Respiratory conditions form the leading cause of morbidity and mortality worldwide, with children and infants at the forefront.¹ These conditions in the pediatric population can occur for several reasons, including: 

• Low birth weight
• High birth weight
• Having a significant weight gain following a low birth weight
• Environmental factors such as smoking during pregnancy
• Genetic factors: conditions such as the following fall on this sword:
  • Asthma
  • Cystic fibrosis
  • Primary cilia dyskinesia
  • Sudden infant death syndrome (SIDS)

Even though paediatricians can not provide respiratory therapy for all respiratory conditions, such as SIDS, they can provide immense relief for most. Despite this, it doesn't stop the fright that comes from hearing your child needs help breathing. Still, this guide aims to make you feel calmer and more informed about your choices.

Your guide to understanding respiratory therapy in children

Definition of key terms 

What is pediatrics? 

Paediatrics is a medical speciality that involves holistic care for specific age groups–they include:

• Neonate: first 28 days of life
• Infant: 0-1 years old
• Toddlers: 1-3 years old 
• Preschooler: 2-3 years old
• School-age: 6-12 years old
• Adolescents: 12-18 years old
• Young adult: 18-25years old

It cares for the following aspects of the previously mentioned age group :

• Mental
• Physical 
• Social 

What is respiratory therapy? 

Respiratory therapy involves trained specialists who help ease your child’s respiratory symptoms. It is an essential field that promotes the following for your child:

• Early detection and treatment
• Non-invasive support 
• Improved quality of life
• Prevention of hospitalisation

Despite the causes, respiratory conditions that need therapy include:

• Respiratory Syncytial Virus (RSV)
• Rhinovirus infection 
• Human metapneumonic virus
• Asthma
• Cystic fibrosis 
• Primary ciliary dyskinesia

What equipment is used for respiratory therapy?

Inhalational therapy 

When it comes to asthma, inhalational therapy is the best option, as it allows for: 

• An immediate effect 
• Use of smaller doses
• Lower side effects than other routes 

Your paediatrician provides inhalational therapy through two devices, these are:

Nebulisers 

Nebulisers are devices that deliver liquid solutions and suspensions, such as the following, into a fine mist, which you inhale directly into the lungs: 

• Bronchodilators
• Corticosteroids 
• Antibiotics 
• Hypertonic saline 

Nebulisers are best for children having acute asthma attacks, regardless of how expensive, time-consuming, and high-maintenance they seem. Despite this, paediatricians use nebulisers when:

• Your child needs a more significant dose than an inhaler can supply
• There is a need to give a wide range of liquid plans 
• Your child doesn't follow through with using a pressurised metered dose or dry powder inhaler 
• Your child has the following conditions:
  • Cystic fibrosis
  • Chronic Obstructive Pulmonary Disease(COPD)
  • Bronchitis 
  • Pneumonia 

There are several types of nebulisers, and proper use of them is essential—these are: 

• Pneumatic jet nebuliser
• Ultrasonic nebuliser
• Vibrating mesh 

Regardless of the type and proper technique in usage, some factors affect its efficiency, theseare: 

• Type of drugs
• Delivery system 
• Your child's tidal volume
• Your child's breathing pattern 
• Nose breathing

Like any procedure in healthcare, there are side effects– these include : 

• Rapid heartbeat 
• Mild tremors
• Dryness of the mouth 
• Headache 
• Glaucoma 

Notify your paediatrician if you notice

• Blurred eye vision 
• Eye pain 
• Nausea   

Inhalers 

Like nebulisers, inhalers deliver drugs such as those listed straight into the lungs.

• Albuterol 
• Salmeterol
• Budesonide
• Fluticasone
• Ipratropium 
• Tiotropium 

Inhalers are good when it comes to your child's management of conditions such as: 

• Chronic Obstructive Pulmonary Disease(COPD) 
• Asthma 

Yet they come in different types, including: 

• Pressurised metered dose inhaler 
• Breath-actuated metered dose inhaler 
• Dry powder inhaler

Regardless of the type, improper use of inhalers causes poor asthma control in children. Unfortunately, only 31% of asthma patients use their inhalers properly ². Using an inhaler becomes easy when you remember the following steps: 

1. Perform hand hygiene by washing your hands
2. Remove the cover on the mouthpiece (make sure there are no obstructions)
3. Hold and jiggle the inhaler in an upright position to ensure uniform mixing of the drug
4. Put the inhaler into the spacer device 
5. Hold at a 45-degree angle 
6. Your child's delivery device could be a mouthpiece or mask; regardless of which, place it in their mouth.
7. Push down the top and ask your child to use the abdominal muscles to take deep breaths. After a minute, repeat twice
8. Remove the spacer and keep the inhaler and spacer clean and around the child at all times 

While using an inhaler, you should be careful, as overuse can produce the following side effects: 

• Tremors
• Hyperactivity 
• Rapid heartbeat
• Runny nose
• Sore throat 
• Bronchospasm 

Notify the paediatrician if you notice: 

• Chest tightness
• Difficulty breathing
• Allergic reactions like hives, rashes or swelling 
• High blood pressure 

Both inhalational devices are effective, despite this, the choice of which is given to your child depends on some factors, such as: 

• Age 
• Administered drugs
• Condition

Regardless, both need adequate education, so ask your paediatrician to clarify what you don't understand.

