Chest Retractions (Breathing Difficulty) in Babies
Content reviewed against published AAP, WHO, Cincinnati Children's guidelines
Last reviewed:
Chest retractions occur when the skin pulls in around the ribs, above the collarbone, or below the rib cage with each breath. They indicate that a baby is working harder than normal to breathe. Retractions are always a sign of respiratory distress and should be taken seriously, as they mean the body is using extra muscles to pull air into the lungs against resistance.
Key takeaways
- Chest retractions occur when the skin pulls in around the ribs, above the collarbone, or below the rib cage with each breath.
- Most common cause: Bronchiolitis (RSV or other viral)
- Emergency: Severe retractions visible in multiple areas (between ribs, above collarbone, below ribs simultaneously)
- Home care: Chest retractions require medical evaluation — do not delay seeking care
Possible Causes
When to Seek Help
Emergency — Call 911 or go to ER:
- Severe retractions visible in multiple areas (between ribs, above collarbone, below ribs simultaneously)
- Retractions with blue or gray color around lips or fingernails
- Retractions with grunting and nasal flaring (respiratory distress triad)
- Baby is lethargic or difficult to arouse with retractions
- Retractions following choking episode (possible foreign body)
- Retractions with drooling and inability to swallow
Urgent — See doctor today:
- Mild to moderate retractions visible when baby is calm
- Retractions with fast breathing and poor feeding
- Retractions not improving after using prescribed rescue inhaler
- Retractions in a baby under 3 months with any respiratory illness
- Worsening retractions over several hours
Same-day appointment:
- Very mild subcostal retractions with a viral illness but baby still feeding and alert
- Retractions present only with increased activity or crying in a mildly ill child
Monitor at home:
- Brief mild retractions only during crying that resolve immediately when calm (can be normal)
- History of retractions that have completely resolved — monitor for return
By Age
0-2 months
Normal: Very mild intermittent subcostal retractions (below ribs) during active sleep can be seen in premature or small newborns. Breathing should be comfortable when baby is calm and awake.
Worry if: ANY visible retractions when baby is calm warrants urgent evaluation. Combined with grunting, nasal flaring, or fast breathing is a medical emergency. Premature infants are especially vulnerable.
2-12 months
Normal: No retractions should be visible during normal quiet breathing at this age.
Worry if: Intercostal retractions (between ribs), suprasternal retractions (above collarbone), or subcostal retractions (below ribs) during calm breathing. Especially concerning with fast breathing, poor feeding, or color change.
1-3 years
Normal: No retractions should be present during normal breathing. Mild retractions during active crying can be normal.
Worry if: Visible retractions with breathing at rest, inability to speak in sentences, refusing to lie flat, or worsening over hours. Severe retractions make the chest look like it is caving in.
Any age
Normal: Brief mild retractions during heavy crying or exertion that resolve immediately when calm.
Worry if: Retractions at rest always require medical evaluation. The more locations (intercostal + subcostal + suprasternal), the more severe the distress.
Home Care
- Chest retractions require medical evaluation — do not delay seeking care
- While waiting for medical help: keep baby calm and upright
- Clear nasal congestion with saline and gentle suctioning
- If prescribed rescue inhaler (albuterol), administer with spacer and mask
- Remove tight clothing around chest and neck
- Run cool-mist humidifier
- Do not offer food or large volumes of fluid if baby is in significant distress (aspiration risk)
- Count respiratory rate and note all signs of distress to report to medical team
Need help deciding what to do?
Use our interactive triage tool →Frequently asked questions
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Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Symptoms
Bottom line
Most cases of chest retractions (breathing difficulty) in babies are not emergencies. However, seek immediate care if severe retractions visible in multiple areas (between ribs, above collarbone, below ribs simultaneously).
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.