Periodic Breathing in Newborns: Why Irregular Patterns Are Normal

As a new parent, you’re probably worried about anything that doesn’t quite make sense, and your baby’s breathing can be one of the scariest things to watch. You might find yourself standing over the cot while they sleep, noticing how their breathing speeds up, slows down, or even pauses for a few seconds. It’s enough to make your heart race.

The good news is that this is often completely normal. It’s called periodic breathing, and it’s very common in newborns. In this post, we will explain what periodic breathing is, why it happens, what normal looks like, and when you should be concerned.

What Is Periodic Breathing in Newborns?

Periodic breathing is a normal variation in a newborn's breathing pattern. It shifts between phases of normal breathing, brief periods of rapid breathing, and short pauses. The fast breathing and pauses typically last only five to ten seconds, and they can occur in any order, not in a predictable sequence.

The key thing to understand is that during periodic breathing:

1. Your baby is comfortable.
2. They show no signs of distress.
3. Their skin color stays normal.
4. They remain relaxed and sleeping.

Research shows that periodic breathing most commonly occurs during the deeper REM phase of sleep (active sleep), or after a baby takes a deep sigh [1]. This is why you're most likely to notice it when your baby is in a deeper sleep, not when they've just drifted off.

How Common Is Periodic Breathing in Newborns?

Periodic breathing is more common than most parents realise. Around 40 percent of full-term healthy infants experience it [1]. It develops during the first month of life and usually resolves on its own by around six months of age as the brain matures.

It is seen even more frequently in premature and low birth weight infants, whose brainstems are less developed at birth. For these babies, the timeline for resolution may be a little longer.

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Why Does Periodic Breathing Happen?

To understand why newborns breathe irregularly, it helps to understand how breathing is controlled.

How Brain Development Affects Breathing?

The brainstem, the part of the brain just above the spinal cord, is responsible for regulating the rhythm of breathing. It monitors oxygen and carbon dioxide levels in the blood and sends signals to the lungs and breathing muscles to respond [2].

At birth, this system is still developing. The nerves in the brainstem haven't fully matured, which means the breathing control mechanism isn't yet running smoothly.

Over time, as the brain develops its nerve connections, periodic breathing naturally resolves. It doesn't require treatment. It simply needs time.

What About Premature Babies?

Premature infants are born with an even less developed brainstem, which means breathing stability takes longer to establish. In preterm babies, a more significant form of breathing pause called apnea of prematurity is common.

This is noticeable when you monitor your baby's breathing, seeing a pause in breathing lasting 20 seconds or longer in a baby born before 37 weeks of gestation. Nearly all infants born at 28 weeks or less experience these episodes [3].

Normal vs. Abnormal: What to Watch For

What Normal Periodic Breathing Looks Like

During a normal episode of periodic breathing, your baby will:

• Breathe rapidly for a few seconds, then pause briefly, then resume normal breathing
• Remain calm and relaxed throughout
• Keep a normal skin color with no blue or grey tones
• Show no signs of struggling to breathe

The pauses should last no longer than ten seconds. No other symptoms are present. Your baby simply continues sleeping as if nothing has happened, because for them, nothing has.

When to Act Immediately?

The line between normal periodic breathing and something that needs urgent attention is clear once you know what to look for. The following symptoms are never associated with normal periodic breathing and require immediate medical attention:

• Cyanosis: A blue or grey hue to the skin, especially around the face and lips.
• Retractions: The skin between the ribs dimples or sucks in with each breath.
• Nasal flaring: The nostrils flare outward with each breath.
• Apnea: Any pause in breathing lasting 20 seconds or longer.
• Decreased muscle tone: Your baby feels limp or "floppy" when held.
• Difficulty arousing: Your baby doesn't respond to efforts to wake them.

If you see any of these signs, call emergency services immediately. Do not wait to see if it passes.

