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Pediatric Respiratory Rate Chart by Age
A child's normal breathing rate falls with age: 30–53 breaths per minute in babies, 22–37 in toddlers and 12–20 in teenagers (AHA PALS). Count for a full minute while the child is calm, and judge the number together with how hard the child is working to breathe.
Normal respiratory rate by age
| Age band | Normal rate (breaths/min) | Counting note |
|---|---|---|
| Neonate (0–28 days) | 30–53 | Count for a full minute; short pauses (periodic breathing) make 15-second counts unreliable. |
| Infant (1–12 months) | 30–53 | Babies breathe with the belly. Fever, feeding and bronchiolitis raise the rate. |
| Toddler (1–2 years) | 22–37 | Count while the child is calm or asleep; crying changes the number quickly. |
| Preschool (3–5 years) | 20–28 | Pair the count with wheeze, retractions and oxygen saturation. |
| School-age (6–9 years) | 18–25 | Recount after fever, pain or a bronchodilator has been treated. |
| Preadolescent (10–11 years) | 18–25 | Same PALS range as school-age; recount after treatment. |
| Adolescent (12 years and older) | 12–20 | Close to adult values. Anxiety and activity raise the rate. |
Ranges are for a resting child. Heart rate and blood pressure by age are in the pediatric vital signs chart and age lookup.
How to count a child's respiratory rate
- Watch before you touch: handling a child changes the rate. In babies, watch the belly.
- Count one rise and fall as one breath, for a full 60 seconds.
- Write down the context: asleep, awake, crying, feeding, febrile, after treatment, on oxygen.
- Recount if the number doesn't match how the child looks, and record the trend over time.
What a fast breathing rate means
Fast breathing (tachypnea) has many causes: fever, pain, anxiety, dehydration, acidosis, asthma, bronchiolitis, pneumonia, croup or sepsis. What matters is the pattern around the number.
- Fast breathing with normal effort in a febrile child: treat the fever and recount.
- Fast breathing with retractions, grunting, low oxygen or tiring: escalate now.
- A falling rate in a child who is getting more tired, drowsy or blue can mean exhaustion, not recovery.
When is a child's breathing rate too fast?
The WHO uses these cutoffs to call breathing "fast", counted for a full minute while the child is calm:
| Age | Fast breathing |
|---|---|
| Under 2 months | 60 breaths/min or more |
| 2 months up to 12 months | 50 breaths/min or more |
| 12 months up to 5 years | 40 breaths/min or more |
These are WHO IMCI screening cutoffs, not the edge of the normal range, so a child can be above the PALS normal range without reaching them. From 2 months to 5 years, fast breathing with cough classifies as pneumonia; under 2 months it is a sign of very severe disease and the baby needs urgent referral.
Breathing red flags
- Pulling in between or under the ribs, nasal flaring, grunting, head bobbing, or sitting forward to breathe.
- Blue or gray lips, low oxygen saturation, or pauses in breathing.
- Too breathless to talk, feed or drink; unusually sleepy or hard to wake.
- A rate that stays well outside the range after fever, pain and distress are treated.
In hospital, an early warning score such as bedside PEWS combines respiratory rate with effort, heart rate and behavior; follow its escalation thresholds, or go to the emergency department if a young child at home shows any of these signs.
Respiratory scores for wheeze and bronchiolitis
When a child has wheeze or bronchiolitis, a score turns rate, effort and oxygen into a severity you can trend after treatment:
- Pediatric asthma score (PAS) for asthma and wheeze.
- Wang bronchiolitis score (rate, wheeze, retractions, general condition).
- RDAI (wheeze and retractions).
- Bronchiolitis severity bands.
Frequently asked questions
It depends on age. In the PALS tables (breaths per minute): Neonate (0–28 days): 30–53; Infant (1–12 months): 30–53; Toddler (1–2 years): 22–37; Preschool (3–5 years): 20–28; School-age (6–9 years): 18–25; Preadolescent (10–11 years): 18–25; Adolescent (12 years and older): 12–20.
22–37 breaths per minute in the PALS band for toddler (1–2 years). A toddler who is breathing fast and also working hard (pulling in between the ribs, flaring, grunting) needs prompt assessment.
Watch the chest or belly before you touch the child and count each rise and fall as one breath for a full 60 seconds. Infants and sleeping children breathe irregularly, so 15- or 30-second counts can mislead.
Get urgent help for fast breathing with pulling in between or under the ribs, nasal flaring, grunting, blue or gray lips, pauses in breathing, being too breathless to talk or feed, or unusual sleepiness. Call emergency services if the child is struggling to breathe or turning blue.
The WHO counts breathing as fast at 60 breaths per minute or more under 2 months, 50 or more from 2 to 12 months, and 40 or more from 1 to 5 years. Fast breathing with hard work of breathing, low oxygen or poor feeding needs prompt assessment at any age.
There is no RSV-specific number. Bronchiolitis often pushes the rate above the normal range for age, and severity is judged by work of breathing, oxygen saturation, feeding and hydration together with the rate. Clinicians use scores such as the Wang score or RDAI to grade and trend it.
Yes. Fever, pain, crying and anxiety all raise the respiratory rate. Recount once the fever is treated and the child is calm. Fast breathing that persists, or comes with hard breathing or low oxygen, points to a chest or other illness.
No. Respiratory rate is one sign. Distress means increased work of breathing: retractions, flaring, grunting, head bobbing, low oxygen or tiring. A tired child whose rate is falling while effort worsens is a danger sign, not an improvement.
References
- American Heart Association. Pediatric Advanced Life Support Provider Manual. 2020. Vital sign tables reproduced from Hazinski MF, Nursing Care of the Critically Ill Child, 3rd ed. Mosby; 2013.
- Pediatric Vital Signs, protocol 14.1 (source: AHA PALS 2020). San Francisco EMS Agency, effective October 1, 2025. media.api.sf.gov/documents/EMSA-Protocol-14.1-Pediatric-Vital-Signs-Final-10.1.25.pdf
- Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet. 2011;377(9770):1011-1018. doi.org/10.1016/S0140-6736(10)62226-X
- World Health Organization. Integrated Management of Childhood Illness: Chart Booklet. Geneva: WHO; March 2014 (fast breathing cutoffs in the young infant and the cough or difficult breathing charts). cdn.who.int/media/docs/default-source/mca-documents/child/imci-integrated-management-of-childhood-illness/imci-in-service-training/imci-chart-booklet.pdf?sfvrsn=f63af425_1