Pneumothorax in Children

A pneumothorax is an air leak in the lungs. It’s when air from the lungs leaks into the chest area. The leak may start suddenly or may develop slowly. It often occurs in the first 24 to 36 hours after birth. How serious the illness is depends on where the leak is, how quickly the leak occurs, and how much air is leaking.

The most common cause of pneumothorax is from air delivered by a breathing machine (mechanical ventilator). A baby born with a lung disease may need to be on a breathing machine.

Pneumothorax can also occur suddenly in children. But this is uncommon.

Another cause is meconium aspiration. This is when a baby is still in the mother’s uterus and breathes in its first stool (meconium). Air may then become trapped, causing the lungs to expand too much. This can lead to air leaks.

Children at risk for a pneumothorax are:

• Babies with other lung diseases such as respiratory distress syndrome
• Babies on a mechanical ventilator
• Premature babies whose lung tissue is more fragile
• Babies with meconium aspiration

Symptoms may be a bit different for each child. Some otherwise healthy babies can develop an air leak that does not cause symptoms or distress. Others may have these symptoms:

• Irritability and restlessness
• Rapid breathing
• Grunting
• Nostril flaring
• Skin on the chest sinks in around the ribs when the child breathes (chest wall retractions)
• Pale or bluish skin color

These symptoms may look like other health problems. Make sure your child sees their healthcare provider right away for a diagnosis.

Your child’s healthcare provider can diagnose a pneumothorax with a health history and physical exam. Your child may also need:

• Chest X-rays. This test makes images of internal tissues, bones, and organs. It may show air in places that is not normal, a collapsed lung, or structures in the chest that aren't in a normal position.
• Transillumination. During this test, the healthcare provider puts a fiber-optic light probe on the baby’s chest wall. The side of the chest with the air leak shows a brighter light. This test is often used in an emergency.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for a pneumothorax depends on how big it is and what symptoms it is causing. Some air leaks that don't cause symptoms or distress may get better on their own without treatment. As the leak seals over, air is absorbed into your child’s body.

For air leaks that cause symptoms, treatment may include:

• Giving extra oxygen. Giving oxygen to your child may help heal the air leak more quickly.
• Removing the collected air. The healthcare provider puts a syringe or a thin tube (catheter) through the chest wall into the air space. The air may be removed with the syringe. Or the tube may be connected to a drainage system to help remove the air until the leak can seal.

A pneumothorax in a child can lead to:

• Cardiac arrest
• Death

Even when the air pressure and settings on mechanical ventilators are carefully watched, air leaks can still happen. Your baby’s healthcare team will watch your baby carefully for signs of an air leak. If that occurs, treatment can be started as quickly as possible.

Call your child's healthcare provider if your child has any symptoms of a pneumothorax.

Call 911 if your child is having trouble breathing.

• A pneumothorax is an air leak in the lungs. It’s when air from the lungs leaks into the chest area.
• It may start suddenly or may develop slowly. It often occurs in the first 24 to 36 hours after birth.
• A baby who needs to be on a breathing machine is most at risk for a pneumothorax.
• A baby with an air leak has a hard time breathing. They may breathe rapidly or grunt.
• Treatment may include giving extra oxygen or removing the air with a syringe or tube.
• Some air leaks may get better without treatment.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.