Seeing your newborn breathe quickly, make unusual noises or pull in around the ribs can be frightening. Newborn breathing is naturally faster and less regular than adult breathing, but persistent rapid breathing, grunting, chest recession, pauses or colour changes can indicate that your baby needs urgent assessment.
Breathing problems may arise from delayed adaptation after birth, prematurity, infection or conditions affecting the lungs, airway, heart or circulation. This article explains common causes and treatments, but it does not replace urgent medical assessment.
Call 999 if your baby stops breathing, is gasping, has long or repeated pauses in breathing, develops severe breathing difficulty, becomes limp or unresponsive, cannot be woken or develops blue, grey, very pale or blotchy colouring. You should also call 999 if your baby is under eight weeks old and you are extremely worried about them.
How a Newborn Baby’s Breathing Changes After Birth
Before birth, your baby receives oxygen through the placenta rather than by breathing air. After birth, your baby must clear fluid from the lungs, take their first breaths and adjust to breathing independently.
Most babies make this change without difficulty, but some need extra support, especially if they are born prematurely or after a complicated birth. If your baby has breathing problems, the neonatal team will monitor them closely and provide the treatment they need.
What Normal Newborn Breathing Can Look Like
A calm newborn baby normally breathes approximately 30 to 60 times per minute. Their rhythm may be less regular than an adult’s, particularly during sleep, and brief pauses can occur between groups of breaths. Soft nasal snuffling may also happen because newborn nasal passages are narrow.
Breathing should still look comfortable, without persistent grunting, nostril flaring or pulling in beneath or between the ribs. Brief pauses lasting a few seconds can occur, particularly during sleep, but the breathing should restart without colour change, floppiness or difficulty waking.
Seek urgent medical assessment if your calm baby’s breathing remains above 60 breaths per minute. Call 999 for a pause lasting more than approximately 10 seconds, repeated breathing pauses, severe breathing effort, blue or grey colouring, floppiness or difficulty waking your baby.
What Doctors Mean by Respiratory Distress
Respiratory distress means that your baby is using extra effort to breathe. Signs include persistent rapid breathing, grunting when breathing out, widening of the nostrils, head bobbing or the skin pulling in under the ribs or at the base of the throat.
These signs may result from a lung condition, infection, low oxygen level, heart problem or airway obstruction. A newborn showing respiratory distress needs prompt clinical assessment because individual signs cannot reliably confirm the cause or show how quickly the condition may progress.
Warning Signs That Need Emergency Help
Call 999 immediately if your baby stops breathing, is gasping, has long or repeated breathing pauses, cannot be woken, becomes limp or unresponsive or develops severe breathing difficulty.
Also call 999 if your baby develops blue, grey, very pale or blotchy colouring. On brown or black skin, changes may be easier to identify on the lips, gums, tongue, palms or soles.
Grunting with every breath, marked chest or abdominal recession, persistent stridor while your baby is calm or being too breathless to feed also requires emergency assessment. Do not wait to see whether these symptoms settle.
When Should You Seek Urgent Medical Assessment?
Seek urgent medical assessment if your baby is breathing persistently faster than usual, has new noisy breathing, feeds much less than normal, becomes increasingly sleepy or has a temperature of 38°C or higher or an unexplained temperature below 36°C.
Contact your maternity or neonatal team, an urgent GP service or NHS 111 according to the advice you were given at discharge. Call 999 instead when the breathing difficulty is severe, your baby cannot be woken, has repeated pauses or becomes pale, blue or grey. NICE lists tachypnoea, grunting, chest recession, low oxygen levels and unexplained temperatures below 36°C or of 38°C or higher among the clinical indicators of possible neonatal infection. The healthcare team must assess these findings together with the baby’s history, examination and any other risk factors.
Clinical Tip
When it is safe to do so, count your baby’s breaths for a complete minute while they are calm and note whether grunting, nostril flaring or chest recession is present. A brief video may help a clinician understand an intermittent noise or movement, but do not delay urgent or emergency care to record or count symptoms.
Transient Tachypnoea of the Newborn
Transient tachypnoea of the newborn (TTN) is a temporary breathing problem that happens when fluid clears more slowly than expected from your baby’s lungs after birth. Your baby may breathe faster than usual and have mild chest recession, nostril flaring or occasional grunting.
