Normal Respiratory Rate
For healthy resting adults, the normal respiratory rate is 10-12 breaths per minute, while for children it varies significantly by age: infants under 1 year have a normal range of 20-60 breaths/minute, toddlers 12-59 months typically breathe below 40 breaths/minute, and adolescents (8-18 years) average 17 ± 2 breaths/minute. 1, 2, 3
Adult Normal Values
- The American Heart Association establishes 10-12 breaths per minute as the normal adult respiratory rate in the context of rescue breathing for patients with spontaneous circulation 1, 4
- In critical care settings, respiratory rates between 5-40 breaths/minute are considered acceptable for ICU patients during physical rehabilitation, though this represents a broader safety range rather than a true "normal" 1
- Long-term care residents demonstrate normal rates of 16-25 breaths/minute, with tachypnea defined as >25 breaths/minute showing 90% sensitivity and 95% specificity for pneumonia 1
Important Clinical Caveat
Research evidence reveals that respiratory rate is frequently inaccurately recorded in hospital settings, with values clustering artificially at 18 and 20 breaths/minute rather than showing a normal distribution. 5 This suggests many recorded "normal" values may represent spot estimates rather than true measurements, potentially leading to misclassification of disease severity 5
Pediatric Normal Values by Age
Infants and Young Children
- Newborns (first 24 hours): 30-60 breaths/minute with a median of 42-46 breaths/minute 2
- Infants under 1 year: 20-60 breaths/minute, with the 50th percentile at 41 breaths/minute for 0-3 months, decreasing to 31 breaths/minute by 12-18 months 2
- Toddlers (12-59 months): Typically below 40 breaths/minute 2
School-Age Children and Adolescents
- Ages 8-18 years: Mean respiratory rate of 17 ± 2 breaths/minute during both NREM and REM sleep in healthy non-obese controls 3
- The respiratory rate decreases progressively with age and height in children, with no significant sex-related differences in most studies 3
Critical Clinical Thresholds
Pediatric Warning Signs
- Tachypnea in newborns/young infants (<2 months): ≥60 breaths/minute indicates potential respiratory distress 2
- Tachypnea in 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 2
Adult Warning Signs
- Tachypnea >25 breaths/minute in long-term care residents has high sensitivity and specificity for pneumonia 1
- Respiratory rates outside the 5-40 breaths/minute range in ICU patients warrant stopping physical activity 1
Measurement Best Practices
Counting respiratory rate for a full 60 seconds is essential for accurate measurement, as shorter observation periods miss significant abnormalities. 2, 6
- Measurements over 15 seconds failed to identify half of the abnormal rates that scored 3 National Early Warning Score points, while 30-second measurements missed a quarter of these abnormal rates 6
- In pediatric patients, measurement should occur during sleep or quiet state when possible, as crying and agitation distort respiratory patterns 2
- Manual measurement has significant intra-observer variation and is particularly difficult with crying, irritable, or moving children 2
Common Pitfall
Using incorrect normal values or abbreviated counting periods leads to inaccurate tachypnea determination and misdiagnosis of conditions like pneumonia 2, 6
Special Resuscitation Context
Pediatric CPR
- For infants and children with pulse but inadequate respiratory effort, deliver 1 breath every 2-3 seconds (20-30 breaths/minute) 2, 3
- During CPR with advanced airway, target 20-30 breaths/minute for children and 30 breaths/minute for neonates 3, 2