Noisy Breathing

Dear Lisa,

My 6-week-old's chest is noisy when he breathes. His nose is not running, he doesn't have a fever, he doesn't have a rash, his appetite is not affected, but he is irritable. What could be wrong with him?

“Buttaflies”

Dear “Buttaflies”,

The chest wall of an infant is very thin and pliable as compared to the chest wall of an adult. Because of this it is very easy to see the muscles in the chest move and hear rumbling from inside of the chest. Babies are also obligate nose breathers which means they breathe only through their nose, not their mouth. They continue to be nose breathers for the entire first year of life. Since all of an infant’s breathing is through his nose, the slightest congestion or mucus tends to make a lot of noise.

Young infants can be very noisy breathers when their nasal passages are congested. The sounds of upper airway congestion can transmit to the lower airway and sound like they are coming from the chest instead. A newborn can develop nasal congestion due to irritants in the environment or due to the build up of secretions from an Upper Respiratory Tract Infection. Signs of an Upper Respiratory Tract infection include nasal discharge, sneezing, fussiness, decreased appetite and an occasional mild cough.(1)

One of the most common causes of obstruction of the airway and resulting noisy breathing in a child is Adenoidal Tonsillar Hypertrophy or enlarged tonsils and adenoids. Tonsil and adenoid tissue can enlarge from recurrent infection, allergy and from non-specific stimuli. (2) Signs of enlarged tonsils and adenoids include snoring, snorting, obstructive sleep apnea and recurrent ear infections.(2) Enlarged tonsils and Adenoids are diagnosed by neck x-ray or by nasopharyngoscopy performed by an Otolaryngologist. (2)

As a child grows the diameter of his airway naturally enlarges. The increased size of the airway can better accommodate the tonsillar and adenoid tissue. In many cases the symptoms of enlarged tonsils and adenoids disappear as a child grows older.

Laryngomalacia is another common pediatric condition that causes noisy breathing during infancy. The symptoms include Stridor or a “high” pitched inspiratory wheeze that begins at birth or shortly after birth. Laryngomalacia is caused by a softening of the cartilage in the upper airway. When a child has Laryngomalacia his upper airway temporarily collapses during inspiration. The airway then opens again during expiration or when the baby exhales.

The breathing of a child with Laryngomalacia is the loudest when he is feeding or quietly relaxing. Viral infections tend to exacerbate the symptoms of Laryngomalacia. The loud breathing usually diminishes during sleep or when the child is crying.(2) As a child grows the cartilage all over the body, including the cartilage in the airway hardens. Because of this, as a child ages the symptoms of Laryngomalacia decreases. In most cases Laryngomalacia resolves on its own by the time the child is one year old.(2)

The presence of a Hemangioma in the airway is another potential cause of Stridor in the newborn period. A Hemangioma in the subglottic space is one of the most common types of airway lesions found in the pediatric population.(2) Children with stridor who also have a Hemangioma on their skin have an increased chance of having a Hemangioma in the airway.(2)

The facts that your baby does not have a fever, has a good appetite and is not in respiratory distress are all good signs. The noisy breathing that you hear may be due to normal newborn congestion or due to an Upper Respiratory Infection or the "Common Cold". An evaluation by your Pediatrician can guide you regarding the proper diagnosis and treatment. If your child’s symptoms continue to concern you a consultation with a Pediatric Pulmonologist can ease your worries by diagnosing the condition that is causing his noisy breathing.

If you are interested in other Pediatric Advice Stories covering topics discussed:

Baby with Stuffy Nose

Newborn Congestion

Treating Baby’s Cold Symptoms

Newborn Breathing Problem

Obstructive Sleep Apnea

References:
(1) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 707-708.
(2)Behrman R, Kliegman R. Nelson Essentials of Pediatrics. Philadelphia ,PA: W.B.Saunders Company. 1990:424-425.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Moms with Newborns