Breathing differences between children and adults

Posted by Nurse Linda in Life After Paralysis on June 03, 2019 # Caregiving

Children are not miniature adults. There are differences in the thinking and development of a child but also in the way a child’s body functions (physiology.) Around the age of 12, a child’s physiologic function begins to become more adult-like but not in all areas. Understanding how a child’s body functions makes a difference in caring for your child.

From the moment a child is born, and that first cry is heard, a baby is breathing using their lungs instead of getting their oxygen from their mother through the umbilical cord. Exactly how this happens is one of the huge mysteries of birth. At this time, the entire hemodynamics of your child change. Birth is one of the biggest changes a human must undertake.

Babies breathe mostly through their nose for up to six months of age. This is why it is so important to keep them on their backs while sleeping and keep blankets, toys or other fabric away from their noses (and mouth). Babies wiggle and move while they sleep. If your baby does not have this mobility because of spinal cord injury, speak with your health professional about how to alter their position. Any compromise to the baby’s nose will cause the baby’s airway to be blocked which does not allow enough oxygen to enter or carbon dioxide to leave their bodies.

In adults, breathing requires the coordinated use of three muscle groups, the diaphragm, intercostal muscles (the muscles between each rib) and the abdominal muscles. When the diaphragm pulls down, air enters the lungs. When the diaphragm relaxes, the air is naturally expelled. The intercostal muscles pull the lungs outward. The abdominal muscles help the diaphragm pull downward to fill the lungs with air.

Babies and young children will use their abdominal muscles much more to pull the diaphragm down for breathing. The intercostal muscles are not fully developed at the time of birth. The baby has to grow to develop these. This can be important if a baby or child has a spinal cord injury, even at a lower level of injury, as the abdominal muscles might not be enough for breathing until they grow, further developing the diaphragm and intercostal muscles.

Because of the importance of the abdominal muscles and other muscles used to breathe, babies can become fatigued quickly. The combination of underdevelopment of the muscles used to breathe and the immaturity of the respiratory system, breathing can be a challenge even without a health condition. Sometimes breathing becomes exhausting and babies stop to take a rest from it which has significant consequences. Use of a respiratory monitor and alarm can be a helpful device to ensure your baby is breathing successfully.

The use of abdominal muscles for breathing can also be complicated after a spinal cord injury if the bowel becomes overdistended. Tightness in the abdomen can affect a good, deep breath or create difficulty breathing. A lot of gas or fecal material will constrict the over tightened abdominal muscles to keep a good breath from occurring.

Because a baby or child’s airway and lungs are small, they might not be able to accommodate a trauma since there is no reserve as in an adult. You can feel the reserve in your own lungs if you breathe in deeply, you can still breathe in a tiny bit more. When you exhale fully, you can exhale just a tiny bit more. Babies and young children do not have this capacity so respiratory failure is quicker to occur.

In the throat and mouth, children have shorter and softer tracheas. That is the tube that goes from the back of the mouth to the lungs. If intubated or on mechanical ventilation, the airway tube is much shorter than an adult and insertion must be very gentle to avoid damage to the delicate tracheal tissue. There are airway tubes in varying size to accommodate the length of your child’s trachea depending on age. Because of the delicate tissue, suctioning must be performed carefully. You might use a bulb syringe instead of a suction catheter depending on your child’s needs.

Structures in the back of the throat can lead to obstruction of the airway in traumatic situations such as spinal cord injury. Tonsils and adenoids grow very fast in babies and children, which can impede intubation. An infection in the tonsils and adenoids can obstruct the airway as they enlarge even further with swelling. The tongue is also proportionately larger than in an adult. In a trauma, the tongue can flop back in the mouth causing another source of obstruction. The epiglottis is the flap that keeps food and fluid out of the lungs. It cannot be seen by looking inside a baby’s mouth as it is deeper in the throat. The epiglottis is another source of obstruction as it is longer and floppier than in adults.

Asthma can develop in children of any age. Asthma is a condition where the airway narrows, swells and produces mucous resulting in wheezing and shortness of breath. It can be very frightening to someone who cannot breathe for any reason. Asthma comes in bouts with triggers that may differ with each child. It is treatable with medication that can be taken by mouth, through an inhaler or nebulizer. Some individuals take medication daily, others use medication only with an asthma episode. Some use a combination of treatments.

All children have respiratory issues at some time. It can be something like a cold or flu or more serious issues. Monitoring your child’s breathing is important at any stage of life. Bronchitis and pneumonia are infections of the lungs that require medical intervention including medication and sometimes oxygen therapy for a short period of time. Like adults, children with spinal cord injury have issues with their immune system and may be more susceptible to respiratory infections.

Respiratory Syncytial Virus (RSV) is an infection that affects breathing. Most babies will have RSV before they are two years old. Some will have symptoms of a cold without much else. Other children will develop serious respiratory illnesses because of RSV which will require hospitalization. The highest numbers of RSV cases arrive in the fall and usually numbers lower in the spring although cases appear year-round. Symptoms include wheezing, shortness of breath, fever, and coughing. As with all respiratory illnesses, RSV can become life-threatening.

Breathing rates in resting adults can range from 10-15 times per minute. Some adults breathe less and some more depending on their general health and activity levels. Children’s breathing is much quicker because they have little space to exchange the oxygen and carbon dioxide in their lungs. Typical respiratory rates in babies and children are listed below. Age-specific information is not provided as the size of the child can affect respirations. This is used for general knowledge only.

  • Neonates: 30-60/minute
  • Infants: 30-40/minute
  • Toddlers: 20-40/minute
  • Young Children: 20-30/minute
  • Older Children: 15-20/minute

You can assess your child’s respirations by counting them for one minute. Just watch their chest rise and fall without touching the child. As with adults, breathing can fluctuate in children depending on their general health and activity. Sleeping babies may have a very slightly slower respiratory rate as opposed to crying infants which might be faster. An average respiratory rate is what you should know about your child. Failure to breathe is not an option for life. Even slower breathing can affect the oxygenation of the body.

There are some signs that your child’s respiratory system is not working effectively. Lips and nail beds of the fingers or toes will develop a blue tinge when oxygen exchange is not effective. Blue lips, hands, and feet are a significant factor. Both indicate the respiratory rate is desperately low or stopped.

Anyone, child or adult with nasal flaring (nostrils enlarge with breath intake) is having a difficult time breathing. Infants with nasal flaring and head bobbing is a sign of respiratory distress.

Other physical signs of breathing distress include the chest wall and/or sternum (breastbone) retracting inward. Grunting is a sign that breathing is difficult as air being drawn in is pressing against the vocal cords. Gasping for air is an indication that not enough air can be brought into the lungs quickly enough.

If your child’s breathing is slowed or slowing or exhibiting any of the above symptoms, it is time to call 911. Having the emergency responders come to your home is safer than taking your child to the hospital yourself. Driving your child not only is a safety hazard as you will be distracted but also delays time to get emergency treatment. As soon as the emergency responders reach your home, they begin treatment. The minute emergency care is provided, the better the outcomes.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.