An infant who is not breathing normally but still has a pulse signals a respiratory arrest. In this situation, the lungs have stopped exchanging oxygen and carbon dioxide effectively, but the heart is still circulating blood. Since the heart will soon fail without oxygen, immediate intervention is required to restart ventilation and prevent a full cardiac event. Understanding the signs of respiratory distress and having a clear action plan is crucial until professional medical help arrives.
Recognizing the Signs of Respiratory Distress
Identifying the early signs that an infant is struggling to breathe is the first step in preventing a full respiratory arrest. One of the clearest indicators is a change in skin color, known as cyanosis, which appears as a bluish tint around the lips, on the tongue, or beneath the fingernails due to low blood oxygen levels. The infant’s breathing pattern may become significantly altered, manifesting as either an abnormally fast, shallow rate (tachypnea) or an extremely slow, gasping pattern (bradypnea).
The physical effort required for breathing becomes visibly apparent as the infant attempts to draw more air into their lungs. Caregivers may observe retractions, which are the visible sinking in of the skin between the ribs, just below the neck, or under the breastbone with each inhalation. Auditory cues like a grunt heard on exhalation, or a flaring of the nostrils as the infant strains for air, also signal severe distress. A rapid heart rate alongside cool, clammy skin can indicate that the body is compensating for a lack of oxygen before breathing stops entirely.
Immediate Emergency Protocol
The immediate and primary action must be to call emergency medical services (911 or local equivalent) for assistance. Once the call is placed, the infant should be carefully positioned on a firm, flat surface to facilitate resuscitation efforts. The caregiver must quickly check for a pulse, typically at the brachial artery on the inside of the upper arm, for no more than 10 seconds to confirm the heart is still beating.
With a pulse confirmed but no effective breathing, the immediate intervention shifts to delivering rescue breaths. The infant’s head should be placed in a neutral or slightly “sniffing” position to open the airway, taking care not to overextend the neck. The rescuer must then cover the infant’s mouth and nose completely with their mouth, forming a tight seal. Deliver a gentle puff of air, lasting about one second, just enough to make the infant’s chest visibly rise, and then watch the chest fall as the air passively exits the lungs.
The recommended rate for rescue breathing is one breath every three to five seconds, which equates to approximately 12 to 20 breaths per minute. This sustained ventilation is designed to reoxygenate the blood and signal the infant’s respiratory center to resume breathing. The caregiver must continue this process, rechecking the pulse approximately every two minutes. If at any point the infant’s heart rate drops below 60 beats per minute, or if the pulse is lost entirely, chest compressions must be added, transitioning the rescue to full cardiopulmonary resuscitation (CPR).
Potential Causes for Breathing Failure
When an infant experiences respiratory arrest while maintaining a pulse, the cause is generally rooted in a severe respiratory or neurological compromise. A common reason is a significant airway obstruction, such as choking on a small foreign object or food, which physically blocks the flow of air into the lungs. Upper airway infections like Croup or lower airway illnesses such as bronchiolitis, often caused by the Respiratory Syncytial Virus (RSV), can lead to so much swelling and mucus buildup that the air passages become critically narrowed.
Systemic infections, including pneumonia or sepsis, can overwhelm the infant’s body, causing respiratory muscles to fatigue and fail, leading to an inability to sustain breathing effort. Infants born prematurely are at a higher risk due to conditions like Respiratory Distress Syndrome (RDS), where their lungs lack sufficient surfactant. Less common causes include neurological events like severe seizures or head trauma, which can disrupt the brain stem’s control center for breathing. A comprehensive medical investigation is required to rule out underlying cardiac or metabolic issues that could lead to future respiratory failure.
Transitioning to Professional Medical Care
Once emergency medical services (EMS) personnel arrive, the caregiver’s role shifts from primary rescuer to information provider. Communicate a clear timeline of events, including when the abnormal breathing was first noticed, the actions taken, and the infant’s current status (pulse maintained, rescue breaths successful). This detailed handover allows paramedics to select the most appropriate advanced interventions immediately.
Even if the infant begins breathing normally and appears to recover after intervention, transport to a hospital for a comprehensive medical evaluation is mandatory. This is necessary to identify the underlying cause of the respiratory failure and prevent a recurrence. Caregivers should also seek post-event psychological support, as experiencing an infant’s respiratory emergency is emotionally traumatic.