Newborns' Raspy Breathing: What's Normal And What's Not?

Newborns tend to have irregular breathing patterns, alternating between fast and slow, with occasional pauses. They also tend to make a variety of noises, from grunts to wheezes, which can be concerning for new parents. While most of these sounds are normal, some may indicate a more serious condition that requires medical attention. One common cause of noisy breathing in newborns is laryngomalacia, a condition where floppy tissue falls over the larynx, partially blocking the airway. This often results in a high-pitched squeak that worsens when the baby is agitated or lying on their back. Other possible causes of noisy breathing include cysts, hemangiomas, and inhaled objects. While it is normal for newborns to have some congestion due to their small nasal passages, warning signs that something more serious may be occurring include persistent grunting, bluish colouring around the lips, and pauses between breaths lasting longer than 10 seconds.

Whistling noise due to blockage in nostrils

It is normal for newborns to have irregular breathing patterns that differ from those of adults. Newborns can breathe fast, take long pauses between breaths, and make unusual noises.

Newborns tend to breathe more through their nostrils than their mouths, and their breathing pathways are much smaller and easier to obstruct. Their nostrils have small air passages, so even a little bit of mucus or dried milk can cause a blockage, leading to a whistling noise or difficulty breathing. This whistling noise can be cleared by suctioning out the blockage.

While newborns often make unusual noises while breathing, it is important to be aware of their typical breathing patterns to identify any potential concerns. If you notice any of the following signs of respiratory distress, contact your paediatrician:

• Persistently increased breathing rate (greater than 60 breaths per minute)
• Increased work to breathe, such as grunting or moaning at the end of each breath
• Flaring nostrils, indicating increased effort to breathe
• Retractions, where the muscles in the baby's chest and neck move in and out more deeply than usual
• Cyanosis, where the blood remains blue due to insufficient oxygenation in the lungs
• Difficulty feeding or a noticeable decrease in feeding intake
• Lethargy or decreased energy levels
• Fever, which can indicate an infection

In summary, while a whistling noise due to a blockage in the nostrils is a common occurrence in newborns, it is important to monitor your baby's breathing patterns and seek medical advice if you have any concerns or notice any persistent or worrying breathing problems.

Hoarse cry and barking cough

A hoarse cry and a barking cough in newborns may be indicative of croup, an infection of the larynx, trachea, and bronchial tubes. Croup is usually caused by a viral infection and is characterised by a hoarse voice, a barking cough, and noisy or laboured breathing. While it is not a common infection in newborns, it can occur in children from 6 months to 10 years of age, with the highest risk being between 6 months and 3 years.

The barking cough associated with croup is due to swelling and irritation around the voice box (larynx) and windpipe (trachea), which causes the vocal cords to produce a noise like a seal barking when air is forced through the narrowed passageway. This swelling can also make breathing difficult, and children with croup may exhibit rapid or laboured breathing, known as stridor, which can sound like a high-pitched squeak or whistling noise. Symptoms of croup are typically worse at night, when the child is upset or crying, or after physical exertion.

In most cases, croup is mild and can be treated at home. It is important to keep the child calm, as crying can worsen the condition. Offering plenty of fluids and humidified air can help ease symptoms and improve breathing. In some cases, medication such as acetaminophen or ibuprofen may be given to reduce discomfort and fever. However, it is important to consult a doctor or healthcare provider if symptoms persist, worsen, or if the child exhibits any of the following:

• Very tired or hard to wake
• Fast or laboured breathing
• Noisy, high-pitched breathing sounds when calm
• Drooling or difficulty swallowing
• Anxiety, restlessness, or extreme fatigue
• Blue, grey, or pale skin around the nose, mouth, or fingernails

While croup is typically a mild condition, it is important to monitor the child's symptoms and seek medical attention if necessary.

High-pitched, squeaky sound

A high-pitched, squeaky sound, known as stridor or laryngomalacia, is a sound that very young babies make when breathing in. It is caused by excess tissue around the larynx, or voice box, and is typically harmless. The condition usually resolves by the time a child reaches the age of 2, with most babies outgrowing it by the time they turn 1.

Laryngomalacia is a common cause of noisy breathing in infants. It occurs when the larynx is soft and floppy, and the part of the larynx above the vocal cords falls in and temporarily blocks the baby's airway. This causes a harsh, squeaky sound when the baby breathes in, which can start as soon as the baby is born, but more often occurs in the first few weeks or months after birth. Symptoms usually worsen over several months before improving.

Most babies with laryngomalacia do not have trouble breathing or feeding, even though their breathing may be noisy. However, in severe cases, it can cause breathing and feeding issues, among other complications. Breathing usually gets noisier when the baby is crying, feeding, sleeping, or lying down.

If you are concerned about your baby's breathing, it is important to contact your pediatrician.

Deep cough

A deep cough in newborns can be a cause for concern for new parents. While newborns tend to have irregular breathing patterns, a deep cough could indicate a blockage in the large bronchi (divisions of the trachea that lead into the lungs).

A newborn's cough can be the body's way of protecting itself, keeping the airways clear and ridding the throat of phlegm, post-nasal drip, or a lodged piece of food. However, it can be challenging to determine the exact cause of a newborn's cough, as they cannot communicate what they are experiencing.

Possible Causes of a Deep Cough

• Respiratory infections: Illnesses such as the common cold, flu, or croup can lead to an increase in mucus in the throat or lungs, resulting in a deep cough.
• Allergies: Although less common in newborns, babies can be allergic to environmental factors such as pet dander, dust, or mold, which may trigger a deep cough.
• Reflux: Gastroesophageal reflux disease (GERD) is common in newborns and can irritate the throat, causing coughing and gagging.
• Whooping cough (pertussis): This serious bacterial infection can affect both babies and adults and may lead to frequent coughing spasms.
• Asthma: Asthma is less common in newborns but can cause a deep cough, especially when trying to fall asleep.
• Pneumonia: Pneumonia is a viral or bacterial infection of the lungs and can result in a wet and mucousy cough.
• Bronchiolitis: This condition is characterised by inflammation of the small airways in the lungs and may be caused by respiratory viruses or environmental factors.
• Foreign object: A persistent cough or gasping could indicate that the baby has inhaled a small object or piece of food, which may require medical attention.

Remedies and When to Seek Help

• Monitor breathing: Observe your baby's breathing pattern and count their breaths per minute. Note any signs of increased work in breathing, such as flared nostrils or retractions in the chest and neck muscles.
• Hydration: Keeping your baby hydrated is crucial to thinning the mucus and making it easier to cough up. Continue breastfeeding or offering formula as frequently as needed.
• Home remedies: Try natural remedies such as saline drops, a cool-mist humidifier, or honey (for babies over one year) to soothe the throat and loosen mucus.
• Medical attention: If your baby's cough is accompanied by high fever, breathing difficulties, or other concerning symptoms, seek medical advice. A cough in newborns, especially those under 3-4 months, can be a sign of something serious, so it's always best to err on the side of caution.

Fast, laboured breathing

Newborns tend to have irregular breathing patterns, alternating between fast and slow breathing with occasional pauses. This is because they are still learning to use their lungs and the associated breathing muscles. Their nostrils are also smaller and easier to obstruct, and their chest wall is more pliable than an adult's.

Other causes of fast breathing include:

• Fever or other infections
• Transient tachypnea of the newborn (TTN) - a lung condition that causes very fast or laboured breathing in the first few hours of life. It usually resolves within 24 hours.
• Allergies
• A short-term illness, such as the common cold
• Heart conditions
• Other health conditions

Frequently asked questions