and grunts happen because babies are nose-breathers. That’s a good thing since it makes it possible for them to breathe and nurse at the same time (“Look Ma, no hands!”). But nose-breathing can be problematic when something is blocking the sole air route. It doesn’t occur to the typical newborn baby to open his mouth as an alternate route for oxygen. And it goes without saying that he’s not coordinated enough to try to blow his nose (nor does he have the verbal chops to request a tissue!). That means that if any bit of dried milk or mucus is hanging out in his nostrils, that’s exactly where it will stay (until it dislodges or disintegrates), producing a whistle, a sniffle, or even a snort. (You could try relieve his stuffy nose by suctioning his nostrils if it’s bothering you or him.)
WHEN TO WORRY:
If your baby’s breathing becomes laboured — if you clock him at more than 60 breaths per minute (and it doesn’t slow down when he’s calm), if you hear persistent grunting at the end of his inhalations, if he’s flaring his nostrils, or if he’s breathing so hard that his chest is pulling in with each inhalation — you should take him to the doctor. And if your baby’s breathing stops for longer than ten seconds at a time, or if he turns blue, call your doctor immediately (or call 911).
THE INS AND OUTS OF NEWBORN SLEEP
Babies don’t come with operating instructions, but if they did you can be sure the following rules would be stamped on their tender tushes. When you’re worried your newborn is sleeping too little, eating too much, or making too many funny noises, remind yourself of these four simple truths — then relax and enjoy that adorable child.
- NEWBORNS VARY IN THEIR SLEEP NEEDS.
The average number of hours babies spend catching z’s during their first month of life is 16.5 hours a day. But before you declare that your baby is definitely sleeping way more (or way less) than that, remember this: 16.5 hours is just an average. That means your little one could be spending 12 hours a day getting some shut-eye, while your best friend’s baby might be snoozing away for 19 hours total (lucky mom!). Whether your tiny bundle falls closer to the low end of the hours-of-sleep spectrum or the high side, the bottom line is that if your baby seems healthy and happy, don’t get too hung up on how much (or how little) he sleeps.
- NEWBORNS NEED TO EAT AROUND-THE-CLOCK.
Like every other part of their adorable bodies, newborns have very tiny tummies, so while it would be nice to load up your baby with breast milk or formula at bedtime and not hear from him till morning, it doesn’t work that way…at least not yet. Newborns need a nosh at least every two to four hours; a five-hour stretch is actually a full night’s sleep.
So how do you know when your baby is waking for a drink, or just waking up because he’s had enough sleep, or because he’s between sleep cycles? Sometimes he’ll let you know, loudly and clearly. But babies make a wide variety of sleeping sounds, from whimpers and snorts to grunts, moans, and yelps, and not all of them necessarily signal hunger or awakening. The key is to learn to differentiate between “feed me!” sounds and all the rest so you can respond quickly when he’s truly hungry (with the hope that, after a snack, he’ll drift back to dreamland quickly) or let him stay sleeping if he’s asleep.
- NEWBORNS ARE RESTLESS SLEEPERS.
Whoever coined the phrase “sleeping like a baby” probably never watched an infant sleep. Far from snoozing peacefully for hours, young babies squirm around and actually wake up…a lot. That’s because around half of their sleep time is spent in REM (rapid eye movement) mode — that light, active sleep during which babies move and dream. At the end of each REM sleep cycle, your baby briefly wakes (and perhaps whimpers) before settling into the next stage of sleep. As he matures, his sleeping patterns will too, with fewer REM cycles and more periods of deeper, quieter sleep.
- NEWBORNS ARE NOISY SLEEPERS.
When it comes to newborns, irregular breathing that may include short pauses and weird noises is rarely cause for alarm. But all parents freak at least once as they hover over the bassinet, listening for signs of respiratory trouble. Here are some facts to help keep things in perspective: A newborn’snormal rate of breathing is about 40 breaths a minute while he’s awake, though that may slow by half once he’s asleep. Or, he might speed up the pace, taking shallow, rapid breaths for 15 to 20 seconds followed by — yikes! — a total pause in which he stops breathing entirely. Yes, this will seem like an eternity to you, but really, he’ll start breathing again in less than ten seconds. You can blame all this on the immature breathing-control center in his brain, which is still a work in progress.
