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The act of breathing is sometimes compared with the movement of a piston because of the cyclical cephalad and caudad motion of the diaphragm, and the chest wall is seen as a passive participant; however, this view is too simplistic. The chest wall is very dynamic during breathing and is critical in maintaining resting lung volume, optimizing lung mechanics, allowing normal respiratory growth, and protecting the thoracic organs.

In healthy children, inspiration begins from functional residual capacity (FRC), which is the point in the respiratory cycle when the outward recoil of the rib cage and the inward recoil of the...

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