Baby Chest Retractions
Content reviewed against published AAP, NIH guidelines
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If your baby has been diagnosed with or you suspect baby chest retractions, here is what the evidence says.
The short answer
Chest retractions occur when the skin between or below the ribs pulls inward with each breath, indicating that your baby is working harder than normal to breathe. This is a sign of respiratory distress that should always be taken seriously. Retractions can be caused by bronchiolitis, croup, asthma, pneumonia, or other respiratory conditions. If you can see your baby's ribs clearly pulling in with each breath, contact your pediatrician or seek emergency care.
Key takeaways
- Chest retractions occur when the skin between or below the ribs pulls inward with each breath, indicating that your baby is working harder than normal to breathe. This is a sign of respiratory distress that should always be taken seriously. Retractions can be caused by bronchiolitis, croup, asthma, pneumonia, or other respiratory conditions. If you can see your baby's ribs clearly pulling in with each breath, contact your pediatrician or seek emergency care.
- Usually normal when: Very mild movement below the ribs in a newborn during calm breathing that does not worsen
- Call your doctor if: Baby has clear, persistent chest retractions visible between or below the ribs during calm breathing -- seek immediate medical care
- Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
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By Age
What to expect by age
0-3 months
Young infants have very flexible ribcages, so mild subcostal (below the ribs) retractions can occasionally be seen even with normal breathing. However, visible intercostal retractions (between ribs), suprasternal retractions (above the collarbones), or substernal retractions (below the breastbone) are always abnormal and indicate significant breathing difficulty. In newborns, retractions along with grunting and nasal flaring form the classic triad of respiratory distress.
3-6 months
Retractions at this age are most commonly caused by viral respiratory infections like RSV bronchiolitis. The small airways of babies can become blocked by mucus and inflammation, forcing them to work harder to breathe. If your baby has retractions along with wheezing, rapid breathing, poor feeding, or fever, they need medical evaluation. Mild retractions may be monitored at home if feeding is adequate, but worsening retractions require urgent care.
6-12 months
Retractions during a respiratory illness indicate that the illness is more than a simple cold. Common causes include bronchiolitis, croup, and reactive airway disease. Look at your baby while they are calm and the shirt is off -- visible retractions during quiet breathing are more concerning than retractions only during crying. If retractions are present when your baby is calm, or are accompanied by very fast breathing, seek medical attention promptly.
12 months+
In toddlers, retractions can occur with croup, asthma exacerbations, pneumonia, or foreign body aspiration. If your toddler suddenly develops breathing difficulty with retractions without a preceding illness, consider the possibility that they may have inhaled a small object. Any new-onset severe retractions with or without choking history warrant immediate medical evaluation.
What Should You Do?
When to take action
- Very mild movement below the ribs in a newborn during calm breathing that does not worsen
- Baby breathes comfortably with normal rate and no visible rib pulling during feeds or sleep
- Temporary mild retractions during hard crying that resolve when baby calms down
- Ribs are slightly visible in a thin baby without actual pulling-in motion during breathing
- You notice mild retractions during a respiratory illness but baby is still feeding and alert
- Baby has occasional retractions that come and go with a cold
- You are unsure if what you are seeing is retractions or normal rib visibility
- Baby has clear, persistent chest retractions visible between or below the ribs during calm breathing -- seek immediate medical care
- Baby has retractions along with grunting, nasal flaring, very rapid breathing, or color changes (blue or pale) -- call 911
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Baby Chest Retractions.
Things to mention
- You notice mild retractions during a respiratory illness but baby is still feeding and alert
- Baby has occasional retractions that come and go with a cold
- You are unsure if what you are seeing is retractions or normal rib visibility
Observations to share
- You notice mild retractions during a respiratory illness but baby is still feeding and alert
- Baby has occasional retractions that come and go with a cold
- You are unsure if what you are seeing is retractions or normal rib visibility
Urgent signs to report immediately
- Baby has clear, persistent chest retractions visible between or below the ribs during calm breathing -- seek immediate medical care
- Baby has retractions along with grunting, nasal flaring, very rapid breathing, or color changes (blue or pale) -- call 911
My notes
From ismybabyalright.com — free, evidence-based baby health guides
Related Resources
Breathing Difficulty Triage
Assess breathing concerns and know when to seek emergency care.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is baby chest retractions normal?
When should I call the doctor about baby chest retractions?
When is baby chest retractions normal?
What causes baby chest retractions?
What should I mention to my pediatrician about baby chest retractions?
Is baby chest retractions normal at 0-3 months?
Is baby chest retractions normal at 3-6 months?
Should I go to the ER for baby chest retractions?
Does baby chest retractions go away on its own?
References
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Resources
Bottom line
Most cases of baby chest retractions are normal. Talk to your pediatrician if baby has clear, persistent chest retractions visible between or below the ribs during calm breathing -- seek immediate medical care.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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