Which physical finding indicates increased work of breathing in a child?

• A. Nasal flaring
• B. Stridor
• C. Intercostal retractions
• D. Grunting

Answer: (C)

Increased work of breathing in a child is best signaled by intercostal retractions, which are the inward pulling of the chest wall between the ribs during inspiration. This happens because the child’s airways or lungs require greater effort to draw air in, so the accessory muscles—especially those between the ribs—pull the chest wall inward to try to assist ventilation. Children have a more compliant chest wall, so these retractions become a visible and reliable cue that breathing is laboring.

Nasal flaring can accompany distress but is a less direct measure of the work being done. Stridor points to an upper airway obstruction rather than overall respiratory effort. Grunting reflects attempts to stabilize or improve oxygenation and airway opening, often seen with specific lung conditions, but it is not as direct a measure of work of breathing as intercostal retractions.