No, substernal retractions in newborns signal breathing distress and need urgent pediatric assessment.
It’s easy to worry over every wiggle a new baby makes. Gentle belly movement after feeds is common, but a deep “dip” under the breastbone with each inhale is a different story. That pulling under the sternum means a baby is working hard to move air. This guide explains what that looks like, what usually causes it, and the practical steps to take now.
Retraction Types In Infants: Quick Map
| Type | Where You See It | What It Suggests |
|---|---|---|
| Substernal | Dip beneath the sternum | Lower airway strain with extra effort |
| Intercostal | Spaces between the ribs pull in | Hard work of breathing; check rate and color |
| Suprasternal | Notch above the collarbones | Upper airway struggle; often noisy airflow |
| Subcostal | Just below the rib cage | Diaphragm overworking, common in bronchiolitis |
Substernal Chest Pulling In Babies — What Counts As Concerning
True retractions look like the skin dipping with each inhale, then returning on the exhale. The pattern is steady: pull in, release, repeat. You may also notice fast breaths, wide nostrils on the in-breath, or a soft grunt at the end of the out-breath. When a sunken spot under the sternum shows up with those signs, plan same-day care. Go sooner if your baby looks floppy, turns blue around the lips or tongue, or cannot stay awake to feed.
Clinicians treat these chest pulls as a marker of breathing trouble, not a harmless newborn quirk. The sign can follow a cold, RSV exposure, meconium at birth, delayed clearance of lung fluid, or less common heart and metabolic problems. The common thread is extra effort just to move air.
Normal Newborn Breathing Patterns Versus Red Flags
What Often Looks Odd But Can Be Okay
- Periodic breathing: brief pauses (under 10 seconds) followed by a few faster breaths during sleep, without color change.
- Hiccup-like belly pulses: from a full stomach or a startle, returning to baseline within minutes.
- Soft snorts: from nasal stuffiness that clears with a gentle saline rinse.
What Points To Distress
- Steady dips beneath the sternum or between the ribs with each breath.
- Breathing faster than 60 per minute when calm or asleep.
- Grunting, pale or blue color, poor feeding, or fewer wet diapers.
How To Check Your Baby’s Breathing At Home
Simple Visual Checks
Lift the shirt so you can see the chest and upper belly. Watch the area under the sternum for a full minute. If it dips with every inhale, you’re seeing a retraction. Also look between the ribs and at the notch above the collarbones.
- Count breaths: newborns often take 30–60 per minute when calm. A higher rate during sleep or quiet wake time is a red flag.
- Listen: a soft “ugh” at the end of the breath (a grunt) suggests air trapping.
- Check color: blue lips or tongue call for emergency care.
- Watch feeding: short, tiring feeds or coughing fits around feeds point to stress.
Context Clues
Think about what’s been happening around your baby. A recent cold in the house? Early arrival or low birth weight? Fast breathing right after birth that never settled? These clues help your clinician judge whether this is a common infection like bronchiolitis, lingering fluid from birth, or a rarer condition.
Common Causes Behind Chest Dips
Bronchiolitis From Seasonal Viruses
Tiny airways can swell and fill with mucus in virus season. That leads to fast, shallow breaths and visible pulling at the chest. You may also hear wheeze or a rough cough. Retractions mean the lungs are working hard and need clinical review for hydration, oxygen needs, and a safe home plan.
Transient Fluid After Birth
Some full-term babies breathe fast in the first hours while lung fluid clears. If sternum pulling appears along with fast breathing, grunting, or color change, staff keep the baby under close watch. Once fluid clears, dips should stop; if not, another cause is likely.
Airway Narrowing That Mimics Asthma
Classic asthma is uncommon in the first weeks. Infections can still narrow small tubes and cause wheeze-like sounds. In this age group, retractions usually reflect swelling and mucus, not a chronic airway disease.
Heart Or Metabolic Conditions
Less often, the heart, blood, or body chemistry drives extra work for breathing. Clues include poor weight gain, sweating with feeds, or long pauses during sleep. These patterns need prompt evaluation.
