Understanding Normal Newborn Breathing Patterns and Warning Signs

By Birth & Baby University · Last updated: October 2026 · 7 min read

Newborn breathing is loud, fast and uneven, and it often looks alarming to parents who have never watched a baby sleep. Postpartum doulas spend long stretches near sleeping babies, which means they are often the first person to hear a parent ask, “Is that normal?” The answer is frequently yes. It is also sometimes no, and the dividing line is not something a doula should have to guess at. This article explains the breathing patterns that pediatric sources describe as typical, the warning signs they list, where the sources differ, and how a doula can reassure without minimizing.

Key takeaways

Quick answer: newborns breathe faster than adults, pause briefly, sigh, snort and sometimes look like their chest and belly move in opposite directions. These patterns are usually normal. Fast breathing (more than 60 breaths per minute), flaring nostrils, grunting, ribs pulling in with each breath, or blue color are warning signs that need immediate medical contact, and a baby whose breathing stops for more than 10 seconds should be evaluated.

• The AAP lists periodic breathing, a pause of under 10 seconds often followed by quicker “catch-up” breathing, as normal when the baby is comfortable, and says a normal rate is under 60 breaths per minute.
• A systematic review of observational studies found a median respiratory rate of about 44 breaths per minute at birth in healthy children, falling to 26 at age 2 years, and noted that published reference ranges disagreed with each other.
• The AAP symptom guidance for trouble breathing says a child under 1 year with trouble breathing should go to the emergency room, and that retractions (ribs pulling in) also warrant an emergency visit.
• AAP pages differ on when periodic breathing goes away: one says usually by about 1 month, another says by about the middle of the first year.

What the research says

What typical breathing looks like. The AAP’s newborn reflexes and behavior symptom guide (from the Schmitt Pediatric Guidelines, copyright 2025) describes four normal irregular breathing patterns. Transient breathing pauses of less than 10 seconds, also called periodic breathing, are often followed by faster “catch-up” breathing and are normal if the baby is comfortable; a normal rate is under 60 breaths per minute, and the pauses usually resolve by about 1 month of age. Transient rapid breathing, in which newborns take rapid, progressively deeper breaths to expand the lungs, is normal if breathing slows to normal within a minute or so. Seesaw breathing, where the chest seems to contract as the stomach expands, is attributed to the soft rib cage of some newborns. Yawning and sighing off and on open up the lungs. The same guide lists normal noises: gurgling in the throat from saliva or refluxed milk, and nasal noises from dried mucus that usually do not mean a cold, with saline drops and, if needed, a suction bulb as the home measure. It advises calling the doctor if nasal washes do not work, if breathing becomes hard, or if pauses last more than 10 seconds.

Another AAP page, Stages of Newborn Sleep (last updated 2013), ties the pattern to REM or active sleep: breathing is often irregular and may stop for 5 to 10 seconds, then start again with a burst of rapid breathing at 50 to 60 breaths a minute for 10 to 15 seconds, and the baby’s skin color does not change, in contrast with apnea. That page says babies generally outgrow periodic breathing by about the middle of the first year. That differs from the 1 month figure in the symptom guide, and neither is a precise rule. Research on healthy newborns’ breathing rate is limited. Fleming and colleagues’ systematic review in The Lancet (2011) gathered 69 studies, with respiratory rate data for 3,881 children, and found a median of 44 breaths per minute at birth declining to 26 at 2 years. It also reported that existing reference ranges disagreed strikingly with its centile charts, often exceeding the 99th and 1st centiles, which is one reason a single “normal” number should be used cautiously. Counting a baby’s breaths in a calm moment is useful; a number alone is not a diagnosis.

What counts as a warning. The AAP’s 11 Common Conditions in Newborns (last updated March 2021) says it may take a few hours after birth to form a normal breathing pattern, after which a baby should have no further difficulty. If a baby breathes unusually, it is most often due to blocked nasal passages. It then lists signs for which parents should notify the pediatrician immediately: fast breathing (more than 60 breaths in one minute, with the reminder that babies normally breathe faster than adults), retractions, nose flaring, grunting while breathing and persistent blue skin color. The AAP’s breathing trouble symptom guide adds a triage ladder. Call 911 for severe trouble breathing (struggling for each breath), passing out or stopping breathing, or bluish lips or face. Go to the emergency room now for any age under 1 year with trouble breathing or with the ribs pulling in with each breath. The newborn guide separately says to seek care now when breathing stopped for more than 10 seconds and is now normal, and for a baby under 1 month who looks or acts abnormal in any way. Breathing trouble, the guide says, is the most common type of pediatric emergency, and the first year of life is the most dangerous time because small airways can close off quickly.

