Pneumomediastinum (pronounced noo-moh-mee-dee-uh-STY-num) is a condition in which air gets trapped in the mediastinum — the space in the middle of the chest that holds the heart, windpipe, esophagus (food pipe), and major blood vessels. It usually happens because of a sudden rise in pressure inside the chest — for example, during a bad asthma flare-up, hard coughing, vomiting, intense exercise, or a chest injury.

Common symptoms can include chest pain, cough, shortness of breath, and trouble swallowing.

Your child needs to rest and avoid strenuous activity. This will prevent more air from going into the mediastinum and let the body heal. Once they are cleared by your healthcare provider (usually within about 2–4 weeks), they will be able to gradually go back to sports and all of their usual activities.

Follow your healthcare provider's instructions for:

• Activities that your child should avoid, such as:
  • Hard exercise
  • Heavy lifting
  • Blowing up balloons or playing a wind instrument
  • Scuba diving
  • Yelling, crying, and coughing (as much as possible)
• Treating any other conditions, such as asthma or vomiting.
• Medicines that are OK to give for pain, such as acetaminophen (Tylenol® or a store brand) or ibuprofen (Advil®, Motrin®, or a store brand). Follow the directions on the label for how much to give and how often.
• What treatments to try if your child is coughing, such as giving a teaspoon of honey (for children over 1 year), running a humidifier, or giving cough medicine (for children over 6 years).
• When to follow up to check your child's progress and when your child can increase their activities.

• Your child has new or worsening chest pain, coughing, or face or neck swelling.
• Your child's pneumomediastinum was caused by vomiting and the vomiting continues.

Your child has:

• worsening shortness of breath or trouble breathing
• severe chest pain

You know your child best. If they have symptoms that worry you or seem very sick, call your healthcare provider or take your child to the ER.

What are the symptoms of pneumomediastinum? Sometimes kids don't have any symptoms of pneumomediastinum, and it is found when a chest X-ray is done for other reasons. When symptoms do happen, children may have chest pain, shortness of breath, coughing, a crackling feeling under the skin of their neck or chest due to air bubbles or pockets of air, neck pain or swelling, painful swallowing or trouble swallowing, and a hoarse voice.

Can pneumomediastinum lead to other problems? Most kids recover fully and don't develop other problems. Rarely, pneumomediastinum can cause more serious medical issues, like pneumothorax (a collapsed lung) or too much pressure on the heart.

When can my child go back to all activities, including sports? It usually takes about 2–4 weeks to fully heal from pneumomediastinum. Your child's healthcare provider will follow their progress and let you know when it's OK for your child to gradually go back to all activities, including sports.

Can pneumomediastinum come back? It's rare for pneumomediastinum to come back, but it's more likely in kids with lung conditions, such as asthma.