Signs of “heavy” breathing in a baby. Causes

The baby sniffles and grunts, but a cold is excluded, and his nose is clean? Does this problem occur when the baby is sleeping or eating?

Don't panic ahead of time: everything is not as scary as it seems.

Why does this happen, and how to make breathing easier for a newborn?

It would seem that all the difficulties are behind us, the baby was born healthy and is already at home. But the mother, listening to the baby’s breathing, gets scared: where are these wheezes coming from, why is breathing difficult?

In a panic, he grabs the drops that he bought “just in case” before giving birth, and tries to drip it into his nose...

First, let's figure out whether drops are needed and what kind?

Causes of difficult breathing in infants

The very first thing parents think when sniffling and wheezing appears is that the child has a cold.

However, with a cold, difficulty breathing is accompanied by symptoms such as:

Runny nose and breathing through the mouth.
Cough.
Redness of the throat.
Often - increased temperature.

If all this is not present, and the pediatrician does not see signs of acute respiratory infections, most likely the cause of grunting and snoring is physiological or pathological .

Features of the structure of the nasopharynx of a newborn

In infants, the nasopharyngeal organs are still immature and continue to develop during the first year of life. The nasal cavity is low and narrow, the middle and upper nasal passages are still underdeveloped, and the lower one is completely absent, starting to form at 6 months, and is finally formed by adolescence.

1.2 - nasal passage; 3 - lower nasal passage; 4 - nasopharynx; 5 - tongue; 6 - thyroid gland; 7 - trachea; 8 - left lung; 9 - heart; 10 - diaphragm; 11 - right lung; 12 - thymus; 13 - oral cavity; 14 - palate; 15 - folds of the nasal cavity.

The nasal mucosa is extremely delicate, it has many capillaries and vessels, so at the slightest irritation it swells, and the already narrow nasal passages become smaller.

The auditory tube passes close to the nasopharynx, which is why often even a common runny nose can cause complications in the ears.

Physiological causes of difficulty breathing in infants

Being in the amniotic fluid during intrauterine development, the child does not breathe through his nose. Therefore, when born, the baby is not ready to use its respiratory organs to its full potential.

After birth, the nasal mucous membranes are dry, but already on the first day adaptation to new breathing conditions begins and mucus begins to be produced.

Sometimes a lot of it is produced, and the baby’s nasal passages may be narrower than the statistical average.

The mucus that accumulates on the back wall of the nasopharynx does not flow well into the larynx, and the child is not yet able to cough it up on his own. When breathing, it vibrates, which is why the grunting sound is heard.

Grunting and sniffling may result too dry air in the room. The mucous membrane dries out, crusts form in the nose, which impede the passage of air.

The nasal mucosa may become irritated and swollen due to frequent regurgitation . A short esophagus allows stomach contents to spill into the nasopharynx, causing it to become inflamed and cause difficulty breathing.

Pathological causes of breathing problems in newborns

A baby may be born with pathological changes in the structure of the respiratory organs. For example, with deviated nasal septum or abnormalities of the nasal passages.

This may not be noticeable immediately after birth, but will appear during the first months of life. An experienced ENT specialist will detect abnormalities during examination. Pathologies are eliminated surgically.

Even babies, unfortunately, are not immune from neoplasms. Tumors can occur in the nasal cavity. As a rule, they rarely metastasize, but are detected at an early stage, and after the operation nothing threatens the baby’s health and breathing.

Foreign body and difficulty breathing

Drinking regime

It is especially important if the baby is artificial, to give him water. But a lack of fluid is also harmful to a breastfed baby.

Dry nasal mucosa, grunting and wheezing when breathing are just a sign that the body does not have enough fluid.

Comfortable microclimate in the room

To make it easier for your baby to breathe, you need to maintain temperature and humidity levels in the room where he sleeps and wakes.

“First of all, you need to maintain an optimal microclimate in the nursery,” advises neonatologist E. Komar (Rostov-on-Don). – And this implies a room temperature not higher than 24 ° C and sufficient air humidity: about 70%. This becomes especially relevant in winter, when heating and rare ventilation create negative breathing conditions not only for infants, but also for adults.”

It is not at all necessary to buy a humidifier if your financial situation does not allow it: a wet towel on a hot radiator will be a successful alternative.

Ventilation and wet cleaning help maintain an ideal microclimate in the house.

Walks

Regular stay in the fresh air improves the child’s condition: the air outside (of course, not on a polluted avenue, but in park areas or squares) is saturated with clean and optimally humidified oxygen.

This is not only not advisable, but also impossible!

Place breast milk in your nose. The myth about the benefits of milk in the fight against a runny nose and difficulty breathing has long been debunked: when milk dries, it forms crusts, which further interfere with normal breathing.
Use vasoconstrictor drops unnecessarily. Not only is it harmful to constrict blood vessels, but it also becomes addictive to them.
Use an aspirator to suck out mucus (not snot). The more often mucus is sucked out, the more it appears.
Inhalations. They are needed only in the treatment of acute respiratory infections without complications and fever. With a physiological runny nose, inhalations lead to the “lazy nose” effect.
Refuse swimming , fearing to worsen the child’s condition.

If there is no fever, runny nose and cough, difficulty breathing - no reason to cancel water procedures. A warm bath will have a relaxing effect, dilate blood vessels, and the baby will breathe easier.

In addition, bathing is also hardening, which means preventing real runny nose and colds.

On average, the child's respiratory system becomes relatively adapted to the outside world, and physiological breathing problems leave the baby.

But sometimes the process can take up to a year.

You should not refuse observation from a pediatrician and ENT specialist; this will allow you to track possible complications in time and reassure young parents.

Newborn babies spend a long time adapting to life outside their mother’s tummy. Their organs and systems are not fully developed and continue to form, so in some cases parents notice changes in the condition of their babies and begin to panic. In particular, infants' breathing can cause anxiety. Mothers notice that it is radically different from their own breath and suspect something is wrong. However, you shouldn’t sound the alarm right away; first, you should figure out why babies breathe differently than we do.

