Respiratory Assessment Skills

It is important for your child’s health that you know how to check their breathing. You need to know when your child is having trouble breathing, and how to help them. This handout will give you basic information. You will have hands-on practice with your child’s nurses and respiratory therapists.

Helpful words to know for counting breaths

Respiratory rate-The number of times your child breathes in one minute

Inspiration-Breathing in

Expiration-Breathing out

Instructions for counting your child’s respiratory rate

Your child’s respiratory rate is usually slower when sleeping and faster when awake.

To count the respiratory rate:

Uncover your child’s chest area.
Count the number of times the chest rises and falls in one minute.
Use a stethoscope and listen for the number of times your child breathes in one minute.

Crying and activity can increase a child’s respiratory rate. If it is high, calm your child and check again. If the rate stays above or below your child’s normal range, let your healthcare provider know.

Respiratory assessment

Before you begin to check your child’s respiratory status (breathing), it is important to know what is “normal” for them. Your child should seem comfortable when breathing. The chest or belly should rise and fall easily.

Know your child’s “normal” respiratory status – your healthcare provider will ask you.

You should check your child’s respiratory status at least twice a day and if you think it is different, call your healthcare provider for directions.

Helpful words to know

Retractions-Your child is working hard to breathe, so the skin on the chest pulls inward with each breath. You may see retractions at the base of the neck, between the ribs, or under the ribs.

Nasal flaring-The outer edges of the nose move in and out as your child breathes.

Wheeze-If your child’s airway gets narrow, they may make a squeaky sound when breathing. This is called a wheeze. Sometimes you can only hear a wheeze with a stethoscope.

Cyanosis-Your child’s lips, nailbeds, or skin looks blue or dusky.

Listening to breath sounds

Try to keep your child calm so that you can hear the breath sounds.
Get your stethoscope. Place the earpieces in your ears. Place the round disk on your child’s chest. Look at the picture below. The numbers on the picture show you where to move your stethoscope and listen to breaths. Listen to at least one full breath (in and out) in each spot.
After you listen in the front and back of your child’s chest, listen right below each armpit. As you listen, ask yourself:

Are the sounds clear and smooth? If so, you do not need to take any action at this time.

Are the sounds noisy or wheezy?

If sounds are noisy, do chest PT and suction your child as you were taught.
If you hear squeaks or a wheeze, suction the airway and listen again. If the breath sounds do not improve, follow the breathing treatment orders from your health care provider.

Are the breath sounds decreased or absent?

First, suction the airway.
Listen again.
If the breath sounds do not improve, look at your child. Are they uncomfortable? Are they working hard to breathe? Is their skin pale or dusky?
If breath sounds do not improve, follow the breathing treatment orders from your healthcare provider.
If your child has a tracheostomy tube and their breathing does not improve after suctioning and respiratory treatment, change the tracheostomy tube right away.

Call your healthcare team with questions, concerns or if:

Your child has any signs of respiratory distress that do not go away with home respiratory treatments, suctioning or a tracheostomy tube change (if applicable), such as:

High respiratory rate
Retractions
Nasal flaring
Blue/gray lips, nails, or skin
Decreased breath sounds
Trouble breathing because of thick or increased secretions, or if the secretions are yellow, green, or have an odor.

Reviewed April 2024 by Amanda Manzi, DNP, Janessa Shainline, MSN, RN and September 2024 by Danna Tauber MD