Newborn Breathing Patterns: What’s Normal?

April 30, 2023

The pauses, the quick breaths, the tiny sighs of your newborn; it all looks so different from adult breathing. This guide, Newborn Breathing Patterns: What’s Normal? written with input from Let Mommy Sleep’s registered nurses and newborn care experts, explains what’s normal, when to call the pediatrician and how to help your baby breathe comfortably.

Normal newborn breathing is 40 to 60 breaths per minute and often includes short pauses of 5 to 10 seconds, grunting, snorting, and irregular rhythms, all of which are completely normal. Blue lips or tongue, breathing faster than 60 breaths per minute, or pauses longer than 20 seconds require immediate medical attention.

Your newborn breaths differently than you because up until birth, baby’s lungs were filled with amniotic fluid. They didn’t need to breathe on their own because oxygen was received from the placenta. Adapting to breathing air instead of fluid happens right away, but the lungs and airway passages are underdeveloped compared to an adults.

Here is a breakdown of what normal newborn breathing looks like, and when to call the doctor:

Normal breathing patterns for newborns can vary depending on their age, activity level, and sleep state but there are general guidelines to keep in mind.

• 40-60 breaths per minute

You can assess your newborn’s breathing by looking at their abdomen. Your infant’s abdomen rises and falls with each breath.  The normal rate is 40-60 breaths per minute in the healthy, full-term infant (counted for a full minute), and will vary depending on whether she or he is sleeping, awake, active, or crying.  (More info in this study on UptoDate)

• Apnea

A baby born preterm, or before 37 weeks gestation, is at risk for apnea. Apnea is a pause in breathing for more than 20 seconds. For any parent, this is a very long time! The good news is that pauses that are 5-10 seconds long are completely normal.  These short pauses, also called periodic breathing, are commonly seen in preterm infants.  After 15 seconds, the baby needs stimulation to resume breathing such as rubbing his or her back, arms, or legs, suggested in this article on KidsHealth.org.  If your baby is prone to Apnea, the hospital will monitor this closely and may prescribe an apnea monitor upon leaving the hospital so you will know if baby ever needs stimulation.

If your baby requires home monitoring due to apnea or respiratory concerns, read Infant Pulse Oximetry: Owlet and More for guidance on prescription versus consumer devices.

• Skin Color and Newborn Breathing

Another good indication that your baby is breathing well is his or her skin color.

• Pink skin = good perfusion of tissues = good breathing.
• Blue hands, feet, and around the mouth are actually normal in newborn babies too.   This is called acrocyanosis and is often seen the first few days of life while newborns transition to life outside the womb.
• Blue INSIDE the mouth is not normal and suggests that baby is not breathing well. 911 should be called immediately if this occurs at home. More on this below.

Luckily, breathing issues will resolve on their own as your baby’s brain and spinal cord mature and muscle tone strengthens. You can help your baby breathe best by laying baby on his or her back on a firm, flat crib or bassinet to ensure baby’s airway is open.

• Obligate Nose Breathing

Babies are obligate nose breathers, which means they breath through their nose primarily. This is because they are born with relatively small nasal passages and underdeveloped lungs compared to adults.

How long are babies obligate nose breathers? Most babies develop the ability to breathe through their mouth around 3 to 4 months of age as their airways and lungs mature. Until then, keeping nasal passages clear with saline drops or a bulb syringe is especially important. How to Use a Bulb Syringe

• Grunting and Noisy Breathing

Parents might surprised by how LOUD their babies can be! Newborns often make noises while breathing, including during sleep. Grunting, snorting, or whistling are perfectly normal. These noises are usually harmless and may be due to their small nasal passages. Grunting in particular may also be due to normal digestion. Remember that the hard work of eating, digesting and ultimately passing breastmilk or formula is new to your baby’s system.

Sometimes grunting can be a sign of gastroesophageal reflux (GER), a common condition where stomach acid flows back up into the esophagus and makes baby uncomfortable. If grunting is accompanied by spitting up, irritability, and poor weight gain and you’re concerned, contact your pediatrician.

When to Call the Doctor or 911:

Below are signs of respiratory distress that while rare, require immediate medical attention:

• Rapid breathing – breathing faster than usual, taking more than 60 breaths per minute.
• Flaring nostrils – Flared nostrils during breathing show that baby is working harder than normal to breathe.
• Retractions – The skin between the ribs or under the ribcage may be sucked in with each breath.
• Grunting – Sounds of grunting with each breath, instead if just once in a while.
• Wheezing – Baby may consistently make a high-pitched whistling sound when they breathe.
• Cyanosis – The baby’s skin, lips, or nails may turn blue or grayish in color. This is different than acrocyanosis which is temporary and normal as newborns circulatory systems adjust to life outside the womb.
  • A new presentation of cyanosis is a sign of low levels of oxygen in the blood. New cyanosis is serious.
  • Persistent cyanosis is a sign of an underlying medical problem.
• Lethargy: Weak or unresponsive, with little energy to cry or move.

When to Call the Doctor or 911

Sign	What It May Mean	What to Do
Breathing pauses >20 sec	Possible apnea	Call pediatrician or 911
Blue lips/tongue	Low oxygen	Emergency – call 911
Flaring nostrils/retractions	Working hard to breathe	Contact pediatrician
Lethargy or poor feeding	Possible infection or distress	Call pediatrician ASAP

How to administer Choking First Aid to infants in an emergency.

Babies are born with relatively small nasal passages and underdeveloped lungs compared to adults. Overwhelmingly this is not cause for concern but parents and infant caregivers should always contact the child’s pediatrician if they’re concerned about baby’s health.

What Can Parents Do

To help your baby breathe comfortably:

• Keep baby on their back for every sleep.
• Use a firm, flat surface without loose bedding.
• Keep nasal passages clear with saline drops or a bulb syringe when needed.
• Avoid smoking or strong fragrances near baby.
• Stay calm; while most newborn breathing quirks are completely normal it’s never wrong to contact your pediatrician for reassurance and guidance.

Read Your First Week Home with Baby: Ultimate Q&A for more information like this.

Let Someone Else Watch Tonight

If your newborn’s breathing patterns are keeping you up at night, that’s exactly what Let Mommy Sleep is here for. Our RN-led newborn care specialist model means monitoring and overnight care across 26 territories nationwide. Find care in your area. We are here to help.

Reviewed by: Kathleen Hager, RN, BSN, Perinatal Nurse and Newborn Care Specialist
Edited by: Let Mommy Sleep Clinical Team