Features of the respiratory system

Infants do not know how to fully control even their innate instincts, because they are just beginning to master them. In addition, the organs are not fully formed and continue to develop. This is also reflected in breathing. The newborn can take very deep breaths - as if the child is trying to capture as much oxygen as possible. This happens because the babies’ respiratory organs are not yet fully developed. They have the following features:

the upper and lower airways are too small, which prevents deep breathing;
narrow nasal passages and nasopharynx;
narrow lumen of the larynx.

All these features make babies vulnerable to even such a small thing as household dust. Microscopic particles can settle on the mucous membranes, causing swelling and hypersecretion, which leads to disruption of normal breathing.

Babies cannot breathe fully, but parental help will quickly improve this process. The best prevention against diseases and a means to stabilize breathing will be massage and gymnastics.

How do babies breathe?

If a newborn breathes frequently during sleep, and no symptoms of pathology appear, this is the absolute norm. This happens due to the physiological immaturity of the upper and lower respiratory tract. The baby’s body must be fully saturated with oxygen, but the baby cannot take a deep breath. Rapid breathing is a compensatory function that newborns use. Due to the fact that the air supply has not yet been fully adjusted, small children may breathe unevenly.

The breathing rate is also different from that of an adult. Most often, babies take two or three short breaths, and then one long one. This process is normal for children from birth to one year; over time, the rhythm of inhalation and exhalation will become more even.

The absence of signs such as wheezing, an open mouth, muscle tension and moaning during sleep is a sign of a completely normal baby.

Finding out your breathing rate

A newborn can breathe quite frequently when calm. It is difficult for parents to determine whether such a condition is within the normal range or beyond it. To confirm or refute irregularities in the child’s breathing rate, it must be measured. This is done using a phonendoscope. Its membrane is preheated with your hands and applied to the baby’s chest. If you don’t have a special device, you can simply put your hand on the baby’s chest and monitor the number of times it rises for one minute.

In pediatrics, there are regulated respiratory rate indicators for children of different ages:

from birth to two weeks of age - the norm is 40-60 breaths per 1 minute;
at the age of two weeks to three months, the norm is 40-45 breaths;
from four to six months - 35-40 breaths;
from seven months to one year - 30-36 breaths.

If the indicators are within the normal range, the child has no signs of infectious or inflammatory diseases, he is steadily gaining weight, you don’t have to worry about his breathing. Over time, all organs and systems begin to function correctly, breathing becomes uniform and less frequent.

Learning to determine type

Not only the frequency of inhalation and exhalation can become an indicator of the baby’s health, but also the type of breathing itself. It determines how well the lungs and upper respiratory tract will be ventilated, what the quality of gas exchange in the tissues will be, and how quickly the brain cells will be saturated with oxygen.

To find out your child's breathing type, just look at which parts of his body are movable during inhalations and exhalations.

In total, it is customary to distinguish three main types:

The first is the chest, we can talk about it if, when inhaling air, the baby’s chest actively works, it rises and falls rhythmically. This type results in insufficient ventilation of the lower part of the lungs.
If movement of the abdominal wall and diaphragm is observed, then the child has abdominal breathing. When it occurs, the upper respiratory organs experience a lack of oxygen.
If both the diaphragm and the chest work simultaneously, this indicates mixed breathing. This type is the most useful and allows you to completely saturate the body with oxygen.

Learning to recognize pathologies

A baby's rapid breathing during sleep can be a sign of many serious pathologies, so it is important that parents know how to correctly recognize them. If you notice that your baby has deviations from the norm, you should closely monitor him. The problem may indicate the following pathologies:

Normal for kids

The breathing of newborn babies can become more frequent for completely harmless reasons. If you do not see any changes in the child’s condition, then there is no reason to panic. Sometimes a disruption in the rhythm of breathing can occur due to the baby choking on something. Also, mothers can often hear bubbling in the baby’s throat, this happens if he does not have time to swallow saliva. This condition resolves over time and should not cause undue concern.

Temporary cessation of breathing also often occurs in newborns. If it does not exceed 10 seconds, then the baby’s condition is normal. The disorder goes away on its own when the baby reaches six months of age.

Also, the breathing rate can be affected by the environment; try installing a humidifier in the nursery and maintaining the humidity at 60-70%, and the air temperature at 18-21 ° C, this will significantly reduce the load on the child’s respiratory system and contribute to the normal saturation of the body with oxygen.

In conclusion

The infant's respiratory system is an imperfect and very vulnerable mechanism that cannot function normally. Rapid breathing during sleep is normal for newborns and should not cause concern to parents. However, if the baby’s condition worsens sharply and other symptoms appear, you should consult a doctor.

It is important to notice disorders in time, since in children they progress very quickly. Keep an eye on your children and seek professional help in a timely manner.

Update: November 2018

The birth of a long-awaited baby is a joyful event, but not in all cases the birth ends successfully not only for the mother, but also for the child. One of these complications is fetal asphyxia, which occurs during childbirth. This complication is diagnosed in 4–6% of newly born children, and according to some authors, the frequency of newborn asphyxia is 6–15%.

Definition of newborn asphyxia

Translated from Latin, asphyxia means suffocation, that is, lack of oxygen. Asphyxia of newborns is a pathological condition in which gas exchange in the newborn’s body is disrupted, which is accompanied by a lack of oxygen in the child’s tissues and blood and the accumulation of carbon dioxide.

As a result, a newborn who was born with signs of a live birth either cannot breathe independently in the first minute after birth, or he experiences isolated, superficial, convulsive and irregular respiratory movements against the background of an existing heartbeat. Such children are immediately given resuscitation measures, and the prognosis (possible consequences) for this pathology depends on the severity of asphyxia, the timeliness and quality of resuscitation.

