Normal Respiratory Rate In Children And When To See A Doctor

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Respiratory rate is defined as the average number of breaths per minute. It is important to know about the respiratory rate in children to ensure the proper functioning of their lungs. The respiratory rate might vary depending upon age and various factors, such as physical activity, the body’s temperature, blood pressure, and level of electrolytes in the body. The respiratory rate is a vital sign that indicates the proper functioning of the lungs, and thus, it is important to monitor it (1).

Read on to know more about the normal respiratory rate in children, factors that alter it, and when to be concerned.

Normal Respiratory Rate For Children

The table illustrates the normal ranges of the respiratory rate of children (2).

AgeRespiratory Rate (breaths/min)
Infant (birth-1year)30-60
Toddler (1-3 years)24-40
Preschooler (3-6 years)22-34
School-Aged Child (6-12 years)18-30
Adolescent (12-18 years)12-16

Source: The University of Iowa and Stead Family Children’s Hospital

Measuring Respiratory Rate In Children

Measuring the respiratory rate in children is an easy task as it can be done using observational cues. The rise in the chest indicates inhalation, while a fall signifies exhalation. Therefore, you would measure one rise and one fall of the chest as one complete respiratory cycle. Here are the steps to follow (3).

  • Ensure your child sits in an upright position
  • Set your timer to one minute
  • Start the timer and note down the number of chest wall movements
  • After a minute, compare the count with the standard chart

Do not conduct the test after any strenuous activity to avoid any discrepancies in the count. Similarly, do not let your child know that they’re under observation as they may consciously alter their breath in such observational or clinical settings. Alternatively, you may use a respiratory sensor to avoid any mistakes.

Reasons For Altered Respiratory Rate In Children

Irregular breathing is when a child’s breathing rate is higher or lower than the acceptable ranges for their age. The reasons may include the following (4) (5).

1. High respiration rate

  • Respiratory illnesses: Any underlying lung conditions could result in an increased respiration rate. Asthma, obstructive pulmonary disease, pneumonia, emphysema, or other lung infections could be the reasons.
  • Fever: It is the most common cause of increased respiration rate in children. This increase in breathing rate is a part of the body’s mechanism to get rid of the excess body heat (7).
  • Anxiety: Panic attacks may cause a child to hyperventilate. This fast breathing rate would recede on its own as the child calms down from the anxiety attack (8).
  • Heart conditions: Heart and lungs work in conjunction. Hence, any cardiovascular health issues that affect the pumping of blood may affect the lungs eventually. The lungs may compensate for this decreased heart function by increasing the respiration rate.

2. Low respiration rate

  • Overdosage: Certain narcotics, especially opioids prescribed for pain management for children, may affect the respiratory rate. An overdose of opioids could result in respiratory depression (9) (10).
  • Obstructive sleep apnea: Pediatric obstructive sleep apnea is a sleeping disorder occurring due to an obstruction in the airway during sleep. In this condition, the child may show decreased or frequent pauses in breathing while asleep (11).
  • Brain injury: Since the brain and lungs share a reciprocal relationship, respiratory dysfunction is a common complication of a brain injury (12).
  • Hypothermia: Lowering of the body temperature due to prolonged exposure to cold environment may lower the respiratory rates.

Metabolic disorders, such as hyperthyroidism or hypothyroidism, may affect breathing patterns, too. While hypothyroidism decreases the respiratory rate, hyperthyroidism increases it (13). Altered respiratory rates could have benign causes, too. For example, an increased respiratory rate after intense physical activity is common.

When To See A Doctor

A breathing rate of more than 40 breaths per minute for a child of 1-12 years or more than 20 breaths for a child older than 12 years indicates irregular breathing patterns. Fewer than 12 breaths per minute could also be a sign of a problem.

Erratic respiration rate due to a problem is mostly accompanied by other signs of respiratory distress. It may help parents determine if the change in respiration rate is normal or due to an underlying condition. Below are some of the notable signs of respiratory distress in children (14) (15) (16).

  1. Increased heart rate: A rapid heart rate could be observed with a decrease in oxygen levels in the body.
  1. Stridor: A high-pitched, wheezing sound that is audible every time the child tries to inhale. It could be an indication of an obstructed airway.
  1. Blue color change (Cyanosis): If the color of the skin is turning blue, it is an indication that the body isn’t receiving sufficient oxygen. This blue color would be more evident near the mouth, inside of lips, and nails.
  1. Grunting: A grunting sound paired with deep breaths indicates respiratory trouble.
  1. Use of accessory muscle: The muscles of the neck appear strained during inhalation.
  1. Flared nostrils: Nostrils open wide during each inhalation if the child is facing issues in breathing.
  1. Chest retractions: The muscles of the chest (between the ribs and below the ribs) get pulled in deeper than normal during inspiration.
  1. Decreased alertness: Low oxygen supply to the brain may result in fatigue and decreased response to verbal cues.

