The respiratory rate (RR) reflects the number of breaths a person takes each minute. This rate indicates how effectively the body takes in oxygen and expels carbon dioxide. For both children and adults, the breathing rate is a standard metric used to assess overall physical condition and detect potential health issues. Monitoring a child’s respiratory rate is particularly informative because a change in their breathing pattern is often the first sign of illness or distress. A child’s respiratory system is distinct from an adult’s, resulting in a normal breathing rate that is significantly higher and more variable across different stages of development.
Defining Normal: Age-Specific Ranges
A child’s normal resting respiratory rate changes dramatically as they grow from a newborn into an adolescent. These ranges decrease steadily as the child’s lungs and body mature. A rate considered normal for an infant would be unusually rapid for a school-age child. Understanding these age-specific limits is necessary for correctly interpreting a child’s breathing pattern when they are calm or asleep.
The highest rates are seen in the youngest patients. A newborn’s rate can range from 30 to 60 breaths per minute while at rest. Infants, aged one to 12 months, maintain a high expected rate, typically between 30 and 60 breaths per minute. This rapid rate reflects their smaller airways and the relatively higher oxygen demand of their growing bodies.
By the time a child reaches the toddler years (one to three years old), the resting range drops to approximately 24 to 40 breaths per minute. Preschoolers (three to five years) have a slightly lower expected range of 22 to 34 breaths per minute. This downward trend continues into the school-age period (six to 12 years), where the rate settles between 18 and 30 breaths per minute. Once children reach adolescence (12 to 18 years), their resting respiratory rate is similar to that of an adult, typically ranging from 12 to 16 breaths per minute.
Accurate Measurement Techniques
Obtaining an accurate count of a child’s respiratory rate requires observation when they are completely at ease. The most reliable measurement is taken when the child is asleep or quietly resting, as upset or movement will artificially increase the count. Parents should choose a moment when the child is calm and unobtrusive observation is possible.
To count breaths, watch the rise and fall of the child’s chest or abdomen; one full cycle of inhalation and exhalation counts as a single breath. Do not let the child realize they are being monitored, as self-consciousness can cause them to intentionally alter their breathing pattern. Counting the breaths for a full 60 seconds provides the most accurate rate. Counting for 30 seconds and multiplying by two can also be used if timing is difficult. For very young children, placing a hand lightly on the back or abdomen may help perceive the subtle movements of breathing more easily.
Common Factors Affecting Respiratory Rate
Fluctuations in a child’s respiratory rate are a normal response to various non-illness factors throughout the day. Physical activity, such as running or vigorous play, naturally causes the rate to increase as the body meets the higher demand for oxygen. Strong emotions, including crying, excitement, or anxiety, can also lead to a temporary spike in the number of breaths per minute.
When a child has a fever, their breathing rate often rises as a mechanism to help the body dissipate excess heat. Conversely, during deep sleep, the rate typically slows down and can sometimes appear irregular, which is a normal variation from the resting awake rate. These temporary changes are usually not concerning, provided the child’s breathing returns to the normal resting range once the activity or emotional trigger has passed.
Recognizing Signs of Respiratory Distress
While a respiratory rate outside the normal range can indicate a problem, physical signs of labored breathing often convey more information about a child’s true condition. One noticeable sign of difficulty is the use of accessory muscles, known as retractions. This occurs when the skin visibly pulls inward under the breastbone, between the ribs, or above the collarbone with each inhalation as the child struggles to draw air into the lungs.
Another common sign is nasal flaring, where the nostrils widen with each breath as the child attempts to maximize air intake. An audible grunting sound, especially on exhalation, is a serious sign that the body is trying to keep air sacs in the lungs open to improve oxygen exchange. Other concerning sounds include: wheezing (a high-pitched whistling sound typically heard when breathing out) and stridor (a harsh, high-pitched sound heard when breathing in, suggesting an upper airway blockage).
Changes in color, such as a bluish tint around the mouth, on the lips, or on the fingernails, indicate low oxygen levels and warrant immediate attention. The child may also appear pale or ashen. Behavioral signs of poor oxygenation include lethargy, extreme tiredness, or an inability to feed or speak normally due to the effort of breathing. If a child exhibits any of these physical signs of distress, or if their respiratory rate is persistently very high or very low, emergency medical services should be contacted immediately.