Classification of newborn asphyxia

Based on the time of occurrence, there are 2 forms of asphyxia:

primary – develops immediately after the birth of the baby;
secondary - diagnosed within the first day after birth (that is, at first the child was breathing independently and actively, and then suffocation occurred).

According to severity (clinical manifestations) there are:

mild asphyxia;
moderate asphyxia;
severe asphyxia.

Factors provoking the development of asphyxia

This pathological condition is not an independent disease, but is only a manifestation of complications during pregnancy, diseases of the woman and the fetus. Causes of asphyxia include:

Fruit factors

) The child has;
Rhesus conflict pregnancy;
anomalies in the development of organs of the bronchopulmonary system;
intrauterine infections;
prematurity;
intrauterine growth restriction;
obstruction of the respiratory tract (mucus, amniotic fluid, meconium) or aspiration asphyxia;
malformations of the heart and brain of the fetus.

Maternal factors

severe, occurring against a background of high blood pressure and severe edema;
decompensated extragenital pathology (cardiovascular diseases, diseases of the pulmonary system);
pregnant women;
endocrine pathology (, ovarian dysfunction);
woman's shock during childbirth;
disturbed ecology;
bad habits (smoking, drinking alcohol, taking drugs);
insufficient and malnutrition;
taking medications contraindicated during gestation;
infectious diseases.

Factors contributing to the development of disorders in the uteroplacental circle:

post-term pregnancy;
premature aging of the placenta;
premature placental abruption;
umbilical cord pathology (umbilical cord entanglement, true and false nodes);
constant threat of interruption;
and bleeding associated with it;
multiple pregnancy;
excess or lack of amniotic fluid;
anomalies of labor forces (and incoordination, rapid and rapid labor);
drug administration less than 4 hours before completion of labor;
general anesthesia for women;
uterine rupture;

Secondary asphyxia is provoked by the following diseases and pathologies in the newborn:

impaired cerebral circulation in a child due to residual effects of damage to the brain and lungs during childbirth;
heart defects that were not identified and did not appear immediately at birth;
aspiration of milk or formula after a feeding procedure or poor-quality sanitation of the stomach immediately after birth;
respiratory distress syndrome caused by pneumopathy:
- presence of hyaline membranes;
- edematous-hemorrhagic syndrome;
- pulmonary hemorrhages;
- atelectasis in the lungs.

Mechanism of development of asphyxia

It doesn’t matter what caused the lack of oxygen in the body of a newly born child, in any case, metabolic processes, hemodynamics and microcirculation are rebuilt.

The severity of the pathology depends on how long and intense the hypoxia was. As a result of metabolic and hemodynamic changes, acidosis develops, which is accompanied by a lack of glucose, azotemia and hyperkalemia (later hypokalemia).

In acute hypoxia, the volume of circulating blood increases, and in chronic and subsequent asphyxia, the blood volume decreases. As a result, the blood thickens, its viscosity increases, and the aggregation of platelets and red blood cells increases.

All these processes lead to microcirculation disorders in vital organs (brain, heart, kidneys and adrenal glands, liver). Disturbances in microcirculation cause swelling, hemorrhages and areas of ischemia, which leads to hemodynamic disturbances, disruption of the functioning of the cardiovascular system, and, as a consequence, all other systems and organs.

Clinical picture

The main sign of asphyxia in newborns is considered to be respiratory failure, which entails a malfunction of the cardiovascular system and hemodynamics, and also impairs neuromuscular conduction and the severity of reflexes.

To assess the severity of the pathology, neonatologists use the Apgar assessment of the newborn, which is carried out in the first and fifth minutes of the child’s life. Each sign is scored 0 – 1 – 2 points. A healthy newborn gains 8–10 Apgar points in the first minute.

Degrees of newborn asphyxia

Mild asphyxia

With mild asphyxia, the number of Apgar points in a newborn is 6 - 7. The child takes the first breath within the first minute, but there is a weakening of breathing, slight acrocyanosis (cyanosis in the area of the nose and lips) and a decrease in muscle tone.

Moderate asphyxia

The Apgar score is 4 – 5 points. There is a significant weakening of breathing, possible disturbances and irregularity. Heartbeats are rare, less than 100 per minute, cyanosis of the face, hands and feet is observed. Motor activity increases, muscular dystonia develops with a predominance of hypertonicity. Possible tremor of the chin, arms and legs. Reflexes can be either reduced or enhanced.

Severe asphyxia

The condition of the newborn is serious, the number of Apgar scores in the first minute does not exceed 1 - 3. The child does not make breathing movements or takes separate breaths. Heart beats are less than 100 per minute, pronounced, heart sounds are dull and arrhythmic. The newborn does not cry, muscle tone is significantly reduced or muscle atony is observed. The skin is very pale, the umbilical cord does not pulsate, reflexes are not detectable. Eye symptoms appear: nystagmus and floating eyeballs, possible development of seizures and cerebral edema, DIC syndrome (impaired blood viscosity and increased platelet aggregation). Hemorrhagic syndrome (numerous hemorrhages on the skin) intensifies.

Clinical death

A similar diagnosis is made when all Apgar indicators are assessed at zero points. The condition is extremely serious and requires immediate resuscitation measures.

Diagnostics

When making a diagnosis: “Asphyxia of a newborn,” data from the obstetric history, how the birth proceeded, the child’s Apgar assessment at the first and fifth minutes, and clinical and laboratory tests are taken into account.

Determination of laboratory parameters:

pH level, pO2, pCO2 (test of blood obtained from the umbilical vein);
definition of base deficiency;
level of urea and creatinine, diuresis per minute and per day (function of the urinary system);
level of electrolytes, acid-base status, blood glucose;
level of ALT, AST, bilirubin and blood clotting factors (liver function).

