HFNC flow in a child with chronic lung disease should be weight- and age-based, with monitoring and an individualized plan from the respiratory/ICU team. Chronic lung disease does not by itself set a higher maximum.

Typical pediatric practice:

For example, a 10-kg child might receive up to 20 L/min if using a 2 L/kg/min protocol. Children’s Minnesota uses maxima of 15 L/min for 0-24 months, 20 L/min for ages 2-10 years, and 30 L/min for older children on the ward, while the NSW pediatric guideline starts at 2 L/kg/min and specifies individual plans for children with chronic respiratory failure. See the Children’s Minnesota protocol and NSW pediatric guideline.

If this is a preterm infant with BPD/CLD: neonatal protocols are more conservative. One guideline uses 4-5 L/min if <1 kg and advises that >6 L/min should not usually be exceeded in that group; for infants >1 kg it begins around 6 L/min and may increase to 8 L/min.

Important: do not keep escalating HFNC solely to improve saturation. In CLD, target SpO₂, acceptable CO₂, pulmonary hypertension status, baseline oxygen requirement, work of breathing, blood gas, and feeding safety all matter. Needing high FiO₂, rising CO₂, persistent distress/apnea, or no improvement within about 1-2 hours requires urgent senior/PICU reassessment and possibly CPAP/BiPAP or ventilation.