Paradoxical breathing or “paradoxical inward rib cage movements” without frank sleep apnea is a clinical description
of the “upper airway resistance syndrome”. Upper airway resistance syndrome is thought to be a distinct entity
and not just a part of the continuum of obstructive sleep apnea; paradoxical breathing in children appears to be a separate
entity from the classic patient with marked adenotonsillar hypertrophy causing obstructive apnea. The treatment also differs.
We present a case of paradoxical breathing in a child who resolved spontaneously over a two year period.