Noisy Newborn Breathing: Does My Baby Have a Cold or What?
Newborns. You’ve just got to stare at them, don’t you? Sleeping newborns? Forget about it. We are bound to watch them, in their slumbering, cherubic beauty, regarding every detail of the curve of their face, and the movements they make. It is from these marathon observation sessions, I think, that parents derive one of the more common questions I get in the visits during the first weeks of life: “My baby breathes noisily and snuffily. Does she already have a cold?”
This is a great question and an understandable concern. First, for all their cuteness, newborns are a different species, almost, from older kids, as their physiology just isn’t the same. They can breathe oddly. Next, discharge teaching to the uninitiated parent can seem less like a list of reasons to contact one’s primary provider if worried, and more like an oracle’s forecast of doom (“when you see a fever, BEWARE! O tempora! O mores!” etc). We recall that babies are fragile little systems with immune systems that are merely booting up in those first couple of months. And lastly, a modicum of sleep deprivation, a dose of consulting too many guidebooks and websites, and a dash of remembering that goobery cousin who kissed the newborn, and voila! Breathing (snoring? snotty?) baby, worried parent.
So first, let’s establish what is normal for respiration in newborns. They do stuff faster than you. Adults breathe around 10-15 times a minute when awake, and a little less when asleep. The average adult heart rate is about 80 beats a minute, more or less. On average, babies breathe more quickly and variably, ranging from 20 to 40 breaths per minute. Newborn heart rates , as any listener to a fetal heart monitor can tell you, also move along at a good clip, at about 100-110 beats a minute.
What’s more, babies have the adaptive tendency to be what neonatologists call ‘obligate nose breathers.’ This is not a reference to those people who stand behind you at the copy machine and respire huffily so they can have their turn. Rather, this refers to the newborns preference to inhale and exhale via the nostrils, permitting the passage of air while feeding. Clever, eh? Those oral and nasal passages are linked as well. Air going into the mouth or nose joins the common lobby at the back of the throat, and travels down the neck to the trachea, where it enters the lungs. Anyone who has regarded or held a crying or screaming baby knows that newborns breathe via their mouths. Conversely, babies who are spitting up may have stomach contents that come roaring up the esophagus will come out the mouth, but may come out the nose. Ick. However, when at rest and being chill, nasal breathing is a baby’s default setting.
“But whence the snuffiliness?,” you may well ask. “How do I know if my child has a cold?”
And here is the rub. Most parents who have this question are observing a phenomena called ‘periodic breathing of the newborn.’ Classically and almost invariably in these benign cases, parents are doing that staring thing, and are looking at their baby sleeping, and they’ll see a change from the steady rise and fall of the child’s chest. Instead, the baby may have a series of shallow and rapid breaths, causing snorkly and (in the case of my kids) piglet-like sounds, that resolve just as soon as they came on. The cause of this periodic breathing isn’t entirely clear, but may be explained by the immaturity of the breathing centers of the brain, and/or the baby blowing off some extra carbon dioxide as he transitions between deeper and lighter stages of sleep. Research suggests it happens in babies in about 2-6% of the time they breathe (quite a bit, actually). While so doing, the faster breathing pushes the air through the upper airway, making musical or brief grunting sounds. It can get pretty loud and it can happen repeatedly over a day or through the night. For the hyperaware new parent, it can be a bit funky.
A few things can be reviewed to help a parent confirm what is being seen is periodic breathing and not, as we say in the pediatric business, badness. Periodic breathing in babies occurs without any appearance of fever, pallor, or blueness around the mouth. Runs of these irregular breaths will only occur for about 15-20 seconds. To be sure, babies may take deep breaths, but should not appear to pause their breathing for more than a second or two. Parents who observe persistent fast breathing, babies who appear to be working to breathe, or any question that their child is having longer pauses in their breathing should run that question urgently by their child’s health care provider. Pronto.
Babies may well have other reasons to breathe irregularly that are benign. During important tasks like pooping, farting, burping, or moving about, our little friends can breathe loudly before they subside. Newborns may also retain gunk in their nasal passages following a heroic spit up. Like a mild cold or runny nose, this material can congest the nose and contribute to noisy nasal breath sounds during sleep and when awake. I encourage parents to deploy the nasal suction bulb with gentleness and caution if attempting to remove these contents. Remember, keep the tip at the entry of the nostrils (you aren’t doing brain surgery!) as you vacuum out the goop. Employing the bulb with too much gusto can irritate the nasal passages further, causing swelling, and perhaps, worsen congestion.
If an infant does have what seems like nasal congestion, I am as much a fan of having the parent steam up the bathroom with the door closed, and a shower running for a few minutes. The warmed, humidified air tends to dilate the vessels in the nasal passages, offering some relief from extra mucus. Once more: if any child under three months has these symptoms and is inconsolably cranky, doesn’t feel or feed well, or has fever over 100 degrees, it’d best be time to put a call in to the doc’s office.
In my post-medical school, on the job training in primary care, I have developed a repertoire of snoring imitations. While the obstructive sleep apnea buzzsaw is hardest to do, the periodic breathing reprise is the most fun. To do so, scrunch up your nose so your upper lip comes off your teeth. Then, snort gently with shallow half-breaths through your nose. A satisfying, Wilbur the Pig sound should result. It kills at parties, and more importantly, helps parents tease out in the office or by phone, what may be happening in the bassinette at 3 am.
In the meantime, to all you adults staring at sleeping babies: carry on! (as if you had a choice). Admire the beauty and splendor of the slumbering prince or princess. Catalog their perfection, and celebrate the joy of their being. And then, when they do their periodic breathing thing, be assured, but watch closely! You’ll want to get some tips so you can better your own imitation, after all.
Photo above by em…ily; Cartoon below by me
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