As with heart rate, compared to that of adults, the respiratory rate in infants Extremely rapid and shallow respi-
and children has a greater range and is more responsive to illness, exercise, ratory rates are seen in newborns and emotion. The rate of respirations per minute ranges between 30 and 60 with cyanotic cardiac disease who in the newborn, 20 and 40 during early childhood, and 15 and 25 during late childhood, reaching adult levels at age 15 years.
The respiratory rate may vary considerably from moment to moment in newborn infants, with alternating periods of rapid and slow breathing. The sleeping respiratory rate is most reliable. However, respiratory rates during active sleep compared to quiet sleep may be up to 10 breaths per minute faster. The respiratory pattern should be observed for at least 60 seconds. In infancy and early childhood, diaphragmatic breathing is predominant; thoracic excursion is minimal.
For young children, observe the movements of the chest wall for two 30-second intervals or over 1 minute, preferably prior to stimulating them. Direct auscultation of the chest or placing the stethoscope in front of the mouth is also useful for counting respirations, but the measurement may be falsely elevated if the child becomes agitated. For older children, use the same technique as used for adults.
Commonly accepted cutoffs for defining tachypnea are:
Infants 0-2 months >60/min
Infants 2-12 months >50/min Children >12 months >40/min have normal lungs but right-to-left shunting, and in conditions of metabolic acidosis.
Children with respiratory diseases such as bronchiolitis or pneumonia have rapid respirations (up to 80-90/min), but also increased work of breathing such as grunting, nasal flaring, or use of accessory muscles.
The best single physical finding for ruling out pneumonia is an absence of tachypnea.
Fever can raise respiratory rates in infants. In the absence of pneumonia, an infant's respiratory rate can increase by up to 10 respirations per minute for each degree centigrade of fever.
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