Categories: Paediatrics

Breathing Issues in Babies

Breathing issues can occur in newborns, small babies, and young children. They take various forms. The common one is difficulty in breathing with distress. The breathing rate is faster or slower than usual. There can be grunting and excessive efforts for breathing. Excessive neck, chest, and abdomen movement while breathing. This can be associated with retraction at chest wall margins. There may be additional noises during inhalation or exhalation whereas normal breathing is fairly quiet. Breathing issues and difficulty can occur in isolation but in a lot of situations, there are other associated symptoms like cough, fever, feeding difficulty, excessive crying, rash, etc.

Breathing difficulty in children particularly in newborn and small babies is quite distressing for parents. As small children and babies can not tell us what is wrong, it makes the parents worry even more. Not all breathing difficulties are serious in nature. Though it can be due to a simple problem and easily treated, at the same time it can be the manifestation of major disorder and problem. Idea is to understand what are the various common reasons for it and be able to get help when required. Many such problems are treated by simple measures and medications, some need hospitalization and some need surgical operation particularly those related to a congenital cardiac defect. Causes of breathing difficulty are many and they vary quite a bit with age. In this article, we will discuss mainly the breathing difficulties in newborns and small babies.

When do we say a child is having breathing issues or breathing difficulty? What are the common features of breathing difficulty? The commonest way to detect is when the respiratory rate goes up i.e. child breaths faster than usual. Other features are child makes more than usual efforts to breath, there are sound or noise during breathing instead of quiet breathing in normal circumstances. At times, the child is just uncomfortable, cries a lot, refuses to feed, and can not be soothed by usual measures. Rarely, there is a change in colour, particularly face, lips, etc. Parents and caregivers are the first to notice even the subtle changes in breathing. Breathing difficulty occurs when the adequate gas exchange does not happen in the lungs. Besides, the disease of airways and lungs can occur as a manifestation of diseases of the cardiovascular system, neurological problems, metabolic problems, etc. In many cases, there are multiple system involvement combining to cause shortness of breath or breathing difficulty. Let us look at common issues that lead to breathing difficulty pattern.

Respiratory and Airway problems:

Most diseases of lungs would cause shortness of breath. This may be congenital or acquired. Commonest being pneumonia, infection in the lung. Others lead to thickening of the lung membrane leading to reduced gas exchange or by simply making lung stiff. Any form of upper respiratory tract infection, something similar to the common cold, also leads to some breathing difficulty. There are various causes of airway obstruction or narrowing. They range from compression from outside, congenital airway obstruction, dynamic narrowing of airways, swollen airway membranes, foreign body inhalation, etc.  Here, the lungs are essentially normal but the air is not able to reach them or not able to come out properly. At times, both airways and lungs are normal but there is a collection of air, fluid in the chest which does not allow expansion of lungs. The same can occur with some chest wall deformities. Respiratory and airway problems require assessment by the trained paediatricians. Various blood tests, X-rays may be required to confirm the problem. Further, investigations like CT scan are only needed to decipher the complex problems. Airway problems may need specialized assessment with endoscopy. Once, the cause is correctly identified appropriate treatment can be administered. The majority of these infections can be treated with simple antibiotics. Serious chest wall or diaphragm problems will need surgical intervention to correct them.

Cardiovascular problems:

Breathing difficulty is one of the common presenting features of congenital heart disease particularly hole in the heart. Here, due to structural defects within partitions of heart, abnormal valves, abnormal connections within the heart, and blood vessels, there is excessive blood flowing into the lungs. This leads to a kind of waterlogging of lungs making gas exchange difficult in the lungs and shortness of breath. In some other congenital heart defects, there is a blockage of blood flow coming back to the heart from the lungs. This leads to back pressure in the lungs and severe breathing difficulty. There are at times abnormal blood vessels in the chest or their course is altered such that they cause compression of airways leading to breathing difficulty. Once suspected, congenital heart defects need various investigations. Besides, X-ray chest, ECG, the most important is echocardiography. Few patients would need further investigations with CT Scan, MRI, or Cardiac Catheterization. Many congenital heart defects will need surgical or percutaneous catheter intervention to treat them. Here, medications can only help temporarily until the defect is corrected. In recent times, heart surgery and interventions for congenital heart defects are very common, relatively safe with good results and excellent long term outcomes. Of course, success depends on the nature, severity, and complexity of defects. Once, again timely assessment and treatment by trained paediatricians followed by paediatric cardiology services are of utmost importance.

Breathing difficulty due to other problems:

Any disease that increases oxygen requirement in the body will lead to shortness of breath. Infection anywhere in the body with high fever will cause some degree of shortness of breath. Then, there are certain problems with metabolism in the body and some neurological defects which cause shortness of breath. These need proper investigation and treatment with appropriate paediatric specialists.

In general, there are several causes of breathing difficulty in babies and small children. Some of the simple and some of them are serious in nature. They require proper assessment and appropriate treatment to prevent any complications. When parents and caregivers notice unusual breathing patterns with their child, they should consult their paediatrician first. Some of the best opportunities are to get your child examined by a paediatrician during routine vaccinations appointment. A lot of problems are detected in a timely manner during such visits.

Though breathing difficulty in children, particularly small babies is very distressing for parents, it is important to get timely evaluations and appropriate treatment. Even when it is worrying, there is nothing to be scared of. It is important to visit a trained specialist for proper evaluation, investigations, and treatment. The specialist will be able to counsel and guide parents with appropriate investigations and treatment. The treating health professional is the best person to make parents understand the nuances of assessment, investigations, and treatment whether it is simple or complex. Once, the correct diagnosis and treatment plan is made, parents can always look up at websites of reputed institutes and organizations for further information. If there are any doubts or concerns, there should be no hesitation at all in discussing these with the treating physician. After all, it is always parents and caregivers who know their child best both in health and in disease.

Dr. Dipesh Trivedi | Senior Consultant – Cardiac Surgery – Paediatric | NH SRCC Children’s Hospital, Mumbai

Narayana Health

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