Medical Conditions

Congenital Lobar Emphysema (Overinflation) in Babies

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published AAP, ATS, NIH guidelines

Editorial policy

Last reviewed:

If your baby has been diagnosed with or you suspect congenital lobar emphysema (overinflation) in babies, here is what the evidence says.

The short answer

Congenital lobar emphysema (also called congenital lobar overinflation) is a condition in which one lobe of the lung becomes progressively hyperinflated, trapping air and compressing the surrounding normal lung tissue. It usually presents in the first 6 months of life with tachypnea (rapid breathing), wheezing, and respiratory distress. The upper lobes are most commonly affected. Mild cases may be observed, while severe cases require surgical removal of the affected lobe (lobectomy).

Key takeaways

  • Congenital lobar emphysema (also called congenital lobar overinflation) is a condition in which one lobe of the lung becomes progressively hyperinflated, trapping air and compressing the surrounding normal lung tissue. It usually presents in the first 6 months of life with tachypnea (rapid breathing), wheezing, and respiratory distress. The upper lobes are most commonly affected. Mild cases may be observed, while severe cases require surgical removal of the affected lobe (lobectomy).
  • Usually normal when: Your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention
  • Call your doctor if: Your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation
  • 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.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to AAP, ATS, NIH guidelines, congenital lobar emphysema (also called congenital lobar overinflation) is a condition in which one lobe of the lung becomes progressively hyperinflated, trapping air and compressing the surrounding normal lung tissue. It usually presents in the first 6 months of life with tachypnea (rapid breathing), wheezing, and respiratory distress. The upper lobes are most commonly affected. Mild cases may be observed, while severe cases require surgical removal of the affected lobe (lobectomy). At 0-1 month, congenital lobar emphysema can present at birth or within the first weeks of life. About half of cases are diagnosed in the neonatal period. The newborn may have tachypnea (rapid breathing), mild to severe respiratory distress, wheezing, or cyanosis. A chest X-ray typically shows hyperinflation of one lobe with compression of adjacent lung tissue and possible mediastinal shift (the heart and structures in the center of the chest being pushed to the opposite side). In severe cases causing significant respiratory distress, emergency surgical lobectomy may be required. It is generally considered normal when your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention. However, you should contact your pediatrician promptly if your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention
Your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation
Your baby has occasional wheezing during viral respiratory infections that resolves completely between illnesses
Your baby with known congenital lobar emphysema has worsening breathing difficulty, is unable to feed, or appears limp and unresponsive
Your child had a lobectomy for congenital lobar emphysema and has recovered with normal breathing and activity
Your baby has a sudden increase in wheezing with labored breathing that does not improve with rest or prescribed treatments
A mild finding on chest imaging was evaluated by a pediatric pulmonologist and deemed stable and not requiring intervention
Your baby has persistent rapid breathing or mild wheezing that does not seem to be related to a cold or infection

When to Seek Immediate Care

  • Your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation
  • Your baby with known congenital lobar emphysema has worsening breathing difficulty, is unable to feed, or appears limp and unresponsive
  • Your baby has a sudden increase in wheezing with labored breathing that does not improve with rest or prescribed treatments

By Age

What to expect by age

0-1 month

Congenital lobar emphysema can present at birth or within the first weeks of life. About half of cases are diagnosed in the neonatal period. The newborn may have tachypnea (rapid breathing), mild to severe respiratory distress, wheezing, or cyanosis. A chest X-ray typically shows hyperinflation of one lobe with compression of adjacent lung tissue and possible mediastinal shift (the heart and structures in the center of the chest being pushed to the opposite side). In severe cases causing significant respiratory distress, emergency surgical lobectomy may be required.

1-6 months

This is the most common window for congenital lobar emphysema to become symptomatic. As the baby grows and becomes more active, the progressive air trapping in the affected lobe may worsen. Parents may notice rapid breathing, wheezing, difficulty feeding, or poor weight gain. The left upper lobe is most commonly affected, followed by the right middle lobe. A CT scan of the chest is typically performed to confirm the diagnosis and plan surgical approach. If symptoms are significant and progressive, surgical lobectomy is recommended.

6-12 months

Some milder cases of congenital lobar emphysema may not become apparent until later infancy. The baby may have recurrent episodes of wheezing or respiratory distress that may initially be attributed to viral infections or asthma. If your baby has persistent wheezing that does not respond to bronchodilators or recurring respiratory problems, a chest X-ray and CT scan should be performed to evaluate for structural causes including congenital lobar emphysema.