Additional methods:

assessment of the functioning of the cardiovascular system (ECG, blood pressure control, pulse, chest x-ray);
assessment of neurological status and brain (neurosonography, encephalography, CT and NMR).

Treatment

All newborns born in a state of asphyxia are given immediate resuscitation measures. The further prognosis depends on the timeliness and adequacy of treatment of asphyxia. Resuscitation of newborns is carried out using the ABC system (developed in America).

Primary care for a newborn

Principle A

ensure the correct position of the child (lower the head, placing a cushion under the shoulder girdle and tilt it back slightly);
suck out mucus and amniotic fluid from the mouth and nose, sometimes from the trachea (with aspiration of amniotic fluid);
intubate the trachea and examine the lower respiratory tract.

Principle B

carry out tactile stimulation - a slap on the baby’s heels (if there is no cry within 10 - 15 seconds after birth, the newborn is placed on the resuscitation table);
jet oxygen supply;
implementation of auxiliary or artificial ventilation (Ambu bag, oxygen mask or endotracheal tube).

Principle C

performing indirect cardiac massage;
administration of drugs.

The decision to stop resuscitation measures is made after 15–20 minutes if the newborn does not respond to resuscitation measures (there is no breathing and persistent bradycardia persists). Termination of resuscitation is due to the high probability of brain damage.

Administration of drugs

Cocarboxylase diluted with 10 ml of 15% glucose is injected into the umbilical vein against the background of artificial ventilation (mask or endotracheal tube). Also, 5% sodium bicarbonate is administered intravenously to correct metabolic acidosis, 10% calcium gluconate and hydrocortisone to restore vascular tone. If bradycardia appears, 0.1% atropine sulfate is injected into the umbilical vein.

If the heart rate is less than 80 per minute, indirect cardiac massage is performed with the mandatory continuation of artificial ventilation. 0.01% adrenaline is injected through the endotracheal tube (can be into the umbilical vein). As soon as the heart rate reaches 80 beats, cardiac massage stops, mechanical ventilation is continued until the heart rate reaches 100 beats and spontaneous breathing appears.

Further treatment and observation

After providing primary resuscitation care and restoring cardiac and respiratory activity, the newborn is transferred to the intensive care unit (ICU). In the intensive care unit, further treatment of asphyxia of the acute period is carried out:

Special care and feeding

The child is placed in an incubator, where constant heating is provided. At the same time, craniocerebral hypothermia is carried out - the newborn’s head is cooled, which prevents. Feeding of children with mild and moderate asphyxia begins no earlier than 16 hours later, and after severe asphyxia, feeding is allowed after 24 hours. The baby is fed through a tube or bottle. Breastfeeding depends on the baby's condition.

Prevention of cerebral edema

Albumin, plasma and cryoplasma, and mannitol are administered intravenously through the umbilical catheter. Drugs are also prescribed to improve blood supply to the brain (Cavinton, cinnarizine, vinpocetine, sermion) and antihypoxants (vitamin E, ascorbic acid, cytochrome C, aevit). Hemostatic drugs (dicinone, rutin, vikasol) are also prescribed.

Carrying out oxygen therapy

The supply of humidified and warmed oxygen continues.

Symptomatic treatment

Therapy is carried out aimed at preventing seizures and hydrocephalic syndrome. Anticonvulsants are prescribed (GHB, phenobarbital, Relanium).

Correction of metabolic disorders

Intravenous sodium bicarbonate is continued. Infusion therapy with saline solutions (saline and 10% glucose) is carried out.

Newborn monitoring

The child is weighed twice a day, the neurological and somatic status and the presence of positive dynamics are assessed, and the incoming and excreted fluid (diuresis) is monitored. The devices record heart rate, blood pressure, respiratory rate, and central venous pressure. From laboratory tests, a complete blood count with and platelets, acid-base status and electrolytes, blood biochemistry (glucose, bilirubin, AST, ALT, urea and creatinine) are determined daily. Blood clotting indicators and blood vessels are also assessed. cultures from the oropharynx and rectum. X-rays of the chest and abdomen, ultrasound of the brain, and ultrasound of the abdominal organs are indicated.

Consequences

Asphyxia of newborns rarely goes away without consequences. To one degree or another, the lack of oxygen in a child during and after childbirth affects all vital organs and systems. Particularly dangerous is severe asphyxia, which always occurs with multiple organ failure. The baby's life prognosis depends on the Apgar score. If the score increases in the fifth minute of life, the prognosis for the child is favorable. In addition, the severity and frequency of consequences depend on the adequacy and timeliness of resuscitation measures and further therapy, as well as on the severity of asphyxia.

Frequency of complications after suffering from hypoxia:

in case of I degree of encephalopathy after hypoxia/asphyxia of newborns - the child’s development does not differ from the development of a healthy newborn;
with stage II hypoxic encephalopathy – 25–30% of children subsequently have neurological disorders;
with stage III hypoxic encephalopathy, half of the children die during the first week of life, and the rest, 75–100%, develop severe neurological complications with convulsions and increased muscle tone (later mental retardation).

After suffering asphyxia during childbirth, the consequences can be early and late.

Early complications

Early complications are said to occur when they appear during the first 24 hours of the baby’s life and, in fact, are manifestations of a difficult course of labor:

cerebral hemorrhages;
convulsions;
and hand tremors (first small, then large);
attacks of apnea (stopping breathing);
meconium aspiration syndrome and, as a result, the formation of atelectasis;
transient pulmonary hypertension;
due to the development of hypovolemic shock and blood thickening, the formation of polycythemic syndrome (a large number of red blood cells);
thrombosis (blood clotting disorder, decreased vascular tone);
heart rhythm disorders, development of posthypoxic cardiopathy;
disorders of the urinary system (oliguria, renal vascular thrombosis, swelling of the renal interstitium);
gastrointestinal disorders (and intestinal paresis, digestive tract dysfunction).

