From the Guidelines
The normal respiratory rate for a 17-month-old child is typically between 24-40 breaths per minute, with the World Health Organization (WHO) defining tachypnea as a respiratory rate of ≥50 breaths per minute for children between 2 months and 11 months of age, and ≥40 breaths per minute for children who are 12–59 months of age 1. When assessing a child's respiratory rate, it's essential to count for a full minute while the child is calm, as activity, crying, or fever can temporarily increase the rate. Some key points to consider when evaluating respiratory rate in children include:
- Respiratory rates naturally decrease during sleep and increase with activity, so context matters when evaluating whether a child's breathing is normal.
- Tachypnea is a predictor of pneumonia in children under 2 years of age, particularly febrile children, and inappropriate reference ranges for normal respiratory rates can lead to an inaccurate determination of the presence or absence of tachypnea and, thus, inaccurate pneumonia diagnoses 1.
- Manual measurement of respiratory rate, although often the reference standard, can be imprecise and is affected by intra-observer variation as it requires focused concentration 1. If you observe a respiratory rate consistently above 40 breaths per minute in a resting toddler, or if the child shows signs of respiratory distress such as nasal flaring, grunting, retractions (visible sinking of the chest between or below the ribs during breathing), or bluish discoloration of the lips or skin, seek medical attention immediately. It's also important to note that the WHO provides tachypnea cutoffs across a broad range of ages, and other factors such as altitude can affect respiratory rate, with baseline respiratory rates of individuals at high altitudes found to be significantly higher when compared with those at sea-level 1.
From the Research
Normal Respiratory Rate for a 17-Month-Old Child
The normal respiratory rate (RR) for a 17-month-old child can be determined based on various studies.
- A study published in 1994 2 found that the respiratory rate decreases with age, and it is faster in the first few months of life.
- Another study from 1992 3 reported that the normal range of respiratory rate is inversely related to age and is higher than previously published studies.
- A 1990 study 4 defined the normal range of respiratory rate in babies under 6 months old, but did not provide specific data for 17-month-old children.
- A systematic review from 2011 5 derived new centile charts for heart rate and respiratory rate in children from birth to 18 years of age, showing a decline in respiratory rate from birth to early adolescence.
- A 1995 study 6 investigated the reliability of respiratory rate in diagnosing pneumonia among children in China, but did not provide specific data for normal respiratory rates in healthy children.
Respiratory Rate Ranges
Based on the available data, the normal respiratory rate range for a 17-month-old child can be estimated as follows:
- The 1994 study 2 provides percentile curves for respiratory rate by age, but does not give a specific value for 17 months.
- The 2011 systematic review 5 reports a median respiratory rate of 26 breaths per minute at 2 years of age, which can be used as a reference point.
- The other studies do not provide specific data for 17-month-old children.
Estimating Normal Respiratory Rate
Considering the available data, a normal respiratory rate for a 17-month-old child could be estimated to be around 24-30 breaths per minute, based on the decline in respiratory rate with age reported in the 2011 systematic review 5. However, it is essential to note that this is an estimate and may vary depending on individual factors.