PAEDIATRICS PHYSIOTHERAPY
MBP specialises in paediatric physiotherapy. Read more below about why chest physiotherapy is needed in paediatrics.
Why the Doctor requests chest physiotherapy?
Normally, there is just the right amount of mucus in the lungs. When the lungs become irritated or infected, a lot of thick mucus is produced. Extra mucus can slow down or stop the cilia (tiny structures on the linings of the lungs that clear excess mucus from the lungs) from working. If the cilia cannot clear the mucus, we must help the lungs get the mucus out. This is why chest physiotherapy is done.
Chest physiotherapy is a way for you to help your child get rid of extra mucus in their lungs. This is important because too much mucus can block the airways in the lungs. If the airways are blocked, the air cannot move in and out as it should.
In most cases, the doctor will request that a sputum sample be taken. This is a specific sterile technique in which a sample is gathered usually through suctioning. This sample is sent to the lab to determine the exact issue for the correct medication to be prescribed.
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How is chest physiotherapy done?
Chest physiotherapy uses chest percussion. This percussion is clapping of the chest by cupping of the hand. This creates vibrations within the airways in the lungs. We also use a technique called vibration with the hands. The vibration helps loosen mucus so that it may be brought up by coughing. Chest physiotherapy is an essential part of your child’s recovery and has the added benefit of speeding up the recovery process immensely.
With chest physiotherapy at MBP, it is important to note that:
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We never percuss over bare skin. The child will always be covered with either a towel or blanket
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The percussion is carried out on the child's chest and back for 2 to 4 minutes.
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It is generally done in a regular rhythm.
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Percussion does not hurt. (Your child may cry or scream during this phase of treatment but be assured that this practice does not hurt. However, we do find that the crying helps for deeper breaths and loosening the secretions while we treat. Most children are quite okay with this.)
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We’ll also be placing your child in various positions which we call Postural Drainage. This assists in removal of secretions.
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Once percussion treatment has been completed.
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What is Suctioning?
Suctioning consists of placing a tube through the child’s nose or mouth, this action will also stimulate a cough and allows us to gather secretions.
This procedure does not hurt; however, it is extremely uncomfortable. The tube is lubricated in order to make the practice easier.
If you child is scheduled for chest physiotherapy, please note:
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Please ensure your child does not eat at least an hour before Treatment
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We may ask you to leave whilst we treat especially for the suctioning procedure as we prefer you be seen as the comforter once we are complete (however, this remains your choice)
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Once your child is discharged you may need to have follow up chest physiotherapy sessions which will be deemed necessary by the doctor.
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We do make available an at home program to be followed in order to assist your child’s recovery – this is made freely available on our website.
PAEDIATRICS HOME PROGRAM
The purpose of this treatment is to help move secretions out of the lungs.
This treatment is to be carried out 2 to 3 times per day.
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There are two parts to chest physiotherapy, i.e., bronchial drainage and percussion
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Bronchial drainage is positioning the body and allowing gravity to help in moving secretions. Different positions are used so that the area can be drained at its highest point.
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Percussion is tapping the chest wall rhythmically to loosen secretions and allow it to move into the bronchial tubes (large airways) of the lungs.
How to do treatment:
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Percussion is done with a cupped hand or manual percussor cup placed over the rib cage.
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Percussion is applied for about one minute to each position on infants and two to three minutes on older children.
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Use a blanket or towel to cover and protect your child’s skin while percussing.
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Follow the positions as highlighted in this program
Things to remember
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Bronchial drainage should be done before your child eats or at least one hour after eating.
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If your child coughs or has trouble breathing during the treatment, sit them upright until they feel better.
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Do not percuss over:​
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Bottom of rib cage​
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Sternum (breastbone)
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Spinal column (backbone)
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Positioning
Always position the child so that the area of the lung required to be drained is at the highest possible point. It is important to be in a comfortable position because this makes the treatment more effective and easier for yourself and the child receiving treatment. You may also use a pillow to make your child more comfortable.
Step 1: Place child on your lap
Step 2: Keep child’s knees and hips bent to help them relax and make coughing easier
Step 3: Carry out treatment
Treatment:
Place child in upright sitting position
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Front - Percuss between clavicle (collarbone) and nipple on each side of the chest.
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Back - Percuss on top half of the shoulder blade on each side of the back.
Place child flat on back
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Front - Percuss between clavicle and nipple on each side of the chest.
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Sides - Percuss directly below armpit on both sides.
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Back - Percuss on top half of the shoulder blade on each side of the back.
Place child in a face down position, lying on tummy
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Front - Percuss right below nipple (right side of chest only).
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Sides - Percuss directly below armpit on both sides
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Back - Percuss below shoulder blade on each side of the back.
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Tips:
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Try to make this as enjoyable as possible for you and your child.
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With infants and younger children, chest therapy can be done just before naps and bedtime as it can assist in putting them to sleep.
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Do not percuss immediately after a meal.
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Do percuss before eating or wait at least one hour after eating.
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Only percuss over the ribcage.
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If aerosol treatments have been prescribed, use them before percussion therapy, unless advised otherwise by the physician.
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Chest physiotherapy needs to be increased at the first sign of cough or illness.
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Remember: it is very important that your child does not think of chest therapy as punishment!
