Intercostal retractions are the inward movement of the muscles between the ribs as a result of reduced pressure in the chest cavity. The movements are usually a sign of difficulty with breathing.

The chest wall is flexible, which allows for normal breathing. Cartilage that attaches the ribs to the sternum (breast bone) allows free movement of bony structures so that the rib cage can expand and contract. During breathing, the muscles between the ribs (intercostal muscles) contract and pull the rib cage upward while the diaphragm moves downward, thus increasing the volume of the chest cavity and causing air to be drawn into the lungs.

When the trachea (upper airway) or the smaller bronchioles (small airways of the lungs) become partially blocked so that air flow is restricted, the normal increase in chest cavity size reduces the pressure within the chest and the intercostal muscles are drawn inward, between the ribs. This sucking in of the chest muscles is a sign of airway obstruction. Diseases or conditions that cause restriction of the airway will cause intercostal retraction.

• Croup
• Pneumonia
• Bronchiolitis
• Foreign body in the trachea (see foreign object aspiration or ingestion)
• Epiglottitis
• Asthma
• Anaphylaxis
• Retropharyngeal abscess
• Respiratory distress syndrome

This is an emergency requiring immediate medical attention.

• Intercostal retractions occur. This can be a sign of airway obstruction, which can quickly become life-threatening.
• Other symptoms are also present. If the skin, lips, or nailbeds are blue, or if the person becomes confused, drowsy, or hard to awaken, this is an emergency situation!

In emergency situations, interventions will be taken first to help with the breathing. This may include oxygen, medications to reduce swelling, or other measures.

When the condition is stable enough to allow it, the history will be obtained and a physical examination performed to determine the cause of the airway obstruction.

Medical history questions documenting intercostal retractions in detail may include:

• Time pattern
  • When did it start?
  • Is it getting better, worse, or staying the same?
  • Does it occur all the time?
• Intensity
  • How bad is it?
• History
  • Did you notice anything significant that might have caused an airway obstruction?
  • Have you or the child been ill, coughing, or complaining of a sore throat?
  • Have you seen the child putting anything in the mouth that might have been inhaled into the airway?
  • What other symptoms are also present? Especially, did the child turn blue, wheeze, or have a high-pitched sound when breathing (stridor)?

Diagnostic tests may include:

• Arterial blood gases
• Chest x-ray
• Laboratory tests, such as a CBC
• Other tests depending on the suspected cause