Dear Doctor,

I recently gave birth to a baby girl. She will be two weeks old on Sunday. However, I’ve noticed her breathing is very heavy, mostly in her sleep. When she’s awake, she seems okay. I don’t know if she’s getting the flu or if she has asthma. I have never given her anything else like formula as she breastfeeds well. She doesn’t have a temperature either so I don’t know why she sounds like she has difficulty breathing. Sometimes, when I place her next to me, it stops. What could this be? Is it normal for her age?

Amina

Dear Amina,

It is indeed worrying for a new parent if she notices that the baby is breathing abnormally. The breathing of a new born is cyclical and in which the cycle is not set. Sometimes it may sound like a grunt, a snort, or it could be calm and even for a moment, there may be apnoea, that is, it may stop just for a moment.

However, the breathing can be watched by the movements of the chest. It can also be felt by gently placing a hand on the chest, or heard by placing an ear on the chest. A premature baby has problems in breathing initially as the lungs are still immature. But this is cared for in premature baby units where the baby is given oxygen. A new born infant can have some breathing trouble for a short time because of the residual foetal fluid that clears off spontaneously as the baby is delivered.  A baby may breathe abnormally if there is throat or chest infection, causing difficulty in breathing. 

Pneumonia is infection of the lungs, where the lung tissue is infected. An infant with pneumonia will have laboured and very rapid breathing, with blueish discolouration around the lips and tip of tongue.  Viral pneumonia usually settles within a week spontaneously. Bacterial pneumonia is associated with high fever, excess crying and refusal to take feeds. Untreated, bacterial pneumonia can lead to complications. There can be respiratory failure and death or infection can pass via blood stream causing septicaemia or infection of the brain tissue. Sudden infant death syndrome (SIDS) is unexplained death of a baby in sleep, presumably due to suffocation. The death usually occurs around midnight to the early morning hours. It occurs silently and post mortem reveals nothing. Exact cause of SIDS is not known but certain factors are postulated to make a baby susceptible to it. Sleeping on the stomach or sides, exposure to tobacco smoke, overheating, accidental suffocation due to sharing the bed with someone older or being smothered by a toy or pillow, are some of these factors.

Before full time of gestation, congenital heart diseases can also cause SIDS. Genetic factors also play a role.  SIDS can be prevented by avoiding loose bed clothing, putting the infant on her back to sleep, avoid keeping toys or any object close to the baby while it sleeps. If the baby shares a bed with the mother, the mother should ensure that she avoids sleeping with her back to the child.

As such if the baby does not have very rapid breathing, fever is absent, there is no excess crying, refusal to feed or blueish discolouration of lips, there is nothing to worry about.

Dr. Rachna Pande is a specialist in internal medicine.

E-mail- rachna212002@yahoo.co.uk