Which type of retraction indicates severe breathing difficulty?

Severe breathing difficulty in pediatric patients can manifest through various forms of retractions, which indicate the effort required to breathe. Supraclavicular retraction occurs above the clavicles where the major muscles of respiration are located. This type of retraction suggests significant respiratory distress, as it indicates that the child is using accessory muscles to aid in breathing because their primary respiratory effort is insufficient.

When a child exhibits supraclavicular retractions, it usually indicates that the airway is compromised or that there is a severe obstruction, leading to labored breathing. Such retractions occur when there is a marked increase in the work of breathing, potentially due to conditions such as severe asthma, pneumonia, or acute respiratory distress.

Understanding the various types of retractions can help clinicians assess the severity of a child’s respiratory condition. Although subcostal, intercostal, and substernal retractions are indicative of respiratory distress, they do not typically signify the same level of severity as supraclavicular retractions, which reflect the most extreme need for respiratory support.