In plain words
A retraction is the skin sinking in between or under the ribs, at the base of the neck, or at the breastbone when a baby breathes in. It happens because the chest muscles pull hard on the chest wall when air is hard to move. Babies can show some retractions for brief periods, and clinicians look at how many there are, how deep they are, and what else is happening. Other signs of effort include fast breathing, grunting, flaring of the nostrils, and a change in color. Retractions with fast breathing, grunting, a blue or gray color, or trouble feeding need care now. A baby who is struggling to breathe needs 911. Mild retractions with normal color and feeding are worth a same-day call to your pediatrician.
The deeper version
Retractions are inward movements of the chest wall during inspiration, classified by location as intercostal, subcostal, suprasternal, or xiphoid. They reflect increased work of breathing, reduced chest wall compliance, or upper airway obstruction. The Silverman-Andersen scale (Silverman and Andersen, 1956) scores retraction location along with nasal flaring, expiratory grunting, and see-saw breathing. Retractions are assessed alongside respiratory rate over a full minute, color, and oxygen saturation. The AAP guideline (Ralston and colleagues, 2014) uses signs of work of breathing in triage. The controversy centers on the reliability of observer-scored retractions and on how well they predict the need for hospital care across infant populations.
Where it comes up
- BabywearingBaby Basics
- Hiccups, sneezes, grunting, and other normal weird thingsBaby Basics
- Newborn breathing, congestion, and the noseBaby Basics
- When to call the pediatrician (and when to go in)Baby Basics
What mothers here say about retraction
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Sources
- Silverman WA, Andersen DH — A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics (1956)
- Ralston SL, Lieberthal AS, Meissner HC, et al. — Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics (2014)