What is the normal respiratory rate in newborns and children?

Normal Respiratory Rate in Newborns and Children

For healthy term newborns, the normal respiratory rate ranges from 30-60 breaths per minute during the first 24 hours of life, with a median of 42-46 breaths per minute, while for infants under 1 year the range is 20-60 breaths per minute, and for children 12-59 months it is typically below 40 breaths per minute. 1, 2, 3

Age-Specific Normal Ranges

Newborns (First 24 Hours)

• Median respiratory rate: 46 breaths/minute at 2 hours of life, then 42-44 breaths/minute thereafter 3
• 95th percentile: 65 breaths/minute at 2 hours, then 58-60 breaths/minute 3
• 5th percentile: 30-32 breaths/minute 3
• The intraindividual variation is wide even within these normal limits 3

Infants Under 6 Months

• Mean respiratory rate when awake: 61 breaths/minute 4
• Mean respiratory rate when sleeping: 42 breaths/minute (significantly lower than when awake) 4
• Mean respiratory rate when crying: 51 breaths/minute (lower than awake but content babies) 4

Infants Under 1 Year

• Normal range: 20-60 breaths/minute 1
• Lower limit of concern: <20 breaths/minute (bradypnea - requires immediate attention) 1
• Upper limit of concern: ≥60 breaths/minute (tachypnea in infants <2 months) 1
• The 50th percentile decreases from 41 breaths/minute at 0-3 months to 31 breaths/minute at 12-18 months 2

Children 12-59 Months

• Median respiratory rate: Approximately 26 breaths/minute by age 2 years 5
• Tachypnea threshold: ≥40 breaths/minute 2
• Severe respiratory distress: ≥60 breaths/minute 2

Critical Clinical Thresholds

When to Be Concerned

• Tachypnea in newborns/young infants (<2 months): ≥60 breaths/minute indicates potential respiratory distress 1, 6
• Tachypnea in older infants/toddlers (12-59 months): ≥40 breaths/minute suggests possible lower respiratory infection 2
• Bradypnea in infants (<1 year): <20 breaths/minute is an alarm sign requiring immediate medical attention 1

Factors That Increase Respiratory Rate

• Awake state: Increases rate by approximately 5.2 breaths/minute compared to sleep 3
• Male sex: Increases rate by 1.6 breaths/minute compared to females 3
• Heavy meconium staining: Increases rate by 3.1 breaths/minute 3
• Mode of delivery (vaginal vs. cesarean) does NOT significantly affect respiratory rate 3

Measurement Best Practices

Technique Considerations

• Count for a full 60 seconds rather than shorter periods for most accurate measurement 2
• Measure during sleep or quiet state when possible, as crying and agitation distort respiratory patterns 1, 2, 4
• Manual measurement can be imprecise with significant intra-observer variation 1, 2
• Measurement is particularly difficult with crying, irritable, or moving children 1, 2

Common Pitfalls to Avoid

• Avoid measuring during crying: Crying paradoxically lowers the respiratory rate compared to awake-content states (51 vs. 61 breaths/minute) 4
• Don't rely on short observation periods: Neonates have high respiratory rate variability even over short time periods; continuous or repeated monitoring is preferable to single measurements 7
• Beware of inappropriate reference ranges: Using incorrect normal values leads to inaccurate tachypnea determination and misdiagnosis of conditions like pneumonia 1, 2
• Remember state-dependent variation: The same infant can have a 19 breaths/minute difference between sleeping (42) and awake (61) states 4

Special Considerations for CPR Context

Respiratory Rate During Resuscitation

• For infants and children with pulse but inadequate respiratory effort: Give 1 breath every 2-3 seconds (20-30 breaths/minute) 8
• During CPR with advanced airway: Target 1 breath every 2-3 seconds (20-30 breaths/minute), accounting for age and clinical condition 8
• Rates exceeding 30 breaths/minute during CPR may compromise hemodynamics 8