Retractions—A Serious Sign of Trouble Breathing In Infants and Children

Retractions, the inward movement of the skin of the chest wall or the inward movement of the breastbone (sternum) during inspiration, is an abnormal breathing pattern. Retractions mean that the child is having to use chest muscles (not usually needed)  and neck muscles to get air into the lungs. The child is having to work too hard to breath.

The trouble getting air into the lungs is due either to obstruction of the airways or to stiffness of the lungs. The more difficult it is for the child to breath, the worse are the retractions.

Mild to moderate difficulty breathing is associated with subcostal retractions, substernal retractions, and intercostal retractions.

Subcostal retractions are inward movement of the abdomen just below the rib cage.

Substernal retractions are inward movement of the abdomen at the end of the breastbone.

Intercostal retractions are inward movement of the skin between the ribs.

Severe difficulty breathing is associated with supraclavicular retractions, suprasternal retractions, and sternal retractions. There can also be the retractions associated with mild to moderate difficulty
breathing listed above.

Supraclavicular retractions are inward movement of the skin of the neck just above the collarbone.

Suprasternal retractions are inward movement of the skin of the middle of the neck just above the top end of the breastbone.

Sternal retractions are inward movement of the breastbone towards the back of the body.

The breathing difficulty that causes retractions can be of due to three different causes: upper airway obstruction (an example is croup), lower airway obstruction (asthma or bronchiolitis), or lung tissue disease which is also called parenchymal lung disease (for example, pneumonia, pulmonary edema, or acute respiratory distress syndrome).

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