Medical Conditions That Can Cause Abnormal Breathing

While periodic breathing is normal, there are medical conditions that can cause abnormal breathing patterns in newborns. These are worth knowing so youcan recognise when something requires medical evaluation.

1. Acute Life-Threatening Events (ALTE)

A prolonged episode of abnormal breathing can indicate what's known as an acute life-threatening event (ALTE). This describes a sudden decrease in blood flow to the brain that alters both breathing and mental status [4].

It can be triggered by an infection or gastroesophageal reflux, though in many cases the cause remains unknown.

2. Congenital Heart Defects

Babies born with a structural heart problem are at increased risk of apnea and abnormal breathing [5]. These infants may experience drops in blood oxygen levels without visibly struggling to breathe, making them harder to detect without monitoring.

3. Seizure Disorders

Repeated episodes of apnea accompanied by skin color changes or lethargy can indicate a seizure disorder. This may follow a neonatal infection or birth trauma, but can also occur without a known cause [6].

4. Infection

Infection is one of the most common causes of breathing abnormalities during the neonatal period (the first month of life). In some cases, apnea is the first and only visible sign of an infection. Prompt evaluation and treatment are essential [7].

5. Food Protein-Induced Enterocolitis (FPIES)

This is a severe allergic reaction, typically to cow's milk protein or soy in infant formula, or to rice or oat cereals when solids are introduced. Infants experience sudden apnea and lethargy after feedings as a result of FPIES.

Other symptoms include vomiting, diarrhea, and poor weight gain. This condition is managed by a gastroenterologist, who works with the family to find the right diet for the baby.

When Abnormal Breathing Is Identified

If a baby presents with concerning breathing symptoms, the evaluation is thorough:

1. Because infections are common and treatable, doctors typically test blood, urine, and spinal fluid.
2. Blood electrolyte levels are checked to rule out low glucose, sodium, or calcium, all of which can trigger seizures.
3. An EEG (a test that measures brain wave activity) may be performed if seizures are suspected.
4. If a heart defect is being considered, an EKG and echocardiogram (heart ultrasound) may be ordered, and a cardiologist may be involved in determining the best treatment plan.

Can Respiratory Risk Be Reduced?

Some steps can be taken during pregnancy to support healthy lung development and reduce respiratory risk after birth:

1. Good prenatal care matters more than most parents realise. A healthy, balanced diet with adequate iron and folate supports brain development and helps prevent anemia, both of which influence respiratory health in newborns.
2. Regular prenatal check-ups allow healthcare providers to monitor the baby's development, screen for maternal health issues, and catch potential problems early.
3. Where possible, avoiding unnecessary caesarean sections is worth discussing with your provider. When it is safe to do so, vaginal delivery is associated with better respiratory outcomes for newborns. Babies born via C-section are more likely to experience breathing difficulties in the neonatal period [8].
4. Prenatal exposure to environmental pollution has also been linked to abnormal lung development and respiratory distress in newborns. Studies show that pollution increases the risk of requiring mechanical ventilation after birth. This is a risk factor that isn't always within a parent's control, but it's worth being aware of, especially when avoiding Sudden Infant Death Syndrome (SIDS) [9].

How to Monitor Baby's Periodic Breathing?

Watching your newborn breathe and wondering if it looks right is one of those universal parenting experiences that nobody quite prepares you for. The pauses, the rapid bursts, the unpredictable rhythm, it's unsettling until you understand what's happening.

Periodic breathing is a normal, temporary part of early infancy. It reflects where your baby's brain is developmentally, and it resolves on its own as the brainstem matures. For most full-term babies, it's gone by around six months.

What matters most is knowing the difference between normal periodic breathing and the signs that need urgent attention. A baby who pauses briefly, stays calm, and keeps a healthy skin color is simply breathing like a newborn. A baby who turns blue, feels floppy, or stops breathing for 20 seconds or more needs help immediately.

When in doubt, trust your instincts. If something feels wrong, call your doctor or emergency services. You know your baby better than anyone.

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