TTN commonly improves during the first few days as the lung fluid is absorbed. Your baby may need monitoring, carefully controlled oxygen or short-term respiratory support while this happens.
Fast breathing after birth can also result from infection, respiratory distress syndrome, a heart condition or another illness. TTN is therefore confirmed only after the team has considered your baby’s birth history, examination, oxygen levels and any investigations that are needed.
Respiratory Distress Syndrome in Premature Babies
Respiratory distress syndrome (RDS) mainly affects babies who are born prematurely because their lungs have not yet produced enough surfactant, which helps keep the air sacs open. Your baby may breathe rapidly, grunt, flare their nostrils or pull in around the ribs as they work harder to breathe.
Treatment depends on gestational age, breathing effort, oxygen requirement and blood-gas results. Support may include carefully controlled oxygen, CPAP or high-flow therapy, while babies with more significant disease may need surfactant and mechanical ventilation.
NICE recommends CPAP or nasal high-flow therapy as primary non-invasive respiratory support for preterm babies when clinically appropriate. The NHS also recognises oxygen, ventilation and artificial surfactant as treatments for neonatal respiratory distress syndrome.
Infection, Pneumonia and Neonatal Sepsis
Infection, pneumonia and neonatal sepsis can make a newborn seriously unwell and often require urgent assessment and treatment. The neonatal team uses your baby’s symptoms, pregnancy history and test results to decide whether antibiotics and further care are needed.
Recognising and Managing Neonatal Infection
| Aspect | What It Involves | Why It Matters | Possible Next Steps |
| Common symptoms | Rapid breathing, grunting, oxygen needs or pauses in breathing | May indicate a serious infection | Immediate medical assessment is required |
| Other warning signs | Poor feeding, abnormal temperature, colour changes, sleepiness or reduced responsiveness | Infection can present in different ways | Ongoing monitoring and examination |
| Risk assessment | Reviews pregnancy, labour and birth risk factors alongside your baby’s condition | Helps identify babies at higher risk of infection | Determines whether treatment should begin |
| Diagnostic tests | Blood cultures and other investigations may be performed | Helps identify the cause of infection | Results guide ongoing treatment |
| Antibiotic treatment | Antibiotics are started promptly when the clinical assessment indicates possible infection and the healthcare team decides that treatment is required. | Early treatment reduces the risk of complications | Medicines may be continued, changed or stopped based on results |
| Ongoing monitoring | Regular review of your baby’s progress and test findings | Ensures treatment remains appropriate | Care is adjusted according to your baby’s recovery |
Meconium Aspiration and Problems Around Delivery
Meconium is your baby’s first stool, and it can sometimes be passed into the amniotic fluid before birth. If your baby breathes meconium into their lungs, it can cause breathing difficulties, although many babies exposed to meconium remain well and only need observation.
If your baby develops meconium aspiration syndrome, they may breathe quickly, grunt or need extra oxygen after birth. Depending on how severe the symptoms are, the neonatal team may provide oxygen, CPAP or other breathing support while monitoring your baby’s recovery.
Persistent Pulmonary Hypertension of the Newborn
Persistent pulmonary hypertension of the newborn occurs when the blood vessels in the lungs do not relax sufficiently after birth. Blood may continue to bypass the lungs, causing low oxygen levels, rapid breathing and pale, blue or grey colouring. It may occur alongside meconium aspiration, infection, respiratory distress syndrome or another lung condition.
Treatment may include ventilation, medicines or fluids to support the circulation and inhaled nitric oxide. A small number of babies with severe respiratory failure may require transfer to a specialist centre for extracorporeal membrane oxygenation, commonly shortened to ECMO.
Air Leaks, Pneumothorax and Structural Lung Problems
An air leak happens when air escapes from your baby’s lung and collects around it, sometimes causing a pneumothorax. A small air leak may only need monitoring, but a larger one can make breathing difficult and require urgent treatment.
A stable, small pneumothorax may be monitored, while a larger or symptomatic air leak may require needle aspiration or insertion of a chest drain. If a tension pneumothorax causes sudden severe deterioration, emergency treatment may begin before there is time to obtain an X-ray.