1 year+

Rarely, mild congenital lobar emphysema may be diagnosed beyond infancy, either incidentally on imaging or during evaluation for chronic respiratory symptoms. Children who have undergone lobectomy for congenital lobar emphysema generally have excellent outcomes with normal exercise tolerance and lung function, as the remaining lung lobes compensate through growth and expansion. Long-term follow-up with periodic assessments of lung function is recommended. Children with mild, stable disease who are managed conservatively also tend to do well with careful monitoring.

What to Tell Your Pediatrician

  • Describe when you first noticed congenital lobar emphysema (overinflation) in babies and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your baby has persistent rapid breathing or mild wheezing that does not seem to be related to a cold or infection.
  • Mention if your baby wheezes frequently and asthma treatments do not seem to help.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention
  • Your baby has occasional wheezing during viral respiratory infections that resolves completely between illnesses
  • Your child had a lobectomy for congenital lobar emphysema and has recovered with normal breathing and activity
  • A mild finding on chest imaging was evaluated by a pediatric pulmonologist and deemed stable and not requiring intervention
Mention at your next visit when...
  • Your baby has persistent rapid breathing or mild wheezing that does not seem to be related to a cold or infection
  • Your baby wheezes frequently and asthma treatments do not seem to help
  • Your baby seems to tire easily during feeds or is not gaining weight as expected along with respiratory symptoms
  • A chest X-ray or CT scan showed an overinflated or hyperinflated area in your baby's lung and you want to discuss what it means
Act now when...
  • Your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation
  • Your baby with known congenital lobar emphysema has worsening breathing difficulty, is unable to feed, or appears limp and unresponsive
  • Your baby has a sudden increase in wheezing with labored breathing that does not improve with rest or prescribed treatments

What You Can Do at Home

  • Keep track of when you notice congenital lobar emphysema (overinflation) in babies — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention — this is generally within the range of normal.
  • At 0-1 month, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
  • While monitoring at home, seek immediate care if your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation.

My Baby Is Breathing Fast

Babies normally breathe faster than adults. A normal respiratory rate for a newborn is 30-60 breaths per minute, slowing to 20-40 by age 1. Brief episodes of faster breathing during excitement, crying, or feeding are normal. However, persistently rapid breathing (tachypnea) at rest, especially with other signs of respiratory distress, may indicate a lung or heart problem that needs prompt evaluation.

Baby Wheezing

Wheezing is a high-pitched whistling sound heard during breathing out, caused by narrowed airways. In babies, the most common cause is a viral infection like bronchiolitis (often RSV). Many babies wheeze once or twice during their first viral illnesses and never wheeze again. However, wheezing with breathing difficulty always warrants medical evaluation.

Baby Chest Retractions

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.

Triage

Breathing Difficulty Triage

Assess breathing concerns and know when to seek emergency care.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

