The major respiratory signs are:

  • Tachypnea: Defined as the respiratory rate 60 breaths per minute. Indicates inadequate ventilation or oxygenation. The child responds to hypoxemia or hypercapnia, breathing faster.
  • Cyanosis: Reflects an increase of more desaturated hemoglobin 3-5 g / dl. It can occur in heart disease, respiratory, neurological and metabolic diseases.
  • Muscle Retractions: These occur in any muscle group of the chest may be intercostal, subxiphoid, supraclavicular … indicate inadequate ventilation that requires the use of accessory muscles. They are common to diseases which reduce alveolar ventilation, eg atelactasias.



  • Moan: An audible sound at the end of expiration. It is caused by the child’s respiratory effort against a closed glottis partially or completely. Represents a physiological response that seeks to increase the residual lung volume.
  • Apnea is defined as a respiratory pause of 15 seconds or more, or less than 15 seconds, if accompanied by bradycardia and / or arterial desaturation.


  • Nasal flaring: Movement of both wings of the nose that occurs during inspiration and an increase of respiratory work.

For objective assessment of respiratory distress syndrome (RDS) there is a “test” Silverman. Measures five parameters that contribute to the overall score of 0, 1 and 2 points. The higher the test score, the greater respiratory compromise. The parameters measured are: nasal flaring, thoraco-abdominal separation, moan, xiphoid retraction and intercostal retractions.

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