NORMAL RESPIRATORY SOUNDS DURING SLEEP INCLUDE:
- THE RATTLE. Just like Mommy and Daddy, your baby has mucus in his tiny nose, which can clog things up, resulting in rattling. If things get too stuffy, use a nasal aspirator (baby size, please) to help clear things out.
- THE WHISTLE. Newborn babies breathe out of their noses, not their mouths. Pretty smart, since this allows them to breathe and eat simultaneously. But that petite schnoz has petite air passages, so bits of mucus or dried milk can easily constrict the airways, resulting in a wacky whistling noise.
- THE GURGLE. No big mystery here — he’s just clearing his throat.
NEWBORN TO 2 MONTHS
The first step in evaluating a newborn with breathing trouble is to assess what body part is the main problem:
NASAL CONGESTION – many newborns will have a stuffy nose for several weeks. This can interfere with sleeping and feeding, but is harmless. This is virtually never a reason to page your doctor after hours. Simply squirt nasal saline (from the drug store) or breast milk into the nose, and suction with a bulb syringe. Steam in the bathroom also helps. Call your doctor during normal business hours for more help.
CHEST CONGESTION – most young infants have chest congestion and “junky breathing” from time to time due to saliva and regurgitated milk. This is virtually never a reason to page your doctor after hours. Holding baby upright and sleeping upright in arms or a car seat can help until you call your doctor during normal business hours.
Rapid breathing or panting is common in newborns. If there is no other sign of illness, it comes and goes and your baby is breathing comfortably most of the time, there’s no need to worry.
WHEEZING – most cases of newborn wheezing are simply due to “junky breathing” due to saliva and regurgitated milk, and are not a worry. True wheezing with labored breathing and “caving in” of the chest that persists for hours despite steam, upright positioning, and gentle clapping on the chest and back does warrant a page to your doctor.
Labored breathing with “caving in” of the chest. This can indicate a serious respiratory illness and warrants a page to your doctor if it persists for hours despite steam, upright positioning, and gentle clapping on the chest and back.
IF YOUR CHILD IS NOT A KNOWN ASTHMATIC:
Then you can try treating this by letting your child breathe steam (turn on the hot shower and sit in the steamy bathroom) for 20 minutes every couple hours, clap on the back and chest for several minutes during the steam, and give your child an expectorant. If your child’s breathing remains labored and difficult despite this, you should probably go to an ER or urgent care because your doctor won’t be able to do much over the phone.
- Transient tachypnea of the newborn
- Respiratory distress syndrome
- Meconium aspiration
- Congenital lung malformations
Birth is a transition from a fluid environment to one where we breathe air. Breathing difficulties are common immediately after birth and during the first few hours of life. In rare cases, a newborn baby may have no or very poor breathing because he has received little or no oxygen due to a problem during labour, delivery, or immediately after birth.
Initially, when a newborn baby is deprived of oxygen, his breaths will become fast and shallow. If the situation continues, he will stop breathing entirely, his heart rate will fall, and he will lose muscle tone. It is possible to revive the newborn baby at this point with simple stimulation and exposure to oxygen. However, if the newborn baby continues to be deprived of oxygen, he will start to gasp deeply, and then he will stop breathing again. His heart rate, blood pressure, and muscle tone will continue to drop, and he will die unless he is promptly resuscitated. There is also the risk of brain damage if not enough oxygen reaches the brain. If a newborn baby is not breathing, or has very poor breathing, he must be resuscitated immediately.
REDUCE HEAT LOSS:
The newborn baby will be placed on his back in a warmer to prevent heat loss, and any amniotic fluid will be dried off.
SUCTION THE MOUTH AND NOSE:
The health care providers will suction the newborn baby’s mouth and nose. If there is meconium present in the mouth or nose, it will be removed by suctioning. If the newborn baby is inactive and not breathing, his windpipe may also be suctioned.
The newborn baby will be examined for breathing, heart rate, and colour. This examination will be done very rapidly, in less than 20 seconds.
