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.

91 responses to “Let Me Count Your Breathing”

  1. Sara C. says:

    I mentioned to my mother about how I knew M. was having trouble because of how her breathing looked, and she said “well, maybe it’s just habit for her to breathe like that.”

    I check M’s breathing a lot at night like that…especially when she’s had a rough day. It’s easier for ME to go to sleep knowing that she’s breathing somewhat easily.

  2. Sarah says:

    My mom had an advantage for that in that she used to be able to hear me breathe from the a different room, because I was always such a “noisy” breather, even when I wasn’t flaring now, I think it’s likely early allergies that weren’t diagnosed until I was an adult because I was never sent for allergy testing as a kid – I remember that more days than not, I had to chew with my mouth open because I couldn’t breathe through my nose.

    Speaking of which, that’s a good allergy sign for parents to keep an eye out for: If your kid chews with their mouth open at the table or makes smacking noises as they chew, past the age when that’s normally acceptable, especially if they insist that they “can’t” chew with their mouth shut. As I got older, I became a very slow eater (I’d take a half hour or more just to finish a peanut butter sandwich in grade five) because I’d always take bites I could chew and swallow in the time that I could hold my breath since my family gave me such a hard time about chewing with my mouth open, but until I was nine or ten or so, I still chewed with my mouth open.

  3. Amy says:

    Sara–Did you say, “Yes, it’s her habit BECAUSE SHE HAS ASTHMA”? Sorry, I couldn’t resist. You know, what’s interesting is that even older and well-controlled, Kyra still breathes a little louder and faster than her sister. The Sidekick, in fact, notices it, too.

    Sarah–That’s a fantastic tip–mind if I repost it in tomorrow’s links? And also, you are full of good information this week. Thank you! And why do you not have a blog yourself?

  4. Sara C. says:

    Oh, don’t get me started on my parents…My dad told me to tell Mariella to…”buck up and don’t be sick” (you know, ’cause there is nothing wrong with her stomach…she just needs to be told not to puke)

    I’m pretty sure it’s just their inability to handle her being chronically ill, and not really being able to fix it (and not even for HER, but for ME…since it’s their job to fix the stuff that upsets ME…KWIM?)

  5. Steve says:

    Great topic Amy!

    Most people though, will loose track when trying to count for a full minute ( especially with newborns or toddlers). I would recommend doing what RT’s and Nurses do in the hospital. Simply count for 15 seconds and then multiply the result by 4.

  6. Amy says:

    Steve–We’d be counting for the full minute for about a year when a nurse finally told us that shortcut! (Dunno why it never occurred to us on our own, though)

    A few months after THAT, a different nurse mentioned that counting for a full minute was more accurate since kids breathe irregularly. I think my kid was almost 4 by this time.

    Any insight on that? I’m guessing the irregularity is maybe not severe enough to mess up the count w/the shortcut?

  7. Samantha says:

    so question, how does this method compare when dealing with a little one who isnt so little anymore? my miss monkey is almost 5, and capable of using a peak flow meter (which we do, 2x/day) but she doesnt always…shall we say cooperate especially when she isnt feeling too well… thankfully she has the “cough variant” type of asthma so I can usually hear when shes bad but sometimes I wish I knew earlier….wonder if counting would give me better/more advance warning than her peak flow?

  8. Sarah says:

    Amy – go ahead… As for me not having my own blog, I do have an Lj, but it’s a friends list only one (suffice to say that when I was a teenager – and dealing with all that teenagery stuff like the world magically becoming filled with idiots intent on making my life aggravating the moment I turned fifteen that maintained until I was 17 or so – I got sick of my mom and sister getting angry with me for ranting about arguments we had on my old journal, identifying details removed, so I changed to a friends-only journal on a different site entirely).

  9. Amy says:

    Sara–Yeah, I do, actually. Part of the reason for starting this site several years ago: when Kyra was very young, I stuck my head in the sand b/c I was terrified over how I couldn’t fix her. Finally, I realized I had to face her health head-on, or she’d keep getting worse, and that even if I couldn’t fix her, I could help her live as full and healthy a life as possible.

