What Are Substernal Retractions?
Substernal retractions are a clinical sign indicating difficulty in breathing, where the soft tissue under the breastbone (sternum) is drawn inward during inspiration. This occurs due to increased negative pressure in the chest cavity, often seen in children experiencing respiratory distress. What Causes Substernal Retractions?
The primary cause of substernal retractions is increased work of breathing due to airway obstruction or lung pathology. Common conditions in
pediatrics that can lead to this symptom include
bronchiolitis,
asthma,
pneumonia, and
croup. In these conditions, the airways are narrowed or blocked, requiring extra effort to inhale air.
How Are They Diagnosed?
Diagnosis of substernal retractions is primarily clinical, observed during physical examination. A healthcare provider will note the child's breathing pattern, particularly the inward movement of the chest wall below the sternum. Further assessment may involve auscultation with a stethoscope to listen for abnormal lung sounds and possibly imaging such as a chest X-ray if an underlying pulmonary condition is suspected.
What Are the Associated Signs and Symptoms?
In addition to substernal retractions, children may exhibit other signs of
respiratory distress, such as nasal flaring, use of accessory muscles, tachypnea (rapid breathing), and cyanosis (bluish discoloration of the skin due to lack of oxygen). Parents might notice their child becoming more irritable or lethargic, having trouble feeding, or experiencing a persistent cough.
When Should You Seek Medical Attention?
Immediate medical evaluation is necessary if substernal retractions are accompanied by severe symptoms such as difficulty speaking or crying due to breathlessness, bluish skin or lips, or marked lethargy. These could indicate serious conditions requiring urgent intervention, such as acute asthma exacerbation or significant airway obstruction.
How Are Substernal Retractions Treated?
Treatment is directed at the underlying cause of the respiratory distress. In cases like
bronchiolitis, supportive care such as oxygen therapy and hydration may be sufficient. For
asthma, bronchodilators and corticosteroids are often used to reduce airway inflammation and obstruction. In severe cases, hospitalization and advanced respiratory support might be necessary.
What Is the Prognosis for Children with Substernal Retractions?
The prognosis depends on the underlying condition causing the retractions. Most children with viral bronchiolitis or mild asthma episodes recover fully with appropriate management. However, chronic respiratory conditions may require long-term treatment and monitoring to prevent recurrent episodes and ensure normal growth and development. Can Substernal Retractions Be Prevented?
While not all cases can be prevented, certain measures can reduce the risk of respiratory distress. Ensuring good
vaccination coverage against respiratory pathogens, avoiding exposure to tobacco smoke, and managing chronic conditions like asthma with regular follow-up and medication adherence are effective strategies.
What Should Parents Monitor at Home?
Parents should be vigilant for signs of worsening respiratory distress, such as increased frequency of retractions, changes in skin color, or altered mental status. Regular follow-up with a pediatrician is crucial for children with known respiratory conditions to adjust treatment plans as necessary and prevent complications.