Late complications

Late complications are diagnosed after three days of the child’s life and later. Late complications can be of infectious and neurological origin. The neurological consequences that appeared as a result of cerebral hypoxia and posthypoxic encephalopathy include:

Hyperexcitability syndrome

The child has signs of increased excitability, pronounced reflexes (hyperreflexia), dilated pupils. There are no convulsions.

Reduced excitability syndrome

Reflexes are poorly expressed, the child is lethargic and adynamic, muscle tone is reduced, dilated pupils, a tendency to lethargy, there is a symptom of “doll” eyes, breathing periodically slows down and stops (bradypnea, alternating with apnea), rare pulse, weak sucking reflex.

Convulsive syndrome

Characterized by tonic (tension and rigidity of the muscles of the body and limbs) and clonic (rhythmic contractions in the form of twitching of individual muscles of the arms and legs, face and eyes) convulsions. Opercular paroxysms also appear in the form of grimaces, gaze spasms, attacks of unmotivated sucking, chewing and tongue protruding, and floating eyeballs. Possible attacks of cyanosis with apnea, rare pulse, increased salivation and sudden pallor.

Hypertensive-hydrocephalic syndrome

The child throws back his head, the fontanelles bulge, the cranial sutures diverge, the head circumference increases, constant convulsive readiness, loss of function of the cranial nerves (strabismus and nystagmus are noted, smoothness of the nasolabial folds, etc.).

Syndrome of vegetative-visceral disorders

Characterized by vomiting and constant regurgitation, disorders of intestinal motor function (constipation and diarrhea), marbling of the skin (spasm of blood vessels), bradycardia and rare breathing.

Movement disorder syndrome

Residual neurological disorders (paresis and paralysis, muscle dystonia) are characteristic.

Subarachnoid hemorrhage
Intraventricular hemorrhages and hemorrhages around the ventricles.

Possible infectious complications (due to weakened immunity after multiple organ failure):

development ;
damage to the dura mater ();
development of sepsis;
intestinal infection (necrotizing colitis).

Question answer

Question:
Does a child who suffered birth asphyxia need special care after discharge?

Answer: Yes, sure. Such children need especially careful monitoring and care. Pediatricians, as a rule, prescribe special gymnastics and massage, which normalize the baby’s excitability and reflexes and prevent the development of seizures. The child must be provided with maximum rest, with preference given to breastfeeding.

Question:
When is a newborn being discharged from the hospital after asphyxia?

Answer: You should forget about early discharge (on days 2–3). The baby will be in the maternity ward for at least a week (an incubator is required). If necessary, the baby and mother are transferred to the children's department, where treatment can last up to a month.

Question:
Are newborns who have suffered asphyxia subject to dispensary observation?

Answer: Yes, all children who have suffered asphyxia during childbirth are required to be registered with a pediatrician (neonatologist) and neurologist.

Question:
What consequences of asphyxia are possible in an older child?

Answer: Such children are prone to colds due to weakened immunity, their performance at school is reduced, reactions to some situations are unpredictable and often inadequate, psychomotor development and speech lag are possible. After severe asphyxia, epilepsy, convulsive syndrome often develops, mental retardation is possible, and paresis and paralysis.

Any changes in the child’s breathing become immediately noticeable to parents. Especially if the frequency and nature of breathing changes, extraneous noise appears. We will talk about why this can happen and what to do in each specific situation in this article.

Peculiarities

Children breathe completely differently than adults. Firstly, babies breathe more superficially and shallowly. The volume of air inhaled will increase as the child grows; in babies it is very small. Secondly, it is more frequent, because the volume of air is still small.

The airways in children are narrower and have a certain deficiency of elastic tissue.

This often leads to disruption of the excretory function of the bronchi. When you have a cold or a viral infection, active immune processes begin in the nasopharynx, larynx, and bronchi aimed at fighting the invading virus. Mucus is produced, the task of which is to help the body cope with the disease, “bind” and immobilize foreign “guests”, and stop their progress.

Due to the narrowness and inelasticity of the airways, the outflow of mucus can be difficult. Children born prematurely most often experience respiratory problems in childhood. Due to the weakness of the entire nervous system in general and the respiratory system in particular, they have a significantly higher risk of developing serious pathologies - bronchitis, pneumonia.

Babies breathe mainly through their “belly”, that is, at an early age, due to the high position of the diaphragm, abdominal breathing predominates.

At 4 years old, chest breathing begins to develop. By age 10, most girls are breathing from the chest, and most boys are breathing diaphragmatically (belly). A child’s oxygen needs are much higher than the needs of an adult, because babies actively grow, move, and significantly more transformations and changes occur in their bodies. To provide all organs and systems with oxygen, the baby needs to breathe more often and more actively; for this, there should be no pathological changes in his bronchi, trachea and lungs.

Any reason, even a seemingly insignificant one (stuffy nose, sore throat, sore throat), can complicate a child’s breathing. During illness, it is not so much the abundance of bronchial mucus that is dangerous, but its ability to quickly thicken. If, with a stuffy nose, the baby breathes through his mouth at night, then with a high degree of probability, the next day the mucus will begin to thicken and dry out.

Not only the disease, but also the quality of the air he breathes can disrupt a child’s external breathing. If the climate in the apartment is too hot and dry, if parents turn on the heater in the children's bedroom, then there will be many times more problems with breathing. Too humid air will also not benefit the baby.

Oxygen deficiency in children develops faster than in adults, and this does not necessarily require the presence of some serious illness.

Sometimes a little swelling or slight stenosis is enough, and now the little one develops hypoxia. Absolutely all parts of the children's respiratory system have significant differences from the adult one. This explains why children under 10 years of age most often suffer from respiratory illnesses. After 10 years, the incidence declines, with the exception of chronic pathologies.