What Your Clinician Will Check
History And Exam
Be ready to share timing, feeds, wet diapers, temperature, and any color change. During the exam, the team checks oxygen levels, breathing rate, and retraction pattern, then listens across the chest. They also look for nasal flare and grunting.
Tests You Might See
- Pulse oximetry for oxygen level.
- Swab tests during virus peaks.
- Chest x-ray only when the story points that way.
- Blood work if infection, heart, or metabolic issues are on the table.
Results guide whether home care is safe or if your baby needs oxygen, suctioning, or IV fluids.
Trusted Rules You Can Read
Two helpful, plain-language references outline the warning signs linked to chest pulling in babies. The AAP breathing trouble checklist explains when rib pulls and fast breaths need care, and MedlinePlus on retractions describes why inward chest movement signals a problem. Share these with caregivers so everyone is on the same page.
Immediate Steps You Can Take Before You Get Seen
- Hold your baby upright on your chest to ease the work of breathing.
- Clear gentle nasal mucus with saline drops and a bulb or controlled suction before feeds.
- Offer smaller, more frequent feeds to limit tiring and reduce spit-ups.
- Avoid over-the-counter cough syrups; they aren’t advised in this age group.
- If lips look blue, if pauses in breathing appear, or if your newborn can’t stay awake, call emergency services now.
When Chest Pulling Needs Urgent Or Emergency Care
Use this table to translate what you see into next steps. When in doubt, choose a same-day visit.
| When To Seek Care | What You May See | Action |
|---|---|---|
| Same-day clinic | Steady dips with feeds, fast rate, mild wheeze, shorter feeds | Call your pediatric office now for a slot |
| Urgent care | Dips at rest, grunting, poor intake, fewer wet diapers | Go today; bring feeding and diaper notes |
| Emergency | Blue lips, pauses >15 sec, extreme sleepiness, ribs and neck pulling in | Call an ambulance or go to the ER |
Home Monitoring Tips That Help Your Doctor Help You
Small notes paint a clear picture. Write down the breath count during sleep, how long feeds last, wet diaper totals over 24 hours, and any color change. A short video of the chest during a spell is valuable for triage. Keep the room smoke-free and limit sick contacts when you can.
During virus peaks, your doctor may hand you a simple plan: when to suction, how to pace feeds, and when to return. That plan reduces guesswork at 2 a.m. and keeps everyone aligned on thresholds for the next step.
Feeding And Hydration Checks
Feeding takes breath control. If a baby works hard just to inhale, feeding often shortens or stops. Signs of strain include sweat on the forehead during feeds, long breaks to catch a breath, or falling asleep at the bottle or breast within minutes. Watch diapers too. Fewer than six wet diapers a day past the first week can point to low intake. Share these details at the visit; they help the team judge effort and fluid status.
Care Timeline: First Hour To 48 Hours
Right Now
- Position upright on your chest.
- Suction the nose gently before feeds.
- Call your pediatric office if dips are steady or the breath count is high during sleep.
Next 6–12 Hours
- Track breath counts during naps.
- Offer smaller feeds more often; stop if the work of breathing rises.
- Re-check color in natural light.
Within 24–48 Hours
- Follow the care plan set by your clinician.
- Return sooner for worse chest pulls, rising rate, poor intake, or any color change.
Prevention Basics For The Season
- Wash hands before every cuddle and after diaper changes.
- Limit face-to-face contact with anyone sick.
- Keep vaccines up to date for household members, including flu and whooping cough shots.
- Ask about protective options for high-risk infants during RSV peaks.
Good sleep, steady feeds, and a smoke-free home reduce baseline strain on tiny airways. None of these steps replaces care when retractions show up; they simply give your baby an easier baseline.
What To Bring To The Visit
- A short log with breath counts, feeding lengths, and diaper totals.
- A brief video clip of the chest during a spell.
- Medication list for the birthing parent and the baby.
- Notes on any known exposures to colds in the last week.
Bottom Line For Worried Parents
Chest pulling beneath the sternum means extra work of breathing. Treat it as a sign, not a phase. Call your clinician the same day for steady dips, and seek emergency care for color change, long pauses, or limpness. Trust your eyes and act early.