If the newborn baby is not breathing, or if his heart rate is less than 100 beats per minute, the doctor will start giving him ventilation with a bag and mask. The doctor will check his heart rate again after a few seconds, and if it is still low and not increasing, the newborn baby will continue to be given ventilation. The doctor may also need to start giving the baby chest compressions.
In some cases when ventilation with a bag and mask is not working, a newborn baby may need to be intubated with a tube that is placed into his windpipe. This tube can deliver gentle puffs of air to the newborn baby’s lungs at a rate of one breath every one or two seconds. Intubation is very helpful if a newborn baby is having a lot of trouble breathing.
If the newborn baby needs chest compressions, the doctor will press on his chest three times every two seconds. The doctor will also give him ventilation with a bag and mask every two seconds. After half a minute of chest compressions, the doctor will check the newborn baby’s heart rate. If it is still too low, the doctor may need to give the newborn baby chemical resuscitation.
If ongoing resuscitation is needed, epinephrine and other drugs will be given to the newborn baby, either using an IV or through the windpipe tube if he has one. These drugs will increase the baby’s heart rate and improve the flow of blood around the baby’s body. They are given rapidly and sometimes in repeated doses.
TRANSIENT TACHYPNEA OF THE NEWBORN
Transient tachypnea of the newborn (TTN) is a condition where breathing is rapid for a short period of time immediately after birth. Newborn babies with TTN, which is also known as “wet lung,” may have the following features in addition to rapid breathing:
RETRACTIONS, ALSO CALLED INDRAWING:
The inward movement of the muscles under the rib cage, between the ribs and in the base of the neck.
A bluish discolouration of the gums, lips, and skin
Pneumonia is when a micro-organism enters the lung and causes its airways to become infected and inflamed. The lung may produce excess fluid that can accumulate in the airways. In general, pneumonia is first suspected when the newborn baby shows unexplained signs of respiratory distress. Certain events during delivery, the condition of the mother during delivery, and indeed the type of delivery can put a newborn at risk for infection.
The first symptoms of pneumonia are:
CONGENITAL LUNG MALFORMATIONS
Although rare, some newborn babies are born with a congenital malformation of the lungs. These types of malformation may be suspected if the newborn baby has an increased breathing rate, grunting, or a bluish tint to the skin, and there is no other explanation. In other words, if lung function remains poor and the conditions listed above are ruled out, a malformation will be suspected.
Generally speaking, X-rays and other imaging techniques are used to confirm a diagnosis of malformation. In most cases, the malformation is corrected with surgery. Until the surgery can be performed, breathing is stabilized and supported.
There are many types of congenital lung malformations. The most common of these are:
CONGENITAL DIAPHRAGMATIC HERNIA:
This is a malformation of the diaphragm, which separates the chest from the abdomen. Usually with this condition, the diaphragm either is missing or has a hole in it. As a result, the organs in the abdomen – the stomach, liver, and so on – can drift into the chest cavity, leaving little room for the lungs to develop during fetal life. The lungs are smaller than usual, especially the lung on the same side as the diaphragmatic hernia. Repair is accomplished with surgery.
CYSTIC ADENOMATOUS MALFORMATIONS:
These are cysts at the end of the small airways within the lung. There may be many small cysts, giving the lung a honeycomb appearance on X-ray, or there may be one or two large cysts. Cysts in the lung usually drain poorly and cause chronic infections. Most newborn babies with these cysts have respiratory distress. Surgical removal of the affected lobe is the treatment. The surgeon will try to remove as little of the remaining healthy lung tissue as possible.
CONGENITAL LOBAR EMPHYSEMA:
This is a malformation that causes over inflation of one of the lobes of the lungs. Congenital lobar emphysema becomes a problem because the overinflated lung takes up more space than it should and therefore interferes with the regular inflation of the rest of the lung. Surgery is the treatment for this condition.
This is an area of lung tissue that is not connected to the airways of the lung. The extra lung tissue has no function. The abnormality may be within or outside the lung. A pulmonary sequestration may cause breathing problems, or there may not be any symptoms at all. Surgery is recommended to remove a pulmonary sequestration.