Respiratory retractions refer to a drawing in of the muscles between the ribs when a person inhales. It indicates that someone is having difficulty getting enough air into their lungs.

Respiratory retractions can affect children and adults, and many conditions — such as asthma, pneumonia, and severe allergic reactions — can cause them.

If respiratory retractions occur, someone should seek medical attention immediately. Emergency treatment may include oxygen as well as medications to reduce swelling. Once the immediate threat is over, a doctor will endeavor to diagnose and treat the underlying condition.

This article examines respiratory retractions and their causes. It also looks at the symptoms of respiratory retractions and some potential treatment options.

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The intercostal muscles lie between the ribs. When a person inhales, these muscles tighten, which pulls the rib cage up and expands the chest.

People with intercostal respiratory retractions experience difficulty inhaling, so the muscles tighten with more force to breathe in more air. This causes a drawing in of the muscles and tissues between the ribs as they suck inward.

Retractions indicate that pressure in the chest cavity is lower than usual, stemming from a blockage in the windpipe down to the bronchioles, which are the small airways in the lungs.

Intercostal respiratory retractions are a symptom of severe respiratory distress because a person is unable to take in enough oxygen. When they happen, the individual needs emergency treatment.

Many conditions and factors can lead to respiratory retractions, including:

  • Asthma: This is a chronic lung condition wherein the airways may narrow and inflame. During a severe asthma episode, respiratory retractions may occur, raising the risk of acute respiratory acidosis. This is a condition of blood acidity from the inability to remove carbon dioxide.
  • Epiglottitis: The epiglottis is the cartilage under the tongue that covers the windpipe during swallowing. Epiglottitis involves the inflammation of the structure, leading to swelling of the upper airways and cessation of breathing. Intercostal respiratory retractions are one of the symptoms of a severe case of epiglottitis.
  • Pneumonia: This is an infection of the lungs that causes mild-to-severe illness. It can occur in both adults and children. If a person’s symptoms include respiratory retractions, it is an indication that their pneumonia is severe.
  • Severe allergy: Anaphylaxis is a life threatening, whole-body allergic reaction. Retractions are one symptom of anaphylaxis resulting from a severe allergy to a food or another substance.
  • Croup: A common respiratory illness that occurs mainly in young children and affects the windpipe, voice box, and airways in the lungs, croup can lead to a barking cough. Other symptoms of croup include retractions, nasal flaring, and a fast breathing rate.
  • Swallowing a foreign object: Children tend to explore the world with their mouths, so they may swallow an object that lodges in the airway, resulting in aspiration and possible asphyxiation. Choking may produce retractions as a sign of respiratory distress.
  • Respiratory distress syndrome: A condition that affects newborns, respiratory distress syndrome occurs most frequently in infants born before 28 weeks of pregnancy. The condition causes infants to have to work harder to breathe. Retractions are a common symptom.
  • Bronchiolitis: Acute viral bronchiolitis is a wheezing illness that links to an upper respiratory tract infection. It typically affects children under the age of 2 years. Intercostal respiratory retractions are a typical symptom.
  • Retropharyngeal abscess: A collection of pus in the back of the throat, retropharyngeal abscesses are most common in children under the age of 5 years. Intercostal respiratory retractions indicate that the condition is obstructing the airway.

When intercostal respiratory retractions occur, the skin and tissues between the ribs pull in and out with each breath. In some people, the ribs may appear more prominent with each breath.

In people with obesity, these changes may not be noticeable, but they may cause a pulling in around the neck and collarbone area when inhaling. This indicates that muscles in the neck that can assist breathing are contracting with more force to help the person inhale.

Intercostal respiratory retractions may be a symptom of respiratory distress. When this occurs, breathing is visibly labored. Accompanying symptoms may include:

  • fast breathing
  • grunting when breathing out
  • flaring of the nostrils when breathing in

According to a 2017 paper, doctors can typically identify respiratory retractions through observation, and no equipment is necessary to make a diagnosis.

However, since several conditions can produce retractions, healthcare professionals tend to order various tests to identify the underlying cause. The specific tests, laboratories, and imaging options will depend on the suspected underlying condition, but they may include:

If the respiratory retractions are severe enough, emergency treatment may be necessary. This may include oxygen and medications to decrease swelling.

Once the emergency is over, a doctor will endeavor to identify the cause so that they can treat it. For instance, if tests show the presence of bacterial pneumonia, they will treat this with antibiotics.

The outlook depends on the severity of the intercostal respiratory retractions and whether treatment can eliminate or control the underlying cause. For example, if antibiotic treatment for pneumonia eradicates the infection, the retractions should disappear and not reoccur unless the pneumonia returns.

Additionally, chronic conditions such as asthma may need continuous monitoring and treatment for symptom management to prevent a recurrence.

Respiratory retractions occur when a person develops a blockage in the windpipe or large and small airways of the lungs. Because an airflow blockage prevents the intake of enough oxygen, the intercostal muscles need to work harder during inhalations.

This results in the drawing in of tissues between the ribs, which indicates a serious difficulty in breathing. Because this is a life threatening concern, a person needs emergency medical treatment.