Major breathing problems in children are accompanied by several symptoms that are understandable to every parent:

the child's breathing has become harsh and noisy;
the baby is breathing heavily - inhalations or exhalations are given with visible difficulty;
the breathing frequency changed - the child began to breathe less often or more often;
wheezing appeared.

The reasons for such changes may vary. And only a doctor in tandem with a laboratory diagnostics specialist can establish the true ones. We will try to tell you in general terms what reasons most often underlie changes in breathing in a child.

Varieties

Depending on the nature, experts identify several types of difficulty breathing.

Hard breathing

Hard breathing in the medical understanding of this phenomenon is such respiratory movements in which the inhalation is clearly audible, but the exhalation is not. It should be noted that hard breathing is a physiological norm for young children. Therefore, if the child does not have a cough, runny nose or other symptoms of illness, then there is no need to worry. The baby is breathing within the age norm.

Rigidity depends on age - the younger the toddler, the harsher his breathing. This is due to insufficient development of the alveoli and muscle weakness. The baby usually breathes noisily, and this is quite normal. In most children, breathing softens by the age of 4, in some it can remain quite harsh until 10-11 years. However, after this age, the breathing of a healthy child always softens.

If a child’s exhalation noise is accompanied by a cough and other symptoms of illness, then we can talk about a large list of possible ailments.

Most often, such breathing accompanies bronchitis and bronchopneumonia. If the exhalation is heard as clearly as the inhalation, then you should definitely consult a doctor. Such harsh breathing will not be the norm.

Hard breathing with a wet cough is typical during the recovery period after an acute respiratory viral infection. As a residual phenomenon, such breathing indicates that not all excess phlegm has yet left the bronchi. If there is no fever, runny nose or other symptoms, and hard breathing is accompanied by a dry and unproductive cough, Perhaps this is an allergic reaction to some antigen. With influenza and ARVI at the very initial stage, breathing can also become hard, but the obligatory accompanying symptoms will be a sharp increase in temperature, liquid transparent discharge from the nose, and possibly redness of the throat and tonsils.

Hard breath

Heavy breathing usually makes it difficult to inhale. Such difficulty breathing causes the greatest concern among parents, and this is not at all in vain, because normally, in a healthy child, inhalation should be audible, but light, it should be given to the child without difficulty. In 90% of all cases of difficulty breathing when inhaling, the cause lies in a viral infection. These are familiar influenza viruses and various ARVIs. Sometimes heavy breathing accompanies serious diseases such as scarlet fever, diphtheria, measles and rubella. But in this case, changes in inhalation will not be the first sign of the disease.

Usually, heavy breathing does not develop immediately, but as the infectious disease develops.

With influenza it may appear on the second or third day, with diphtheria - on the second, with scarlet fever - by the end of the first day. Separately, it is worth mentioning such a cause of difficulty in breathing as croup. It can be true (for diphtheria) and false (for all other infections). Intermittent breathing in this case is explained by the presence of laryngeal stenosis in the area of the vocal folds and in nearby tissues. The larynx narrows, and depending on the degree of croup (how narrowed the larynx is) depends on how difficult it will be to inhale.

Heavy, intermittent breathing is usually accompanied by shortness of breath. It can be observed both during exercise and at rest. The voice becomes hoarse and sometimes disappears completely. If the child breathes convulsively, jerkily, while inhalation is clearly difficult, clearly audible, when trying to inhale, the skin above the collarbone slightly sinks, you should immediately call an ambulance.

Croup is extremely dangerous; it can lead to immediate respiratory failure and suffocation.

You can help a child only within the limits of pre-medical first aid - open all the windows, ensure a flow of fresh air (and don’t be afraid that it’s winter outside!), lay the child on his back, try to calm him down, since excess excitement makes breathing even more difficult and makes the situation worse. All this is done while the ambulance team is on its way to the baby.

Of course, it is useful to be able to intubate the trachea yourself at home using improvised means; in the event of a child suffocating, this will help save his life. But not every father or mother will be able to overcome fear and use a kitchen knife to make an incision in the trachea area and insert the spout of a porcelain teapot into it. This is how intubation is done for life-saving reasons.

Heavy breathing along with a cough in the absence of fever and signs of a viral disease may indicate asthma.

General lethargy, lack of appetite, shallow and small breaths, pain when trying to breathe deeper may indicate the onset of a disease such as bronchiolitis.

Rapid breathing

A change in breathing rate is usually in favor of faster breathing. Rapid breathing is always a clear symptom of a lack of oxygen in the child’s body. In medical terminology, rapid breathing is called “tachypnea.” A disruption in respiratory function can occur at any time; sometimes parents may notice that a baby or newborn is breathing frequently in their sleep, while the breathing itself is shallow, similar to what happens to a dog that is “out of breath.”

Any mother can detect the problem without much difficulty. However You should not try to look for the cause of tachypnea on your own; this is the task of specialists.

The breathing rate norms for children of different ages are as follows:

from 0 to 1 month - from 30 to 70 breaths per minute;
from 1 to 6 months - from 30 to 60 breaths per minute;
from six months - from 25 to 40 breaths per minute;
from 1 year - from 20 to 40 breaths per minute;
from 3 years - from 20 to 30 breaths per minute;
from 6 years - from 12 to 25 breaths per minute;
from 10 years and older - from 12 to 20 breaths per minute.

The technique for counting your breathing rate is quite simple.

It is enough for the mother to arm herself with a stopwatch and put her hand on the child’s chest or tummy (this depends on the age, since at an early age abdominal breathing predominates, and at an older age it can be replaced by chest breathing. You need to count how many times the child will inhale (and the chest or stomach will rise - will fall) in 1 minute. Then you should check the age standards presented above and draw a conclusion. If there is an excess, this is an alarming symptom of tachypnea, and you should consult a doctor.