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 congenital lobar emphysema (overinflation) in babies normal?
Congenital lobar emphysema (also called congenital lobar overinflation) is a condition in which one lobe of the lung becomes progressively hyperinflated, trapping air and compressing the surrounding normal lung tissue. It usually presents in the first 6 months of life with tachypnea (rapid breathing), wheezing, and respiratory distress. The upper lobes are most commonly affected. Mild cases may be observed, while severe cases require surgical removal of the affected lobe (lobectomy).
When should I call the doctor about congenital lobar emphysema (overinflation) in babies?
Your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation Your baby with known congenital lobar emphysema has worsening breathing difficulty, is unable to feed, or appears limp and unresponsive Your baby has a sudden increase in wheezing with labored breathing that does not improve with rest or prescribed treatments
When is congenital lobar emphysema (overinflation) in babies normal?
Your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention Your baby has occasional wheezing during viral respiratory infections that resolves completely between illnesses Your child had a lobectomy for congenital lobar emphysema and has recovered with normal breathing and activity
What causes congenital lobar emphysema (overinflation) in babies?
Congenital lobar emphysema (also called congenital lobar overinflation) is a condition in which one lobe of the lung becomes progressively hyperinflated, trapping air and compressing the surrounding normal lung tissue. It usually presents in the first 6 months of life with tachypnea (rapid breathing), wheezing, and respiratory distress. The upper lobes are most commonly affected. Mild cases may be observed, while severe cases require surgical removal of the affected lobe (lobectomy). Common explanations include: Your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention. Your baby has occasional wheezing during viral respiratory infections that resolves completely between illnesses.
What should I mention to my pediatrician about congenital lobar emphysema (overinflation) in babies?
You should mention congenital lobar emphysema (overinflation) in babies at your next visit if: Your baby has persistent rapid breathing or mild wheezing that does not seem to be related to a cold or infection. Your baby wheezes frequently and asthma treatments do not seem to help. Your baby seems to tire easily during feeds or is not gaining weight as expected along with respiratory symptoms.
Is congenital lobar emphysema (overinflation) in babies normal at 0-1 month?
Congenital lobar emphysema can present at birth or within the first weeks of life. About half of cases are diagnosed in the neonatal period. The newborn may have tachypnea (rapid breathing), mild to severe respiratory distress, wheezing, or cyanosis. A chest X-ray typically shows hyperinflation of one lobe with compression of adjacent lung tissue and possible mediastinal shift (the heart and structures in the center of the chest being pushed to the opposite side). In severe cases causing significant respiratory distress, emergency surgical lobectomy may be required.
Is congenital lobar emphysema (overinflation) in babies normal at 1-6 months?
This is the most common window for congenital lobar emphysema to become symptomatic. As the baby grows and becomes more active, the progressive air trapping in the affected lobe may worsen. Parents may notice rapid breathing, wheezing, difficulty feeding, or poor weight gain. The left upper lobe is most commonly affected, followed by the right middle lobe. A CT scan of the chest is typically performed to confirm the diagnosis and plan surgical approach. If symptoms are significant and progressive, surgical lobectomy is recommended.
Should I go to the ER for congenital lobar emphysema (overinflation) in babies?
Seek emergency care if your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation, or if your baby with known congenital lobar emphysema has worsening breathing difficulty, is unable to feed, or appears limp and unresponsive. When in doubt, call your pediatrician's after-hours line for guidance.
Does congenital lobar emphysema (overinflation) in babies go away on its own?
In many cases, congenital lobar emphysema (overinflation) in babies resolves on its own, especially when your baby had mild transient rapid breathing after birth that resolved within a few hours without intervention. By 1 year+, rarely, mild congenital lobar emphysema may be diagnosed beyond infancy, either incidentally on imaging or during evaluation for chronic respiratory symptoms. Children who have undergone lobectomy for congenital lobar emphysema generally have excellent outcomes with normal exercise tolerance and lung function, as the remaining lung lobes compensate through growth and expansion. Long-term follow-up with periodic assessments of lung function is recommended. Children with mild, stable disease who are managed conservatively also tend to do well with careful monitoring.
AAPATSNIH

References

  1. [1]American Academy of Pediatrics. Congenital Lung Lesions. NeoReviews, 2019. AAP
  2. [2]American Thoracic Society. Evaluation and Management of Congenital Lung Malformations. Proceedings of the American Thoracic Society, 2006. ATS
  3. [3]National Library of Medicine. Congenital Lobar Emphysema. StatPearls, 2024. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Congenital Lobar Emphysema (Overinflation) in Babies.

Things to mention

  • Describe when you first noticed congenital lobar emphysema (overinflation) in babies and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your baby has persistent rapid breathing or mild wheezing that does not seem to be related to a cold or infection.
  • Mention if your baby wheezes frequently and asthma treatments do not seem to help.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your baby has persistent rapid breathing or mild wheezing that does not seem to be related to a cold or infection
  • Your baby wheezes frequently and asthma treatments do not seem to help
  • Your baby seems to tire easily during feeds or is not gaining weight as expected along with respiratory symptoms

Urgent signs to report immediately

  • Your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation
  • Your baby with known congenital lobar emphysema has worsening breathing difficulty, is unable to feed, or appears limp and unresponsive
  • Your baby has a sudden increase in wheezing with labored breathing that does not improve with rest or prescribed treatments

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Breathing TriageWell-Baby Visit PrepEmergency ContactsBaby Tracker

Bottom line

Most cases of congenital lobar emphysema (overinflation) in babies are normal. Talk to your pediatrician if your baby has sudden onset of severe respiratory distress with rapid breathing, chest retractions (skin pulling in between ribs), nasal flaring, or cyanosis (blue color), as this may indicate acute compression of normal lung tissue and requires emergency evaluation.

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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My Baby Is Breathing Fast

Babies normally breathe faster than adults. A normal respiratory rate for a newborn is 30-60 breaths per minute, slowing to 20-40 by age 1. Brief episodes of faster breathing during excitement, crying, or feeding are normal. However, persistently rapid breathing (tachypnea) at rest, especially with other signs of respiratory distress, may indicate a lung or heart problem that needs prompt evaluation.

Baby Wheezing

Wheezing is a high-pitched whistling sound heard during breathing out, caused by narrowed airways. In babies, the most common cause is a viral infection like bronchiolitis (often RSV). Many babies wheeze once or twice during their first viral illnesses and never wheeze again. However, wheezing with breathing difficulty always warrants medical evaluation.

Baby Chest Retractions

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.

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