What is the normal respiratory rate for a healthy newborn?

Normal Respiratory Rate of Newborns

The normal respiratory rate for healthy newborns is 30-60 breaths per minute, with rates below 20 breaths per minute requiring immediate medical attention and rates at or above 60 breaths per minute indicating tachypnea. 1, 2

Age-Specific Normal Parameters

• Newborns (0-2 months): The normal range is 30-60 breaths per minute 2
• First 24 hours of life: Median rates are 46 breaths/minute at 2 hours after birth, then stabilize to 42-44 breaths/minute thereafter, with the 95th percentile at 65 breaths/minute at 2 hours and 58-60 breaths/minute subsequently 3
• Infants under 6 months: Mean respiratory rate when awake and content is 61 breaths/minute, dropping to 42 breaths/minute during sleep 4
• Infants under 1 year: The lower limit of normal is approximately 20 breaths per minute 5

Critical Thresholds Requiring Action

Bradypnea (Dangerously Slow)

• Any respiratory rate <20 breaths per minute in infants under 1 year is a medical emergency requiring immediate transport to higher-level care, as it indicates risk of serious injury, respiratory depression, or impending respiratory failure 5, 1, 2

Tachypnea (Abnormally Fast)

• ≥60 breaths per minute defines tachypnea in infants less than 2 months of age and suggests potential respiratory distress or lower respiratory tract infection 1, 2, 6
• This threshold is used by both the American Academy of Pediatrics and World Health Organization as a diagnostic criterion for pneumonia 2

Measurement Best Practices

• Always count for a full 60 seconds rather than extrapolating from shorter periods, as 15-second counts significantly underestimate the true rate 6, 1, 7
• Measure during sleep or when the infant is calm and content for the most reliable baseline, as crying babies have paradoxically lower rates (51 breaths/minute) compared to awake content babies (61 breaths/minute) 4, 1
• Respiratory rate measured by observation is consistently higher than by auscultation 6
• Place the bell of a stethoscope in front of the nostrils and mouth for the most accurate manual count 3

Factors Affecting Respiratory Rate

• State of consciousness: Awake infants have rates approximately 5 breaths/minute higher than during sleep 3
• Gender: Boys have rates approximately 1.6 breaths/minute higher than girls 3
• Meconium staining: Heavy meconium staining increases rates by approximately 3 breaths/minute 3
• Mode of delivery: No significant difference exists between vaginal and cesarean deliveries 3

Common Pitfalls to Avoid

• Do not rely on brief observation periods — manual measurement requires focused concentration for the full minute and is subject to significant intra-observer variation 5, 1
• Avoid measuring during crying or agitation, as this distorts respiratory patterns and paradoxically lowers the measured rate 4
• Using inappropriate reference ranges leads to inaccurate tachypnea determination and misdiagnosis of conditions like pneumonia 5, 1
• Recognize high intraindividual variability — even in the same infant, respiratory rate can vary substantially over short time periods, with limits of agreement ranging up to 34.7 breaths/minute when comparing measurements just minutes apart 7

During Neonatal Resuscitation

• When providing positive pressure ventilation to newborns who cannot maintain adequate spontaneous breathing, deliver assisted ventilation at 40-60 breaths per minute 5, 2
• The primary measure of adequate ventilation is prompt improvement in heart rate, not just chest wall movement 5