What is the normal range for respiratory rate in adults and children?

Normal Respiratory Rate Ranges

The normal respiratory rate for adults is 12-20 breaths per minute, while for children it varies significantly by age: newborns 30-60 breaths/min, infants <1 year 20-60 breaths/min, toddlers 12-59 months <40 breaths/min, and adolescents approaching adult values of approximately 17 breaths/min. 1, 2, 3

Adult Respiratory Rates

• Adults typically breathe 12-20 breaths per minute at rest, though clinical practice often shows clustering around 18-20 breaths/min when manually recorded 4
• The median respiratory rate in healthy adults during NREM and REM sleep is approximately 17 ± 2 breaths per minute 5
• Values of 18 and 20 breaths/min are frequently recorded as "normal" spot estimates in hospital settings, though this clustering suggests potential measurement inaccuracy rather than true physiological distribution 4

Pediatric Respiratory Rates by Age

Newborns and Young Infants (<2 months):

• Normal range: 30-60 breaths/min during the first 24 hours of life, with median 42-46 breaths/min 1
• Tachypnea threshold: ≥60 breaths/min indicates potential respiratory distress 1, 6

Infants (<1 year):

• Normal range: 20-60 breaths/min 1, 2, 6
• The 50th percentile decreases from 41 breaths/min at 0-3 months to 31 breaths/min at 12-18 months 1, 2
• Bradypnea alarm: <20 breaths/min requires immediate medical attention 1, 2, 6
• Median at birth is 44 breaths/min, declining to 26 breaths/min by age 2 years 3

Toddlers (12-59 months):

• Normal range: typically <40 breaths/min 1, 2
• Tachypnea threshold: ≥40 breaths/min suggests possible lower respiratory infection 1, 2

Adolescents (13-18 years):

• Respiratory rates approach adult values at approximately 17 breaths/min during sleep 5
• Can be assessed using either pediatric or adult scoring criteria per clinical context 5

Critical Measurement Considerations

Measurement Technique:

• Count for a full 60 seconds for most accurate measurement, particularly in children 1, 2, 7
• Measurements over 15 seconds have bias of -1.22 breaths/min with wide limits of agreement (-7.16 to 4.72), missing half of abnormal rates 7
• Measurements over 30 seconds perform better but still miss a quarter of abnormal rates (bias -0.46 breaths/min) 7

Optimal Conditions:

• Measure during sleep or quiet state when possible, as crying and agitation distort respiratory patterns 1, 2
• Manual measurement has significant intra-observer variation and is particularly difficult with crying, irritable, or moving children 1, 2, 6

Common Pitfalls to Avoid

• Avoid "short-cut" measurements (counting for <60 seconds then multiplying), as these frequently fail to identify sick patients with abnormal respiratory rates 7
• Do not measure during crying or agitation, which artificially elevates the rate 1, 2
• Be aware that recorded respiratory rates in hospitalized adults often cluster artificially at 18-20 breaths/min, representing spot estimates rather than accurate measurements 4
• Using incorrect age-specific normal values leads to inaccurate tachypnea determination and misdiagnosis of conditions like pneumonia 1, 2

Special Context: CPR Settings

During cardiopulmonary resuscitation with an advanced airway in place:

• Adults: 10 breaths/min 5
• Infants and children: 20-30 breaths/min (1 breath every 2-3 seconds), adjusted for age and clinical condition 5, 1
• Rates exceeding 30 breaths/min during CPR may compromise hemodynamics 1