    Samantha–At the very least, counting her breathing will probably give you a better overall picture of her daily patterns. Since she’s 5, though, I wouldn’t let her know you’re counting, or she may change her breathing without meaning to.

  10. Krystyna says:

    I have a 10-month old asthmatic, who was diagnosed with reactive airways at 4 mos. My ped told us to count for 30 seconds and multiply by 2 because it was more accurate than counting for 15… Do you keep a “breathing log” of sorts? I’m still trying to figure out if my baby actually has allergic asthma, because she used to only wheeze when she was ill, but now it has escalated and I notice it more often, even when she is not sick. I am thinking perhaps a log of symptoms, including breaths per minute would be helpful.

  11. Amy says:

    Hi Krystyna–Thanks for stopping by, and I hope you find good information and support here. My daughter is 11 now, with well-controlled asthma. But when she was younger and we didn’t know her triggers and couldn’t stop her from flaring all the time, we used to track both her breathing counts and her flares, to figure out what was bothering her airways. A breathing log is a great idea and really, any trackable information helps. On a side note, having triggers other than just illness doesn’t necessarily mean allergic asthma–my daughter’s an example of that, actually. She does have a dust mite allergy, but no other ones. She has intrinsic asthma, and her triggers are things like illness, strong laughter or crying, fatigue and/or stress, some airborne irritants, heavily humid weather during strenuous exercise, etc. I hope that helps a little!

  12. Joanna Heath says:

    Hello, it’s nice to know that I am not the only one that is trying to help her asthmatic child. My daughter is 2and a half and she has allergies to cats, dogs, dust mites, mold, shell fish, she also has exzema since birth which has spread to her hands, ankles, tows and fingers, she is asthmatic because when she gets a cold I am instructed to use the orange and blue puffers. Last summer I didn’t need to use any puffers but this year it seems as things have gone for the worst, she is allergic to more things, her excema has spread to other past of her little body and I am scared not to use the puffers because I am scared that she will end up in the hospital. I keep questioning my instinct do I give her the ventilin, does she need it. I don’t like giving her the ventilin puffer (blue puffer) it makes her very shaky for a couple of hours and what’s strange is recently I noticed that after giving her the blue puffer her face turned all red? What does that mean, is this an indication of something? My pediatrician didn’t answer on this. Then I keep listening to her and She seems like she is sometimes breathing faster and short? Does this mean she is having a attack? If I don’t do anything will this go away on it’s own? Some times she seems like she is breathing really deep and not rapid like it’s hard for her to take a breath and she really needs to inhale? What does that mean…..her oxygen level is lower? How do I detect this? Is there a device that you Moms heard of to detect oxygen levels, I am so scared because at one time when we were in the hospital she needed oxygen and that’s all I see, can’t get this out of my mind, it’s killing me not knowing what to do at times. any suggestions? I am a new Mom to this site, my name is Joanna

  13. Nicole says:

    Thank you. This is very helpful!

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  15. Laura says:

    I loved reading this – my children were both born in Colorado and were on supplemental oxygen for 6 months post birth (twins). We had to move to sea level to get them off! My son still struggles every single time he gets sick. The stress it causes me is unreal, and I know that feeling of pain in your gut every single time they cough. It hurts your whole body and takes a real emotional toll out of you. It is nice to know I’m not alone! I do the same thing with the breath counting – using my iPhone stopwatch and hoping they stay under 30 – 35 breaths per minute. Just wanted to tell you thank you – you have described my feelings to a tee and it was just nice to read this and know I am not alone. Sometimes I feel that way and when I start feeling sorry for myself I remember all the other moms and dads out there who are dealing with the same thing or even worse. Bless out little ones and hope they grow out of it someday! However, I’m learning to just appreciate controlling the symptoms to the extent possible and that while nebulizing in the middle of the night is a pain, it beats sitting in the ER. : )

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