Quite often, parents complain about their baby’s frequent intermittent breathing, not being able to distinguish tachypnea from simple shortness of breath. Doing this in the meantime is quite simple. You should carefully observe whether the baby’s inhalations and exhalations are always rhythmic. If rapid breathing is rhythmic, then we are talking about tachypnea. If it slows down and then accelerates, the child breathes unevenly, then we should talk about the presence of shortness of breath.

The causes of increased breathing in children are often neurological or psychological in nature.

Severe stress, which the baby cannot express in words due to age and insufficient vocabulary and imaginative thinking, still needs a way out. In most cases, children begin to breathe more often. This counts physiological tachypnea, violation does not pose any particular danger. The neurological nature of tachypnea should be considered first of all, remembering what events preceded the change in the nature of inhalations and exhalations, where the baby was, who he met, whether he had severe fear, resentment, or hysteria.

The second most common cause of rapid breathing is in respiratory diseases, primarily in bronchial asthma. Such periods of increased inhalation are sometimes harbingers of periods of difficulty breathing, episodes of respiratory failure characteristic of asthma. Frequent fractional breaths quite often accompany chronic respiratory ailments, for example, chronic bronchitis. However, the increase does not occur during remission, but during exacerbations. And along with this symptom, the baby has other symptoms - cough, elevated body temperature (not always!), decreased appetite and general activity, weakness, fatigue.

The most serious reason for frequent inhalation and exhalation lies in diseases of the cardiovascular system. It happens that it is possible to detect pathologies of the heart only after the parents bring the baby to an appointment regarding increased breathing. That is why, if the frequency of breathing is disturbed, it is important to have the child examined in a medical institution, and not to self-medicate.

Hoarseness

Poor breathing with wheezing always indicates that there is an obstacle in the respiratory tract to the passage of a stream of air. A foreign body that the child inadvertently inhaled, dried bronchial mucus if the child was treated for cough incorrectly, and narrowing of any part of the respiratory tract, so-called stenosis, can get in the way of the air.

The wheezes are so varied that you need to try to give a correct description of what parents hear from their own child.

Wheezing is described by duration, tone, coincidence with inhalation or exhalation, and the number of tones. The task is not easy, but if you successfully cope with it, you can understand what exactly the child is sick with.

The fact is that wheezing for different diseases is quite unique and peculiar. And they actually have a lot to say. Thus, wheezing (dry wheezing) may indicate a narrowing of the airway, and moist wheezing (noisy gurgling accompaniment of the breathing process) may indicate the presence of fluid in the respiratory tract.

If the obstruction occurs in a bronchus with a wide diameter, the wheezing tone is lower, bassier, and muffled. If the thin bronchi are clogged, then the tone will be high, with a whistle when exhaling or inhaling. With pneumonia and other pathological conditions leading to changes in tissues, wheezing is noisier and louder. If there is no severe inflammation, then the child’s wheezing is quieter, more muffled, sometimes barely audible. If a child wheezes, as if sobbing, this always indicates the presence of excess moisture in the respiratory tract. Experienced doctors can diagnose the nature of wheezing by ear using a phonendoscope and tapping.

It happens that wheezing is not pathological. Sometimes they can be noticed in an infant up to one year old, both in a state of activity and at rest. The baby breathes with a bubbling “accompaniment”, and also noticeably “grunts” at night. This occurs due to the congenital individual narrowness of the airways. Such wheezing should not alarm parents unless there are accompanying painful symptoms. As the child grows, the airways will grow and expand, and the problem will disappear on its own.

In all other situations, wheezing is always an alarming sign, which necessarily requires examination by a doctor.

Moist, gurgling wheezes of varying severity may accompany:

bronchial asthma;
problems of the cardiovascular system, heart defects;
lung diseases, including edema and tumors;
acute renal failure;
chronic respiratory diseases - bronchitis, obstructive bronchitis;
ARVI and influenza;
tuberculosis.

Dry whistling or barking rales are more often characteristic of bronchiolitis, pneumonia, laryngitis, pharyngitis and may even indicate the presence of a foreign body in the bronchi. The method of listening to wheezing - auscultation - helps in making the correct diagnosis. Every pediatrician knows this method, and therefore a child with wheezing should definitely be shown to a pediatrician in order to identify a possible pathology in time and begin treatment.

Treatment

After diagnosis, the doctor prescribes appropriate treatment.

Hard Breathing Therapy

If there is no temperature and there are no other complaints except for hardness of breathing, then there is no need to treat the child. It is enough to provide him with a normal motor mode; this is very important so that excess bronchial mucus comes out as quickly as possible. It is useful to walk outside, play outdoor and active games. Breathing usually returns to normal within a few days.

If hard breathing is accompanied by a cough or fever, it is necessary to show the child to a pediatrician to rule out respiratory diseases.

If the disease is detected, treatment will be aimed at stimulating the discharge of bronchial secretions. For this, the baby is prescribed mucolytic drugs, plenty of fluids, and vibration massage.

To learn how vibration massage is done, see the following video.

Hard breathing with cough, but without respiratory symptoms and temperature requires mandatory consultation with an allergist. Perhaps the cause of the allergy can be eliminated by simple home actions - wet cleaning, ventilation, eliminating all chlorine-based household chemicals, using hypoallergenic baby laundry detergent when washing clothes and linen. If this does not work, the doctor will prescribe antihistamines with calcium supplement.

Measures for heavy breathing

Heavy breathing due to a viral infection does not require special treatment, since the underlying disease needs to be treated. In some cases, antihistamines are added to standard prescriptions for influenza and ARVI, as they help relieve internal swelling and make it easier for the child to breathe. In case of diphtheria croup, the child must be hospitalized, since he needs the prompt administration of anti-diphtheria serum. This can only be done in a hospital setting, where, if necessary, the baby will be provided with surgical care, connection to a ventilator, and administration of antitoxic solutions.

False croup, if it is not complicated and the child is not an infant, may be allowed to be treated at home.

