Let Me Count Your Breathing

kyra flowers

Ever do something for so long, it’s like second nature and you sort of forget that people in regular life don’t do it, too?

And then you stop doing that thing, and even though it took up a large chunk of your life for several years, you actually forget you ever did it in the first place?

I’m talking about counting respirations, an almost daily habit when my kid was younger, a fact apparently pushed back into the deepest corners of my brain until Sarah mentioned it in the comments on Tuesday.

Before my daughter grew old enough to use a peak flow meter and way, way back before she turned into the asthma cougher she is now, I didn’t have a whole lot of ways to figure out when the airway inflammation and bronchospasms started. She would only start those harsh, hacking coughing fits after flaring more or less silently for days. In other words, we’d only hear the loud, obvious asthma symptom right when it was too late for preemptive treatment and her airways would need hospital/ER/clinic-level care or prednisone.

Oh, and also? She was two years-old when diagnosed, with a typical toddler’s vocabulary and the inability to express complex thoughts like, “I’m having trouble breathing” until she was much older. So there was that. (Have I mentioned, ever, how hard and terrifying it is to parent a little kid with bad asthma?)

My experience was fairly typical.

If you’re new here and new to asthma with a kid under school age, A) I’m sorry, and B) this next sentence is your best friend:

Come here, baby, let me count your breathing.

Because toddlers (babies, too) can’t use peak flow meters and they can’t always express or even recognize when something’s wrong inside, but they can – and will – breathe faster than they should when an asthma attack starts up.

Here’s how to do it:

Counting Respiratory Rates in Children

1. As always, talk to your doctor first.

2. Make sure your kid’s at rest, meaning coloring quietly or watching a movie and not jumping around or throwing a tantrum or chasing the dog or anything active. (Physical activity increases respiration rate, so you won’t get an accurate count.)

3. Holding your child helps because you can feel the breathing as well as see it.

4. Use a stopwatch or a watch with a second hand to count respirations for one minute.
1 full inhale + 1 full exhale = 1 respiration

5. MAKE SURE YOU GET THAT EQUATION RIGHT. If you count each inhale and each exhale separately, you’ll end up with a number off the charts that will freak you out and make you call an ambulance.

6. Compare your child’s breathing to these typical ranges:

Normal Respiratory Rates for Babies and Children

Newborns
44 breaths per minute

Infants
20-40 breaths per minute

Preschoolers
20-30 breaths per minute

(Source and older ages here.)

7. If your child’s number is too high, treat according to your Asthma Action Plan. We’re talking noticeable, sustained differences, not an extra breath here and there.

There’s a medical term for rapid breathing. It’s called tachypnea.

Our doctor’s recommendation based on tachypnea went something like this:

If your daughter reaches ____ breaths per minute, give her a nebulizer treatment. If that doesn’t slow her down, wait _____ minutes and then give her another one. If she still doesn’t slow down, then call the office. If she reaches _____ breaths per minute, bring her in or take her to the ER, no matter what.

Eventually, I stopped counting and started recognizing her pattern of problematic breathing to the point where I could look across the room, observe the rapid movement of her chest/abdomen for a few seconds, and know she needed the nebulizer.

She’s used a peak flow meter for about 6 years now, but it’s still a useful tool.