These medical conditions are an emergency and indicate a severe respiratory problem, and require immediate medical intervention.

Frequently Asked Questions

1. Why is the respiratory rate higher in children than in adults?

Children have a higher respiratory rate than adults because they have limited space in their lungs to exchange oxygen and carbon dioxide (17).

2. What is the normal respiratory rate of children while sleeping?

The normal respiratory rate of children while sleeping is as follows (18):

  • Newborn to 12 months (infants): 30 to 60 breaths per minute
  • 1 to 2 years (toddlers): 24 to 40 breaths per minute
  • 3 to 5 years (preschoolers): 22 to 34 breaths per minute
  • 6 to 12 years: 18 to 30 breaths per minute
  • 13 to 17 years (adolescents): 12 to 20 breaths per minute

The measurement of the rate of breathing doesn’t need any advanced tools, and you could check if your child is uncomfortable or faces any breathing issues at home easily. The respiratory rate for children varies as they age. Nevertheless, it is important to know their breaths per minute as this sign is as crucial as heart rate or blood pressure.

Key Pointers

  • Respiratory rate in children may be measured by counting the number of rises and falls of the chest or using a respiratory sensor.
  • High respiration rate may be due to dehydration or fever, while low respiration rate may be due to brain injury or hypothermia.
  • Consult a doctor if you notice symptoms such as increased heart rate, cyanosis, or flared nostrils in children.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Vital Signs.
    https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure
  2. Vital Signs: Normal Respiratory Rates (PICU Chart).
    https://uichildrens.org/health-library/vital-signs-normal-respiratory-rate-picu-chart
  3. Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure).
    https://www.columbiadoctors.org/treatments-conditions/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure
  4. Rapid Shallow Breathing.
    https://medlineplus.gov/ency/article/007198.htm
  5. Vital Signs.
    https://my.clevelandclinic.org/health/articles/10881-vital-signs
  6. Vega R. M. and Avva U., Pediatric Dehydration.
    https://www.ncbi.nlm.nih.gov/books/NBK436022/
  7. Fever- Children.
    https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fever-children
  8. Paulus. M. P., The breathing conundrum – interoceptive sensitivity and anxiety.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805119/
  9. O’Donnell F.T. and Rosen K.R., Pediatric Pain Management: A Review.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179554/
  10. Barbour S.J. et al., Increased tidal volume variability in children is a better marker of opioid-induced respiratory depression than decreased respiratory rate.
    https://pubmed.ncbi.nlm.nih.gov/15562983/
  11. Obstructive Sleep Apnea In Children.
    https://my.clevelandclinic.org/health/diseases/14312-obstructive-sleep-apnea-in-children
  12. Koutsoukou A. et al., Respiratory mechanics in brain injury: A review.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733457/
  13. Lencu C., Respiratory manifestations in endocrine diseases.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111483/
  14. Signs Of Respiratory Distress In Children.
    https://www.chop.edu/conditions-diseases/signs-respiratory-distress-children
  15. Signs Of Breathing Problems In Children.
    https://www.blf.org.uk/support-for-you/signs-of-breathing-problems-in-children/breathing-problems-to-look-out-for
  16. Breathing Problems.
    https://www.stanfordchildrens.org/en/topic/default?id=breathing-problems-90-P02666https://www.stanfordchildrens.org/en/topic/default?id=breathing-problems-90-P02666
  17. Breathing differences between children and adults.
    https://www.christopherreeve.org/blog/life-after-paralysis/breathing-differences-between-children-and-adults
  18. Sleep Respiratory Rate.
    https://www.sleepfoundation.org/sleep-apnea/sleep-respiratory-rate
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Dr. Neema Shrestha

(MD)
Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.Y. Patil University in 2011, MD from Nepal Medical College in 2015 and Fellowship in Neonatology from Sir Ganga Ram Hospital, New Delhi in... more

Sindusha MS

Sindusha is a clinical nutritionist with over two years of experience in diverse fields of nutrition. She did her Masters in Food Science and Nutrition and has qualified UGC-NET. She interned as a quality control analyst and as a dietitian during her graduation. She was a part of several community nutrition projects and a phytochemical-based nutrition study during the same... more