Have you ever noticed that when your little one has a cold or a fever, the skin between the ribs of the chest goes in when they breathe? Or does it look like their chest is throbbing? It's normal for any mother or father to be a little scared when they see this. This is what we call Intercostal Retractions in medicine. This is an important sign of difficulty breathing. So let's talk about this in a simple and clear way today.
Simply put, what are Intercostal Retractions?
Intercostal retractions are when the muscles and skin between your ribs pull inward when you inhale. 'Intercostal' refers to the space between two ribs. This chest retraction means that there is inflammation or obstruction in the lungs, making it difficult to breathe.
Think of it this way. When we breathe normally, the muscle between our chest and abdomen, called the diaphragm, pulls down. This creates a negative pressure inside the chest, and air is drawn into the lungs. This is like drawing medicine into a syringe. But what happens if the airway, the passage through which air passes, is blocked or narrowed by mucus or something else? Even though the diaphragm pulls down, not enough air can get into the lungs.
It's like you're closing one end of a straw and sucking on the other end. No matter how hard you pull, nothing comes down the straw, instead the sides of the straw sink in. That's what happens inside the chest. Because the air isn't coming in, the muscles and skin of the chest start to pull in.
This may be normal after running and playing, but if this symptom occurs at rest, without any exertion, it is a sign of serious breathing difficulties.
What are other symptoms of shortness of breath?
Intercostal retractions are the appearance of hollows between the ribs. It's as if the ribs are being pulled in. This is especially noticeable in babies and young children because they have less body fat. Doctors may have sometimes told you to look for chest tightness if your baby is having difficulty breathing. In addition to this symptom, there are several other symptoms that can be seen if your baby is having difficulty breathing.
| Symptom | Description |
|---|---|
| Nostril flaring | The nostrils widen and narrow with each breath. |
| Rapid breathing (`Tachypnea`) | The number of breaths per minute increases significantly with age. |
| Unusual sounds | Wheezing or a harsh sound (stridor) in the chest or throat when breathing. |
| Shortness of breath | Feeling or appearing to be short of breath, even when talking. |
| Taking longer to exhale | Taking longer to exhale than to inhale. |
If you see one or more of these symptoms, especially with intercostal retractions, it is a medical emergency. Take the child or person to the nearest hospital emergency department (ETU) immediately.
Are there different types of retractions?
Yes, these can be divided into several types depending on where the skin on the chest and neck is pulled in. Based on that location, a doctor can get a rough idea of where the airway is obstructed.
| Retraction type | The place where you pull in | Often shows |
|---|---|---|
| Intercostal | Between the ribs | Lower respiratory tract obstruction. |
| Subcostal | Under the rib cage, stomach area | Lower respiratory tract obstruction. |
| Substernal | Under the breastbone | Lower respiratory tract obstruction. |
| Suprasternal (`Tracheal tug`) | In the middle of the neck, above the middle of the chest bone | Upper airway obstruction. |
| Supraclavicular | Above the collarbone | Upper airway obstruction. |
What are the main reasons for this situation?
Intercostal retractions are caused by a narrowing or blockage of the airway. This can have several causes.
- Exacerbation of diseases such as asthma or COPD: In these conditions, the airways narrow, making it difficult to breathe.
- Respiratory diseases: Especially in diseases like `RSV` virus, `COVID-19`, which is common in children.
- Respiratory tract inflammation: Conditions such as `Bronchiolitis` (inflammation of the small airways), `Croup` (inflammation of the larynx), and `Pneumonia` (pneumonia).
- Obstruction: Blockage of the airway due to something stuck in the throat (e.g., a piece of food, a toy), thick mucus, or a tumor.
- Severe allergic reaction (`Anaphylaxis`): A severe allergic reaction to a food, medicine, or insect sting can cause the airways to swell and become blocked.
- Other causes: Vocal cord paralysis, diabetic ketoacidosis, and rare conditions such as Reye's syndrome.
What treatment do doctors give for this?
When a person with intercostal retractions is brought to the hospital, the first goal of doctors is to reduce breathing difficulties and provide the body with the necessary amount of oxygen. Depending on the cause, various treatment methods are used.
- Oxygen therapy: Oxygen is given through a nasal tube or face mask.
- Nebulizer treatments: Inhaling a vapor of medication, such as bronchodilators that open the airways or corticosteroids that reduce inflammation.
- Removing the obstruction: Removing something that is stuck in the airway.
- Positive pressure ventilation: When breathing on your own is too difficult, a machine delivers air or oxygen at high pressure. This can be done through a face mask such as `CPAP` or `BiPAP` or, in very severe cases, by connecting to an artificial respirator (`mechanical ventilation`).
During this treatment, the doctor may perform several tests to find the underlying cause of this condition.
- A chest X-ray or CT scan.
- Taking a nasal swab to detect viral infections.
- Blood tests.
What are the risks if left untreated?
If the underlying condition causing intercostal retractions is not treated, the condition can worsen. In severe cases, difficulty breathing,
- Decreased oxygen supply to body tissues (hypoxia).
- Increased carbon dioxide levels in the blood (hypercapnia).
- Life-threatening complications such as complete respiratory failure can occur.
Take-Home Message
- Intercostal retractions are the pulling in of the skin between the ribs when breathing. This is an important sign of difficulty breathing .
- This characteristic can be clearly seen among young children and babies.
- If you experience this symptom while you are just standing, without any exertion, it is an emergency. Go to the nearest hospital's Emergency Department (ETU) immediately.
- This condition can occur due to various reasons, such as asthma, pneumonia, or something blocking the airway.
- Treatment opens the airways and provides the body with the oxygen it needs. It is very important not to panic when you see this condition and to seek proper medical advice quickly.
👩🏽⚕️ Additional questions (FAQs)
💬 What kind of neurological condition is tremors?
Tremors are not the same as shaking when you're cold/scared! 'Tremors' are a severe nervous system disorder in which a person's arm, leg, head, or voice shakes involuntarily (involuntary, rhythmic muscle contractions), continuously shaking/shaking like a pendulum. This makes life so difficult that you can't even hold a cup or write a letter.
💬 What are the main causes of uncontrollable tremors?
There are several main causes for this: 1) 'Parkinson's Disease' - The most dangerous symptom of this is that the patient shakes one hand when 'standing still' without doing anything (Resting tremor - like counting coins in hand). 2) 'Essential Tremor' - These people only shake when they go to get a cup/write (Action tremor). 3) An abnormally fast thyroid gland (Hyperthyroidism). 4) Stress, excessive caffeine consumption and alcohol withdrawal.
💬 Why should you see a doctor about tremors? What are the 'life-threatening/emergency situations' that require immediate hospitalization?
If you are shaking, you should definitely see a neurologist (maybe there is severe brain damage). But the biggest danger! A person who was fine can, in a matter of minutes, 1) have one arm/leg shaking, and at the same time, be unable to speak/face drooping (Stroke), 2) have their eyes rolling/lose consciousness and their whole body shaking/trembling (Seizures), so you should go to the hospital's emergency department without delay, as the patient may fall into a coma and die!
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