For this purpose it is usually prescribed courses of inhalation with drugs. Moderate and severe forms of croup require hospital treatment with the use of glucocorticosteroid hormones (Prednisolone or Dexamethasone). Treatment of asthma and bronchiolitis is also carried out under medical supervision. In severe form - in the hospital, in mild form - at home, subject to all the recommendations and prescriptions of the doctor.

Increased rhythm - what to do?

Treatment in case of transient tachypnea, which is caused by stress, fear or excessive impressionability of the child, is not required. It is enough to teach a child to cope with his emotions, and over time, when the nervous system gets stronger, the attacks of rapid breathing will disappear.

You can stop another attack with a paper bag. It is enough to invite the child to breathe into it, inhaling and exhaling. In this case, you cannot take air from the outside; you only need to inhale what is in the bag. Usually, a few such breaths are enough for the attack to subside. The main thing is to calm down yourself and calm the child.

If the increased rhythm of inhalation and exhalation has pathological causes, the underlying disease should be treated. Cardiovascular problems of the child are dealt with pulmonologist and cardiologist. A pediatrician and a pediatrician will help you cope with asthma. An ENT doctor and sometimes an allergist.

Treatment of wheezing

None of the doctors treat wheezing, since there is no need to treat it. The disease that caused their appearance should be treated, and not the consequence of this disease. If wheezing is accompanied by a dry cough, to relieve the symptoms, along with the main treatment, the doctor may prescribe expectorants that will facilitate the rapid transition of a dry cough into a productive cough with sputum production.

If wheezing is the cause of stenosis, narrowing of the respiratory tract, the child may be prescribed medications that relieve swelling - antihistamines, diuretics. As swelling decreases, wheezing usually becomes quieter or disappears completely.

Wheezing wheezes that accompany short and labored breathing are always a sign that the child needs emergency medical care.

Any combination of the nature and tone of wheezing against a background of high temperature is also a reason to hospitalize the child as soon as possible and entrust his treatment to professionals.

The most obvious consequence of childbirth is the cessation of the child’s connection with the mother’s body, provided by the placenta, and, consequently, the loss of metabolic support. One of the most important adaptive reactions immediately realized by a newborn should be the transition to independent breathing.

Cause of a newborn's first breath. After a normal birth, when the functions of the newborn are not suppressed by narcotic drugs, the child usually begins to breathe and develops a normal rhythm of respiratory movements no later than 1 minute after birth. The rapidity of spontaneous breathing is a reaction to the suddenness of the transition to the outside world, and the reason for the first breath may be: (1) the formation of slight asphyxia in connection with the birth process itself; (2) sensory impulses coming from the cooled skin.

If a newborn does not begin to breathe on his own immediately, he develops hypoxia and hypercapnia, which provide additional stimulation of the respiratory center and usually contribute to the occurrence of the first breath no later than the next minute after birth.

On delay spontaneous breathing after childbirth - the danger of hypoxia. If during childbirth the mother was under the influence of general anesthesia, then the child after childbirth will inevitably also be under the influence of narcotic drugs. In this case, the onset of spontaneous breathing in the newborn is often delayed for several minutes, which indicates the need for the least possible use of anesthetic drugs during childbirth.

In addition, many newborns Those who were injured during childbirth or as a result of protracted labor cannot begin to breathe on their own or they exhibit disturbances in the rhythm and depth of breathing. This may be the result of: (1) a sharp decrease in the excitability of the respiratory center due to mechanical damage to the fetal head or hemorrhage in the brain during childbirth; (2) prolonged intrauterine hypoxia of the fetus during childbirth (which may be a more serious reason), leading to a sharp decrease in the excitability of the respiratory center.

During fetal hypoxia during labor often occurs due to: (1) compression of the umbilical cord; (2) premature placental abruption; (3) extremely strong contractions of the uterus, leading to cessation of blood flow through the placenta; (4) maternal drug overdose.

Degree hypoxia experienced by a newborn. Cessation of breathing in an adult for more than 4 minutes often results in death. Newborns often survive even if breathing does not start within 10 minutes after birth. In the absence of breathing in newborns for 8-10 minutes, chronic and very severe dysfunction of the central nervous system is observed. The most frequent and severe damage occurs in the thalamus, inferior colliculus and other areas of the brain, which most often leads to chronic impairment of motor functions.

Expansion of the lungs after birth. Initially, the alveoli of the lungs are in a collapsed state due to the surface tension of the film of liquid filling the alveoli. It is necessary to reduce the pressure in the lungs by approximately 25 mmHg. Art. to counteract the force of surface tension in the alveoli and cause the walls of the alveoli to straighten during the first inspiration. If the alveoli open, such muscular effort will no longer be necessary to ensure further rhythmic breathing. Fortunately, a healthy newborn is able to demonstrate a very powerful force in connection with the first breath, resulting in a decrease in intrapleural pressure of approximately 60 cmHg. Art. relative to atmospheric pressure.

The figure shows extremely high values negative intrapleural pressure necessary for the expansion of the lungs at the moment of the first inhalation. The upper part shows the volume-pressure curve (distensibility curve), reflecting the first breath of the newborn. First of all, note that the lower part of the curve starts from the zero pressure point and moves to the right. The curve shows that the volume of air in the lungs remains practically zero until the negative pressure reaches -40 cm of water. Art. (-30 mmHg). When the negative pressure approaches -60 cm water. Art., about 40 ml of air enters the lungs. To ensure exhalation, a significant increase in pressure is necessary (up to 40 cm of water), which is explained by the high viscous resistance of the bronchioles containing fluid.

Please note that second breath is carried out much easier against the background of significantly lower negative and positive pressures required for alternating inhalation and exhalation. Breathing remains subnormal for approximately 40 minutes after delivery, as shown in the third compliance curve. Only 40 minutes after birth, the shape of the curve becomes comparable to that of a healthy adult.