You come home from the hospital. Your pregnancy and delivery were normal, your baby had no complications in the nursery, and the discharge was routine. Your little one takes her first home feed well, and you put her down on her back to sleep. Suddenly, you realize you hear “that noise.” No one in the hospital commented on anything being wrong with her breathing! Is something wrong now?
While you should always give your child’s provider a call if you are concerned about a breathing issue, it’s worth looking at some of the possibilities. While some respiratory patterns are true emergencies, others can be normal variants. But before discussing those, it’s worth looking at what happens before the baby gets home.
A fetus doesn’t breathe at all in the womb; all oxygen is delivered by way of the placenta. Moreover, the entire body, including the airway-and-lungs-to-be, is bathed in amniotic fluid. When the baby is born, he has just a few minutes to transition successfully to breathing air. About 90% of newborns make this change quite easily; the remaining 10% need some help, generally given by a trained hospital team, for their lungs (and heart) to work well.
Of the babies that need this early assistance, the great majority will go on to breathe comfortably on their own. However, all newborns are monitored for breathing problems especially during those first few hours. Your baby is more likely to have a true respiratory problem at this point if she is:
- Infected (say, from a Group B Strep infection, which mothers are generally screened for a few weeks before delivery)
- Born with an abnormality in the heart or lung
- Born by Cesarean section. The most common problem here, known as transient tachypnea of the newborn, is due to amniotic fluid in the lungs that is not absorbed as quickly as in babies who are delivered vaginally. Although as the name implies this ultimately gets better, infants sometimes need some help to breathe—usually in the form of oxygen—for the first few hours or days of life.
However, regardless of whether a newborn suffers from any of these conditions, his breathing may be affected by certain characteristics shared by all babies. Their nasal passages, larynx (“voice box”), and trachea (“windpipe”) are all very small. Occasionally, the larynx can be quite soft. Certainly, for the first few days at least, there may be the remains of amniotic fluid lurking in the nostrils. And a spitty baby—even one that doesn’t have a true problem that needs treatment—can get a little breast milk or formula in the nose, since the nasal passages have a connection to the mouth and throat.
Finally, although young infants carry natural immunity against a variety of diseases that their mothers have been exposed to or immunized against, such immunity wanes pretty quickly where the common cold is concerned—that’s why we keep getting colds throughout life! Thus, if exposed, a stuffy nose from a common cold is a possibility.
More serious respiratory problems can and do occur. For example, labored breathing can be a sign of a bacterial infection or an abnormal heart. While any concern about something more serious should prompt a call to your baby’s provider, there are certain clues that may make simply noisy breathing a little less concerning:
- Does she look like she’s breathing comfortably? (If you couldn’t hear the noise, would you think that anything is wrong?)
- Is she feeding well?
- Does she seem generally happy and content?
- Does her color look normal to you?
- Is she free of any other signs of illness, such as a fever?
If the answer to all of these is “yes,” there may be less reason for worry. And for babies that are noisy but OK, there are a few things to try at home to make them more comfortable. Sometimes using a bulb to gently suction his nose will bring some comfort, as will elevating the head of the bed slightly. If he’s spitty, talking to your provider about remedies may be helpful. Often, however, less treatment is better for a comfortable baby with a slight stuffy nose!