Congenital abnormalities affecting the lungs, diaphragm or airways can also cause respiratory distress. These conditions may require specialist imaging, neonatal intensive care and assessment by paediatric respiratory or surgical teams.
Heart Conditions That Can Look Like a Breathing Problem
Not every newborn breathing problem is caused by the lungs. Some congenital heart conditions can make your baby breathe quickly, feed poorly, appear blue or grey, or become unusually tired during feeds.
If a heart problem is suspected, your baby’s doctor may examine their heart, check oxygen levels and arrange an echocardiogram to assess blood flow and heart structure. Seek emergency help immediately if your baby develops breathing difficulty with a blue or grey colour, becomes floppy or is difficult to wake.
Airway Problems and Noisy Breathing
Soft nasal snuffling is common in newborn babies, but a harsh, high-pitched noise while breathing in is called stridor and usually arises from the upper airway. One possible cause is laryngomalacia, although infection, swelling, vocal-cord problems or another airway abnormality can produce similar sounds.
Persistent stridor needs prompt assessment, particularly when it occurs while your baby is calm. Call 999 if it is accompanied by severe recession, repeated breathing pauses, blue or grey colouring, difficulty waking or being too breathless to feed. Stridor that occurs continuously at rest is recognised as an emergency warning sign in NHS newborn safety advice.
How Does the Neonatal Team Diagnose the Cause?
Assessment begins with the pregnancy, labour and birth history and an examination of your baby’s respiratory rate and effort, colour, oxygen saturation, heart rate, temperature, responsiveness and feeding. The team looks for grunting, recession, nostril flaring, abnormal breath sounds, murmurs and differences between oxygen measurements.
Tests are selected according to the suspected cause and may include blood tests, a blood culture, blood-gas analysis, chest X-ray, pulse oximetry or echocardiography. Not every baby requires every investigation, and the team should explain what each test may show and how it could affect treatment.
Breathing Support and Treatment in a Neonatal Unit
Treatment depends on the cause and severity of the respiratory problem. Some babies need observation or carefully controlled oxygen, while others require high-flow support, CPAP, mechanical ventilation or specialist treatments such as surfactant or inhaled nitric oxide.
Antibiotics may be given when infection is suspected, and fluids or nutrition may be provided through a vein or feeding tube when breathing makes oral feeding unsafe. Oxygen levels, blood gases, temperature and circulation are monitored so that treatment can be increased or reduced according to your baby’s response. NICE provides separate recommendations for non-invasive ventilation, mechanical ventilation and safe oxygen support in preterm babies.
Recovery, Follow-Up and What You Can Do as a Parent
Recovery and follow-up depend on the diagnosis, gestational age and duration of respiratory support. Discharge is considered when your baby is medically stable and any continuing respiratory, feeding or medicine needs can be managed safely at home.
Some babies leave hospital without equipment, while selected babies may go home with oxygen, tube feeding or neonatal outreach after parents have received suitable training. Before discharge, you should receive written information about medicines, equipment, safe sleep, follow-up, emergency warning signs and whom to contact if your baby’s breathing changes.
Myth vs Fact
| Myth | Fact |
| Newborn breathing should be as regular as adult breathing. | Newborn breathing can be faster and mildly irregular, but persistent rates above 60, repeated pauses or visible effort require assessment. |
| Every noisy breath means that the lungs are diseased. | Sounds may originate in the nose or upper airway, but persistent stridor or noise with feeding or colour changes needs urgent assessment. |
| TTN can be diagnosed simply because a baby is breathing quickly after birth. | Infection, RDS, heart disease and other causes may look similar, so TTN is diagnosed after clinical assessment. |
| Every baby with respiratory symptoms receives antibiotics. | Antibiotics are based on infection risk factors, clinical signs and investigation results. |
| Oxygen is the only treatment for newborn breathing problems. | Treatment may include CPAP, ventilation, surfactant, nitric oxide, antibiotics or circulatory support, depending on the cause. |
| A baby must always be completely free from respiratory support before going home. | Selected babies may leave with home oxygen or other support after medical assessment, family training and community arrangements. |
Key Takeaways
- A calm newborn normally breathes approximately 30 to 60 times per minute.