When “normal pauses” may not be. A 2024 French case series by Cheyrou-Lagrèze and colleagues describes 10 term infants with persistent, symptomatic periodic breathing after the first month. They had been referred for events such as brief resolved unexplained events, desaturation, pauses, cyanosis or signs of respiratory distress, and sleep studies found obstructive or central apnea in most of them. All improved during the first year of life. The authors describe periodic breathing as physiological in the neonatal period and usually gone within the first months, but this is a very small, selected series, not evidence about healthy babies. It illustrates why prolonged or symptomatic pauses are a reason to ask a clinician, not a reason to rely on a rule of thumb.

What this means for doulas

• Describe, don’t diagnose. “Many newborns breathe in bursts and pause for a few seconds while sleeping; the AAP lists that as normal when the baby stays comfortable and pink” is reassurance grounded in a source. “Your baby’s breathing is fine” is a clinical judgment.
• Know the red flags cold. Fast breathing, retractions, flaring, grunting, blue color, pauses over 10 seconds, or a baby who is hard to wake, limp or struggling: these should prompt a call to the pediatric provider right away, or 911 for severe distress, bluish color or stopped breathing.
• Handle stuffiness with care. Noisy nasal breathing is common, and the AAP points to saline drops and a bulb syringe, but if the baby cannot feed or breathing becomes hard, the pediatrician should be called.
• Do not use monitors as a substitute. This article does not review evidence on consumer breathing monitors, so do not recommend one as a safety measure.
• Be calm and clear. Parents who fear their baby will stop breathing need a short list of what to watch for and what to do, not a long argument.

Putting the evidence into practice

1. Prepare a one-page handout. Normal patterns on one side, red flags and who to call on the other.
2. Teach where to look. Face, lips and tongue color, chest and ribs, nostrils, and sounds when the baby is calm and unwrapped.
3. Count with the parent. If the parent asks, count breaths for a full minute while the baby is calm or asleep, since a quick count may mislead, and report the number to the clinician rather than judging it yourself.
4. Know local emergency steps. Make sure the family knows their pediatric provider’s after-hours number and when to go to the emergency room. Check that the information in your handout is current.
5. Link to related topics. Safe sleep is covered in Safe Sleep Recommendations: What Every Postpartum Doula Must Know and broader red flags in Recognizing When a Newborn Needs Medical Evaluation: Essential Red Flags for Postpartum Doulas.

Limits and uncertainty

The AAP pages cited are parent-facing and, in two cases, adapted from older or third-party protocols (one dated 2013, one 2021), and their descriptions of periodic breathing are not identical. The rate evidence is from a systematic review that itself found existing ranges disagreed with observed data, and it pools heterogeneous studies. The case series is small, retrospective and limited to infants who were referred because of symptoms. It does not review pulse-oximetry screening, consumer monitors or evidence on specific respiratory illnesses in newborns, and this article does not give a treatment plan. Premature babies and babies with medical conditions can breathe differently and need individualized guidance. When in doubt, a parent should call the baby’s clinician.

The bottom line

Newborn breathing is irregular by design, and that is usually harmless. But the same source that explains periodic breathing also lists clear signs of trouble: fast breathing, retractions, nose flaring, grunting, persistent blue color, and pauses longer than 10 seconds. A doula can help families learn the difference, stay calm with the ordinary and act immediately on the extraordinary.

Birth & Baby University’s For Doulas page sets out its postpartum doula training, recertification and mentorship for doulas who support newborn families. Confirm that any program meets your certifier’s, employer’s or state’s requirements before you enroll.

This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work. For concerns about a baby’s health, contact a pediatric provider or emergency services.

Sources and further reading

• American Academy of Pediatrics (HealthyChildren.org symptom checker; Schmitt Pediatric Guidelines, copyright 2025). Newborn Reflexes and Behavior. Read the source
• American Academy of Pediatrics (HealthyChildren.org symptom checker; Schmitt Pediatric Guidelines, copyright 2025). Breathing Trouble. Read the source
• American Academy of Pediatrics. 11 Common Conditions in Newborns (HealthyChildren.org, last updated March 2021). Read the source
• American Academy of Pediatrics. Stages of Newborn Sleep (HealthyChildren.org, last updated September 2013). Read the source
• Fleming S, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. The Lancet (2011). Read the source
• Cheyrou-Lagrèze O, et al. Persistent and symptomatic periodic breathing beyond the neonatal period in full-term infants: a case series. Archives de Pédiatrie (2024). Read the source

More for professionals: the Professionals Blog.