Newborn Breathing Pauses in Sleep

The pattern has a name

The American Academy of Pediatrics describes it in its account of newborn sleep stages, and the description is unusually specific. During REM or active sleep, "breathing is often irregular and may stop for 5 to 10 seconds — a condition called normal periodic breathing of infancy — then start again with a burst of rapid breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular breathing until the cycle repeats itself."

Two more sentences from the same source do most of the reassuring: "The baby's skin color does not change with the pauses in breathing and there is no cause for concern (in contrast with apnea)." And: "Babies generally outgrow periodic breathing by about the middle of the first year."

That is the whole normal picture. Pause. Fast catch-up breaths. Settle. Repeat. Colour unchanged throughout.

Why newborns breathe like this

Newborn sleep is roughly half active sleep and half quiet sleep, and the AAP's stage description makes clear that the irregular breathing belongs to active sleep specifically. In the deeper non-REM stages, the AAP notes, twitching and other movements cease and breathing becomes more regular. So the same baby can look alarming for twenty minutes and then completely settled for the next twenty, without anything having changed.

It is also why parents notice this at 3am and not in the afternoon. You are watching a sleeping baby closely, in silence, at the point in the night when active sleep is easy to catch.

The line that matters

The AAP draws the distinction itself: periodic breathing is in contrast with apnea. The practical difference is colour and duration. A pause that goes past about ten to fifteen seconds, or any pause that comes with your baby going pale, grey, blue or floppy, is not the pattern above.

NICE's postnatal care guideline NG194 does not describe periodic breathing, but it does name what counts as an abnormal breathing pattern in a young baby, and each item is a red flag on its own:

• Grunting respirations — a short noise at the end of every breath out.
• Increased respiratory rate, over 60 breaths a minute, sustained rather than in a short burst.
• Chest indrawing — the skin sucking in between or under the ribs with each breath.

Note the difference between that 60-a-minute threshold and the AAP's figure. The AAP's 50 to 60 breaths a minute is a burst lasting 10 to 15 seconds after a pause. NICE's over-60 red flag is a rate the baby is holding. A newborn who is simply breathing fast, continuously, is not doing periodic breathing.

NICE's sepsis guideline for under-16s, NG254, sets the same line from the infection side. For a baby under one year, its high risk criteria include a raised respiratory rate of 60 breaths per minute or more, grunting, and apnoea — and a rate of 50 to 59 breaths a minute sits in its moderate to high risk band. Apnoea appearing on a sepsis risk table is the clearest signal available that pauses which are not the pattern above get taken seriously.

What does not help

The obvious response to counting pauses is to buy something that counts them for you. The AAP's position on home apnoea monitors is that they are not a way to prevent sudden infant death syndrome in healthy babies, and that home monitoring should be a medical decision for specific infants rather than a consumer purchase. The NHS makes the same point in a different form on its SIDS page: the things that reduce risk are position, environment and smoke exposure, not monitoring.

The AAP's account of newborn respiratory problems also flags the most common innocent explanation for odd breathing: "if she seems to be breathing in an unusual manner, it is most often due to blocked nasal passages", and saline drops with gentle suction may fix it. Newborns breathe mainly through the nose, so a small amount of dried mucus changes the sound of everything.

What the safer sleep advice does cover

The NHS's SIDS guidance and the general safer sleep consensus are worth following whether or not your baby has noticeable pauses: sleep your baby on their back for every sleep, in a clear, flat, separate sleep space in the same room as you for the first six months, with no loose bedding or pillows, keeping them smoke-free and not letting them get too hot. None of that is a treatment for periodic breathing. It is the intervention with actual evidence behind it.

When to call

Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand) if your baby:

• Stops breathing and does not start again, or goes limp, pale, grey or blue during a pause.
• Has lips or a tongue that look blue or grey, or skin that looks pale, ashen or mottled.
• Is grunting with each breath, drawing their chest in under the ribs, or flaring their nostrils.
• Is holding a rate above 60 breaths a minute rather than in short bursts.
• Is unresponsive or unrousable, or has a weak or abnormally high-pitched cry.
• Has a temperature of 38C (100.4F) or above, or below 36C (96.8F).

Those are NICE's red flags for serious illness in young babies, from NG194, and they overlap almost exactly with the high risk criteria in NICE's sepsis guideline NG254.

Speak to your midwife, health visitor, public health nurse or GP if: the pauses are getting longer or more frequent, your baby was born prematurely and is having pauses at home, your baby feeds poorly or tires during feeds, or you are lying awake watching them. Prematurity changes this picture and is worth naming when you call.

What to let go of

Counting is not a plan. If the pattern matches what the AAP describes — a short pause, a burst of fast breaths, then regular breathing, with no colour change — nothing needs doing, and the pattern will go by itself during the first year. If it does not match, no amount of watching will make it safer than a phone call will.