Spinal muscular atrophy (SMA) is the first inherited cause of mortality in infants. The clinical severity is a continuos with three subtypes in children: SMA1 in newborns non sitters, SMA2 sitters and SMA3 walkers. Respiratory insufficiency is the most severe complication. The respiratory care is preventive, with parental decisions being relevant: it includes cough assistance, prevent chest deformity and lung underdevelopment, treat aggressively respiratory infections, hypoventilation, swallow problems, gastroesophageal reflux and malnutrition. In the perspectives of the new therapeutics advances, with nonsense oligonucleotids or gen therapy, we need to optimize treatments with standard of care in a multidisciplinary approach.