Difficulty Breathing and Intercostal Retracting

“Intercostal retraction” is a term used by medical professionals for when the intercostal muscles (the muscles between the ribs) pull inward when a person is inhaling. It is most commonly seen in people with asthma or other chronic lung diseases, but it may also occur in children or adults who have a respiratory illness and are having trouble breathing.

Doctor examining young girl
Blend Images / Jose Luis Pelaez Inc / Getty Images

When looking at the chest of a person with retractions, they may have a skeletal appearance. The skin pulls in and out between each rib with each breath, and you may be able to “count ribs.” If the appearance of the ribs is unusual or becomes more pronounced with each breath, the person is probably experiencing retracting. If you suspect retracting or aren’t sure because the person is overweight or has a large abdomen, look around the neck and collarbone area. Often it will appear that the skin is being pulled in when breathing in these areas as well.

What You Should Do

Retracting is a serious sign of difficulty breathing and one that shouldn’t be ignored. The more pronounced it is, the more difficulty the person could be having getting adequate oxygen. Retracting can occur in children even if they don’t appear to be having trouble with their breathing. It’s a sign that a person is working harder to breathe than they should be and may not be getting enough oxygen.

If you or your child has no history of asthma or reactive airway disease and you notice retracting, seek medical attention right away.

If you or your child has asthma, you are probably familiar with retracting and what it looks like. If you notice it, follow your asthma action plan. If you don’t have an asthma action plan and the retracting does not improve after using a fast-acting inhaler or nebulizer treatment, seek medical attention.

Other Signs to Watch For

You may not always be able to see a person’s ribs if they are having trouble breathing. Other signs to watch for include:

  • Wheezing (a high-pitched whistling sound when breathing out)
  • Nasal flaring
  • Frequent coughing
  • Blue or grayish color on the face or lips
  • Appearance that the neck muscles are being used to breath

Children who are having difficulty breathing do not always show signs that adults would recognize. It’s important to know what to watch for, even if your child has no history of breathing problems.

Retracting is a term you may not be familiar with, but knowing what it is and what to do if you see it could save someone’s life. If you are in doubt about what you are seeing, seek medical attention to be safe. Ignoring signs that indicate a person is having a hard time breathing could be life-threatening.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Library of Medicine: MedlinePlus. Intercostal retractions.

  2. World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. 2nd ed. Geneva, Switzerland: World Health Organization; 2013.

By Kristina Duda, RN
Kristina Duda, BSN, RN, CPN, has been working in healthcare since 2002. She specializes in pediatrics and disease and infection prevention.