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by Christina Elston
What parent hasn’t stood over their sleeping infant in awe, marveling at the tiny hands, the little nose and ears, and just watching him breathe? Despite the fact that she has Mom’s eyes or he has Dad’s dimple, your little wonder is also a little mystery. Infant breathing is one of the things parents worry most about. Knowing more about the quirks of your baby’s airways can help you relax when things are normal, and take quick action when they aren’t.
If you’ve made that late-night visit to your baby’s quiet crib, you might have been startled by something called “central apnea.” This is when a baby stops breathing for up to five seconds, “which to a parent is an eternity,” but is really perfectly normal says Nina Shapiro, M.D., director of Ear, Nose and Throat at Mattel Children’s Hospital UCLA and author of Take a Deep Breath (Jan. 2012, World Scientific), a practical guide to breathing issues for newborns through age 4. A baby’s brain stem is still immature, and doesn’t yet do a good job of regulating breathing. But there’s nothing to fear. Your baby’s breathing will start up again as if nothing happened, and he’ll eventually outgrow this quirk.
Babies’ smaller lungs mean that infants also breathe faster than we do – 24 to 38 times per minute compared with our 12 to 20 – and their breathing rates can vary wildly, shooting from 20 to 40 breaths in just a few seconds. Again, this is no cause for alarm, explains Shapiro, who suggests that worried moms and dads count their baby’s breaths for 30 seconds and multiply by two. If the number is under 40, the baby is just fine.
One other big difference is that babies’ breathing and swallowing passages are really close together, right up near the back of the tongue in newborns. This means that it’s easy for breast milk or formula to get into the airway. For most babies, staying slightly upright during feeding, and for a little bit after, allows gravity to keep the food where it belongs and the airway clear.
Babies younger than 3 or 4 months can’t breathe through their mouths – except when they are crying, and this makes an especially big difference in fall and winter, when colds and flu abound. “If they have a stuffy nose, they’re going to be miserable,” says Shapiro.
Infants with nasal congestion really struggle to breathe, and can have trouble with eating and sleep. Hospitals send new parents home with rubber-bulb suction devices to help keep the nose clear, but Shapiro urges parents to use them in moderation. “If you see a lot of mucus, it’s reasonable to suction,” she says. “But people sometimes get a little too suction happy.”
Shapiro often hears parents say they’ve suctioned and suctioned, but aren’t getting anything out. That’s because all that suctioning has irritated the nasal passages, causing swelling that makes the congestion worse. The mucus may be gone, but the baby’s tiny nasal passage is now even tinier.
Instead of suctioning, Shapiro recommends using an over-the-counter nasal saline spray. Prop your baby semi-upright on your lap, put the tip of the nozzle into your baby’s nostril, aim the nozzle parallel to the floor (your baby’s nasal passage runs straight back, not up toward the top of the head) and squirt a few drops in. Your baby won’t enjoy this, but it will relieve the congestion and is completely safe. “You cannot use too much,” Shapiro says. “There’s no damage you can do.”
Use this trick at the first sign of congestion and your baby will breathe much easier.
When something goes wrong with a baby’s delicate respiratory system, things can get serious fast. Here’s what you need to know about a few common issues:
SIDS – Rates of this terrifying condition, which many experts consider breathing-related, have dropped 50 percent in the past decade, largely because of a huge push by the American Academy of Pediatrics (AAP) to get parents to put their babies to sleep on their backs. In addition, your baby’s crib or bassinet mattress should be firm, and you should not put your baby to sleep with pillows, toys, or fluffy blankets that might obstruct airflow. Along with these recommendations, Shapiro advises:
• Keep your infant near, but in her own bed. A bassinet in the parents’ bedroom is ideal at first. When you move your baby to her own room, use a baby monitor.
• Consider a cool mist humidifier if the air is dry.
• Don’t overheat or under-heat the house. A temperature of 68-72 degrees is ideal.
• Don’t smoke. “Even if you smoke outside, it’s on your clothes,” Shapiro says.
Respiratory Viruses – Because their airways are so tiny and their immune systems are still developing, babies are at special risk from colds, flu and other bugs in the air. Most of these infections, including a common one called RSV (respiratory syncytial virus), can be fairly mild or quite dangerous. Because of this, parents of babies under 6 months old should:
• Immunize your baby – and your family. “Flu is a very real concern this time of year if you have a newborn,” Shapiro says. And pertussis, also known as “whooping cough” killed 10 babies and sickened thousands during a 2010 epidemic in California. Babies can’t be immunized against the flu until they are 6 months old, and do not develop full immunity from vaccinations against pertussis until 7 months of age, so the best way to protect your infant is to make sure everyone in the family and all your baby’s caregivers are up-to-date with their vaccines. Adults and older children need flu shots annually, and a pertussis booster every 10 years.
• Be cautious around schools. Because being around unimmunized children and adults puts your baby at risk, Shapiro cautions parents to keep babies under 8 months old away from functions at the schools of older siblings – unless the immunization rate at the school is 90 percent or higher. You can find rates for pubic and private elementary schools on the California Department of Public Health website at www.cdph.ca.gov/programs/immunize. Click “Schools and Childcare Centers,” then click the “Immunization Coverage” link to download a document with rates for the state’s schools.
To minimize the spread of viruses that other children in the family might bring home from school or daycare, get them in the habit of washing their hands, and maybe even changing their shirt, immediately after they come home. And if they’re sick, try to keep them away from the baby.
• Watch colds and other illness closely. Seek immediate medical attention for fever above 100.4º F in infants younger than 6 weeks, or if illness interferes with your baby’s ability to breathe, eat or sleep.
If your baby develops croup – where a swelling of the area below the voice box causes a cough that sounds like a barking seal – Shapiro recommends 10 minutes outdoors in the night air or 10 minutes in a steamy shower to relieve coughing spasms. If that doesn’t work, however, it’s time to head for the ER.
And if your baby is sick and you aren’t sure what to do, a phone call to the doctor is probably better than a stint in the pediatric waiting room with others who might be ill. Shapiro says most babies develop a cold sometime during the first months of life, and that many of these illnesses are mild, so calling first will also save you some trouble. “You don’t want to miss something, but you don’t want to run to the doctor every time your baby sneezes,” she explains.
Structural Problems – Most serious structural problems with babies’ airways (being born with completely blocked nasal passages, for instance) are caught in the delivery room, or in the hospital before the baby goes home. About 10 percent, however, are born with a less-serious condition called laryngomalacia. This means the tissue above the voice box is unusually soft, causing the baby to occasionally make noisy clucking or choking sounds. The baby’s breathing is otherwise normal, and the baby isn’t bothered by the noise, though it can distress parents. Most babies who have laryngomalacia don’t require any sort of treatment, and outgrow it as the tissue firms up, usually by age 6 months. A very small percentage of these babies need surgery to correct the problem.
Shapiro points out in her book that as many as 90 percent of children will, at some point, have a breathing problem. Watching your baby struggle to breathe can be terrifying, and knowing what to do about it is essential. But if your baby isn’t struggling, there’s no need for obsessive monitoring. During infancy, babies wake often enough for feeding and diaper changes that you’ll have plenty of chances to make sure yours is breathing easy.
So take a deep breath, relax and leave the cribside (but we’ll understand if you can’t resist just a peek).
Christina Elston is editor of L.A. Parent, and blogs about health at LAParent.com.
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