Intercostal Recession in Babies: Types of Recession Breathing, Subcostal vs Intercostal, and Sternal Signs

Intercostal Recession in Babies:

• What is Intercostal Recession in Babies?
• Types of Recession Breathing
• Subcostal vs Intercostal Recession
• Sternal Signs

What is Intercostal Recession in Babies?

Intercostal recession in babies refers to the visible sinking or retraction of the skin between the ribs during breathing. It occurs when a baby has to work harder to breathe due to airway obstruction, lung infection, or reduced oxygen exchange. Normally, breathing in infants should appear smooth and effortless, but during respiratory distress, the soft chest wall muscles are pulled inward with each breath. This is a clinical sign that the baby’s breathing effort is increased.

Because infants have more flexible rib cages and less developed respiratory muscles compared to adults, they are more prone to showing visible recessions when struggling to breathe. Common causes include bronchiolitis, pneumonia, asthma, croup, or any condition leading to airway narrowing. Healthcare providers assess the degree and location of recession—whether intercostal, subcostal, or suprasternal—to determine the severity of respiratory distress. Prompt recognition and medical attention are vital to prevent respiratory failure.

Types of Recession Breathing

Recession breathing can be categorized based on where the chest wall pulls inward during inspiration. The main types of recession seen in babies include intercostal (between ribs), subcostal (below ribs), suprasternal (above the breastbone), and supraclavicular (above the collarbones). Each type provides clues about the severity and level of airway obstruction. For example, mild intercostal recession may indicate early distress, while combined sternal and supraclavicular recession may signal severe breathing difficulty.

Healthcare professionals often observe recession in combination with other symptoms such as nasal flaring, grunting, rapid breathing, or cyanosis (bluish discoloration of lips and skin). The pattern and depth of retraction can help identify the underlying issue—whether it’s related to the upper airway, lower airway, or lung parenchyma. Documenting these signs accurately helps guide treatment decisions, including oxygen support, nebulization, or hospital admission.

Subcostal vs Intercostal Recession

Subcostal recession occurs when the skin just below the rib cage pulls inward during breathing. It often indicates diaphragmatic overuse and is common in conditions where lung compliance is reduced, such as pneumonia or bronchiolitis. This type of recession can be an early indicator of increased work of breathing, especially in infants who rely heavily on diaphragmatic movement to breathe.

Intercostal recession, on the other hand, involves visible retraction of the soft tissue between the ribs. It usually points to airway narrowing or partial blockage that requires the baby to use accessory muscles for breathing. In clinical practice, both subcostal and intercostal recessions are assessed together to gauge the severity of respiratory distress. The presence of multiple types of recession, particularly along with nasal flaring or head bobbing, often signals a need for urgent medical evaluation and potential oxygen or ventilatory support.

Sternal Signs

Sternal retraction (also called suprasternal or substernal recession) occurs when the area around the breastbone visibly sinks during inspiration. This is a more severe form of respiratory distress, indicating significant airway obstruction or reduced lung compliance. It usually accompanies other types of recession and may occur in conditions such as severe bronchiolitis, croup, or congenital airway abnormalities.

Clinicians use sternal signs as part of an overall respiratory assessment in babies. When combined with fast breathing, chest indrawing, or grunting, it suggests that the baby is tiring and may soon experience respiratory failure if not treated promptly. Sternal retraction should always be considered a warning sign requiring immediate medical attention. Early intervention with oxygen therapy, suctioning, or mechanical ventilation can be lifesaving in such cases.