Your newborn baby’s breathing
In early January 2012, a new book called Take a Deep Breath: Clear the Air for the Health of Your Child, by Dr Nina Shapiro (World Scientific), is due to be published. Dr Nina is the Director of Pediatric Ear, Nose and Throat at the Mattel Children’s Hospital, at America’s UCLA, and her book covers breathing issues for your newborn through to your 5 year old child.
Here we’re bringing you a sneak peek of just one of the many chapters relating to your baby in her first three months after birth. Find out:
You can also find Dr Nina tweeting @drninashapiro
(Following images not taken from publication, included for editorial purposes only)
When born, your baby’s vision is blurred, but he’ll be able to recognise you after a few weeks.
Wheezing: Can a newborn have Asthma?
Wheezing is the turbulent passage of airflow in the bronchi (lower windpipe passages) or alveoli (tiny air-filled sacs within the lungs). When we think of wheezing, we commonly think of older children with asthma. Newborn wheezing is a bit different. Asthma itself is a chronic inflammatory condition of the airways, which usually develops over time. Young infants can have asthma-like symptoms, and this is often termed reactive airway disease. The lower airways ‘reacts’ to respiratory illnesses or inflammation, thus the term ‘reactive’ airway disease. In the absence of a respiratory illness, wheezing in newborn is usually related to lung and/or airway immaturity. In this chapter, I will explain what causes a newborn to wheeze, how to recognize it, and when to call your doctor.
My baby’s chest sounds ‘congested’. She seems comfortable, but she sounds kind of ‘junky’, and I can feel some rattling sound when I hold her. What’s going on?
Many newborns have some degree of occasional chest congestion. They are learning to coordinate swallowing and breathing, and occasionally some milk/formula or saliva/mucus gets into their windpipe. This wet stuff settles in either their windpipe or lower airways and lungs, and you can hear some rattling. Chest congestion sounds ‘wet’, and you don’t usually hear any high-pitched squeaks from either the throat or the chest. For the most part, a little chest congestion in an otherwise comfortably breathing baby is not a concern. By ‘comfortably breathing’, I mean no retractions (where the chest, stomach, or neck is caving in with each breath), no rapid breathing (newborns breathe 24 to 38 times per minute), and no visible discomfort (arching, crying, skin discoloration). For occasional chest congestion, try holding your baby upright, with her head over your shoulder, as if you were burping her. Tap her back gently. This may encourage some coughing, and help loosen up the wetness. Ideally, she will cough it up into her mouth and then swallow it. If you notice more chest congestion after feeds, make sure your baby stays upright during and after feeding times.
Newborns should breathe 24 to 38 times per minute
How to count your baby’s breaths:
Have him lying comfortably, and count the number of breaths for thirty seconds.
Multiply this number by two for the number of breaths per minute.
Breathing rate can go up slightly during a respiratory illness or a fever.
If your baby is breathing more than 60 times per minute, call your doctor.
My five-year-old son has Asthma, and my newborn daughter sounds like she’s wheezing. Can she have Asthma so soon?
Probably not. Or at least not yet. While asthma can run in families, especially if it’s the type of asthma related to allergies, very young infants who wheeze do not necessarily have a diagnosis of true asthma. Asthma is a chronic lung condition that leads to swelling in the airways. The airways, in turn, produce more mucus, making it harder for air to pass through the tiny sacs and tubes in the lungs. In a newborn, recognition of a problem and treating that problem is more important than coming to a diagnosis of a chronic condition. ‘True’ asthma is diagnosed not only by wheezing, but also by lung function tests, whereby the child breathes in and out through a tube into a machine. The machine records the breathing capacity. Needless to say, a cooperative (and older) child is necessary. When you hear wheezing (a whistling sound usually when your baby breathes out, sometimes accompanied by retractions or pulling in of the neck, abdominal or chest muscles), the two most likely causes are lung immaturity. This is usually seen more commonly in premature babies, or in full-term babies during an acute respiratory illness. Over 50% of infants have at least one episode of wheezing in the first year, but only one-third of those go on to develop asthma.