Physiotherapy: Airway Clearance Techniques in infants

Question

Hello
Our daughter is 15 months old and followed by a group of physiotherapists specialized in pediatric respiratory diseases since she is three months at home. We have always heard "she goes well, she is not congested, not productive," with two sessions per week, more would be useless according to them. A technique used is the Forced Expiratory Technique, with gestures rather "brutal", a cough caused by pressing on the trachea and suctioning the nose and back of the throat. So we relied quite logically to professionals feeling.
Following the annual review we got disappointed, with the test results showing a deterioration of bronchi. Our CF Centre has recommended one session per day. We work for a week with a new physiotherapist, a second one, which places her hands on each lung and drains smoothly. Performed on two sessions, she felt a difference in amplitude between the lungs breathing, and mucus, mobile, and it happens to be traced.
What are effective methods to drain the mucus in an infant or baby (say until the child is able to cooperate, blow, cough)?
Does this vary depending on the damage of the bronchi? (alveoli distended and trapped residual air)
Thank you in advance for your help.

Answer

Dear user,
The respiratory physiotherapy for a young child has three aims:
- Facilitate the drainage of the viscous secretions, and this is the subject of your question;
- Prevent the accumulation of these secretions inside the bronchi and bronchioles (bronchial tree);
- Teach and train the infant/young child and his(her) parents with the techniques of breathing control and airway clearance.
We will focus on the first aim : facilitate the evacuation of mucus.
This process can be divided in 5 steps:
1- Prepare the mucus : good hydration of the infant;
2- Prepare the bronchi (in case of hyper responsiveness): give a broncho dilator through an spacer;
3- Bring air behind the secretions : take a deep and long breath in;
4- Help the secretions to move towards the release: exhale air at a sufficient rate ;
5- Clear secretions : swallowed or spat.
The airway clearance techniques to be used will be chosen by the therapist according to the pulmonary situation of your child. Today, the trend is to consider the CF infant’s lungs as potentially fragile and congested with a thickly mucus. So, the Airway Clearance Techniques (ACT) used should not generate high positive pressure in the bronchi to avoid alveolus or bronchi’s distension. At the same time, the techniques will aim to keep bronchi and bronchioles “open”, so that the air won’t be trapped anywhere in the bronchial tree and will always be able to move inside, even when breathing in or breathing out. This is the reason why the respiratory therapist will use soft, gentle, large maneuvers, with a guidance of the infant breathing patterns. He will be able to use as well manual techniques and instrumental helps such as semi elastic thoracic strap, PEP devices (Positive Expiratory Pressure) varied and fun.
The infant and the child learn very quickly. He will soon participate and blow, inhale and then cough when asked.
The physiotherapists who take care of your daughter know these techniques. We invite you to talk to them about this.
With my best regards.

Claudine Lejosne

29.09.2011