- Grunting, chest recession, persistent rapid breathing and nostril flaring indicate increased breathing effort.
- Call 999 if your baby stops breathing, is gasping, has long or repeated breathing pauses, develops severe breathing difficulty, becomes limp or unresponsive, cannot be woken or develops blue, grey, very pale or blotchy colouring.
- Prematurity, infection, retained lung fluid, meconium, heart disease and airway conditions can all cause breathing problems.
- Tests and treatment depend on the suspected cause rather than on one symptom alone.
- Some babies can go home with oxygen or feeding support after careful discharge planning.
Frequently Asked Questions
1. How can parents tell if a newborn’s breathing is normal?
A calm newborn normally breathes around 30 to 60 times per minute, and brief irregularity may occur during sleep. Persistent breathing above 60, grunting, nostril flaring, chest recession, repeated pauses, colour changes or difficulty feeding requires medical assessment.
2. Does every baby with breathing problems need admission to a neonatal unit?
No. Some babies receive examination, observations or short-term support on a postnatal or transitional-care ward. Admission depends on the diagnosis, oxygen requirement, feeding safety and overall condition, but any newborn showing respiratory distress still requires prompt clinical assessment.
3. Why are premature babies more likely to have breathing difficulties?
Premature babies often have immature lungs that may not produce enough surfactant, making it harder to keep the air sacs open. They are therefore more likely to need breathing support after birth.
4. Can a baby develop breathing problems after leaving hospital?
Yes. Infection, bronchiolitis, heart conditions and airway disorders may become apparent after discharge. Seek urgent advice for persistent rapid breathing, poor feeding, increasing sleepiness, grunting or chest recession, and call 999 for severe difficulty, breathing pauses, blue or grey colour or inability to wake.
5. What tests may be needed to find the cause of breathing problems?
Tests are chosen according to the suspected cause and may include oxygen-saturation monitoring, blood tests, a blood culture, blood-gas analysis, chest X-ray or echocardiogram. Not every baby needs every test.
6. Can newborn breathing problems be treated successfully?
Many neonatal respiratory conditions improve with timely assessment and appropriate support. The treatment and likely recovery depend on the diagnosis, gestational age, severity and whether infection, heart disease or another complication is present.
7. How long does a baby usually stay in a neonatal unit for breathing problems?
The length of stay varies depending on the diagnosis and how quickly the baby improves. Some babies only need a short period of monitoring, while others require longer specialist care before they are ready to go home.
8. Will a baby who needed breathing support have long-term breathing problems?
Many babies recover without lasting breathing difficulty. Babies born very prematurely or requiring prolonged oxygen or ventilation may need follow-up for chronic lung disease, growth and development, while other babies need no specialist respiratory follow-up.
9. Can parents stay involved while their baby is receiving neonatal care?
Yes. Parents are encouraged to be involved in their baby’s care whenever it is safe, including providing skin-to-skin contact, helping with feeding and taking part in routine care under the guidance of the neonatal team.
10. When should emergency medical help be sought for a newborn with breathing difficulties?
Call 999 if your baby stops breathing, is gasping, has long or repeated breathing pauses, develops severe breathing difficulty, becomes limp or unresponsive, cannot be woken or develops blue, grey, very pale or blotchy colouring.
Grunting with every breath, marked chest or abdominal recession, persistent stridor at rest or being too breathless to feed also requires emergency assessment. Call 999 if your baby is under eight weeks old and you are extremely worried about them.
Final Thoughts: Breathing Problems in Newborn Babies
Breathing problems in a newborn can range from a temporary adjustment after birth to a condition that requires urgent specialist treatment. Recognising warning signs such as persistent fast breathing, grunting, chest recession, poor feeding or blue or grey colouring and seeking prompt medical attention can make a significant difference to your baby’s care and recovery. If you’re considering a neonatologist in London, you can get in touch with us at London Paediatric Clinic.
References:
- Alhassen, Z., Vali, P., Guglani, L., Lakshminrusimha, S. and Ryan, R.M. (2021) ‘Recent advances in pathophysiology and management of transient tachypnea of newborn’, Journal of Perinatology, 41(1), pp. 6–16. Available at: https://pubmed.ncbi.nlm.nih.gov/32753712/
- British Association of Perinatal Medicine (2022) Service and quality standards for provision of neonatal care in the UK. Available at: https://www.bapm.org/resources/service-and-quality-standards-for-provision-of-neonatal-care-in-the-uk
- British Association of Perinatal Medicine (2023) NEWTT2 – Deterioration of the newborn: A framework for practice. Available at: https://www.bapm.org/resources/deterioration-of-the-newborn-newtt-2-a-framework-for-practice
- Chen, I.-L. and Chen, H.-L. (2022) ‘New developments in neonatal respiratory management’, Pediatrics and Neonatology, 63(4), pp. 341–347. Available at: https://www.sciencedirect.com/science/article/pii/S1875957222000481
- Costa, F., Titolo, A., Ferrocino, M., Biagi, E., Dell’Orto, V., Perrone, S. and Esposito, S. (2024) ‘Lung ultrasound in neonatal respiratory distress syndrome: A narrative review of the last 10 years’, Diagnostics, 14(24), article 2793. Available at: https://www.mdpi.com/2075-4418/14/24/2793
- Gallacher, D.J., Hart, K. and Kotecha, S. (2016) ‘Common respiratory conditions of the newborn’, Breathe, 12(1), pp. 30–42. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4818233/
- Lamary, M., Bertoni, C.B., Schwabenbauer, K. and Ibrahim, J. (2023) ‘Neonatal Golden Hour: A review of current best practices and available evidence’, Current Opinion in Pediatrics, 35(2), pp. 209–217. Available at: https://pubmed.ncbi.nlm.nih.gov/36722754/
- Mathew, B. and Lakshminrusimha, S. (2017) ‘Persistent pulmonary hypertension in the newborn’, Children, 4(8), article 63. Available at: https://www.mdpi.com/2227-9067/4/8/63
- Mustaqeem, A., Yadav, A., Kumar, J. and Debata, P. (2025) ‘Continuous positive airway pressure versus conventional oxygen therapy in meconium aspiration syndrome: A randomized controlled trial’, Journal of Tropical Pediatrics, 71(2), article fmaf002. Available at: https://academic.oup.com/tropej/article/71/2/fmaf002/8002255
- National Health Service (2023) Is your baby or toddler seriously ill? Page last reviewed 24 August 2023. Available at: https://www.nhs.uk/baby/health/is-your-baby-or-toddler-seriously-ill/
- National Health Service Nottingham and Nottinghamshire Integrated Care Board (no date) New baby – what’s normal and what’s not. Available at: https://notts.icb.nhs.uk/your-services/childrens-health-and-wellbeing/concerned-your-newborn-baby-is-unwell-less-than-3-months/new-baby-whats-normal-and-whats-not/
- National Institute for Health and Care Excellence (2019) Specialist neonatal respiratory care for babies born preterm. NICE guideline NG124. Available at: https://www.nice.org.uk/guidance/ng124
- National Institute for Health and Care Excellence (2021, updated 13 May 2026) Neonatal infection: Antibiotics for prevention and treatment. NICE guideline NG195. Available at: https://www.nice.org.uk/guidance/ng195
- Resuscitation Council UK (2025) Newborn resuscitation and support of transition of infants at birth guidelines. Published 27 October 2025. Available at: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/newborn-resuscitation-and-support-transition-infants-birth
- Reuter, S., Moser, C. and Baack, M. (2014) ‘Respiratory distress in the newborn’, Pediatrics in Review, 35(10), pp. 417–428. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4533247/
- Sankaran, D. and Lakshminrusimha, S. (2022) ‘Pulmonary hypertension in the newborn—Etiology and pathogenesis’, Seminars in Fetal and Neonatal Medicine, 27(4), article 101381. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1744165X22000609
- Zheng, L. and Jing, H. (2023) ‘Feasibility of ultrasound in the diagnosis of neonatal respiratory distress syndrome in preterm infants’, Journal of Tropical Pediatrics, 69(2), article fmad007. Available at: https://academic.oup.com/tropej/article/69/2/fmad007/7028467