Oxygen therapy 

Oxygen therapy means providing the tissue with adequate oxygenation to prevent anaerobic metabolism and cell death. In the '60s and '70s, doctors administered oxygen therapy based on the following: 

• Skin colour 
• Breathing frequency 
• Breathing regularity 
• Work of breathing 

But today, specialists base oxygen therapy on the following criteria:

• An SPO2 less than 90% on a pulse oximeter
• Cyanosis 

Oxygen therapy uses supplemental oxygen delivery systems and devices to help your child breathe. Oxygen delivery systems include: 

• An oxygen cylinder
• A concentrator
• A Portable oxygen machine

Specialists match the oxygen delivery systems with the following delivery devices:

• Nasal cannula: Specialists use these for mild to moderate oxygen delivery with a 2-6l/min flow rate 
• Face mask: Specialists use these for high-concentration and precise measurement of oxygen delivery. Several face mask types are available, each with a different flow rate– these include:
  • Venturi mask: a flow rate of 4-10L/min
  • Non-rebreather mask: a flow rate of 10-15L/min
  • Simple face mask: a flow rate of 5-8L/min 
• Trach mask: Specialists use these  when your child has a tracheostomy opening 

There are two reasons why your child will not be able to receive oxygen therapy, these include : 

• Congenital heart disease
• Premature neonate 

Despite this, improper use of oxygen therapy can lead to: 

• Dry and cracked mucosa, hence promoting Staphylococcus aureus growth
• Dehydration
• Atelectasis
• Tracheitis
• Thick secretions  

Mechanical ventilation

Mechanical ventilation is a life support machine that helps deliver oxygen and treat mild to moderate hypoxemia. You can refer to this machine by other names such as:

• Ventilator
• Respirator 
• Breathing machine

The delivery device is an endotracheal tube, which the specialist passes through the nose to the trachea, where, with the aid of the mechanical ventilator, it: 

• Delivers oxygen into the body
• Holds a constant low pressure to prevent the lungs from collapsing 
• Ease the removal of mucus 

Your child would need a mechanical ventilator in events such as:

• SPO2  less than 80-85%
• Need for a high concentration of oxygen
• Your child needs carbon dioxide out of their system
• Need for conservation of energy
• Your child needs help breathing since they cannot breathe on their own. This occurs in the following cases:
  • Unconsciousness
  • Nervous system injury 
  • Weak respiratory muscles
• Shortness of breath as a result of respiratory infections like pneumonia

When your child uses a mechanical ventilator, you are at risk of the following:

• Infections
• Collapsed lungs 
• Lung damage
• Confusion and delirium: This is because of the drugs the specialist uses for treatment

Cough assist devices 

When your child coughs, it causes you to pause, but it's natural–the act helps the body clear the central secretion. Despite this, coughing can become tiring and ineffective when your child is sick. Cough assist devices can help here. Outside this pivotal function, cough assist devices are equipment that help with the following: 

• Weaning your child from mechanical ventilation
• Improving your child's outcome 

Cough assist devices help your child through the following mechanism of action: 

• Creating positive pressure
• Increasing pulmonary inhalation
• Immediate change from positive pressure to exhalation using negative pressure

What techniques are used in respiratory therapy?

Chest physiotherapy 

A medical field that involves the following:

• Body positioning 
• Changes in the flow of breathing through breathing control 
• Devices 

Techniques for chest physiotherapy 

Techniques used in chest physiotherapy include:

• Forced expiration
• Active cycle breathing 
• Autogenic drainage
• Assisted autogenic drainage 
• Prolonged expiration
• Increased expiratory flow
• Total slow expiration with the glottis open in sideway position
• Inspiratory controlled flow

Devices for chest physiotherapy 

Devices used in chest physiotherapy are non-invasive ventilation—these are:

• Continuous  positive airway pressure (CPAP) is often effective for low birth weight and preterm babies
• Bubble continuous positive airway pressure (BCAP): It is handy when respiratory distress happens in neonates 
• Incentive  spirometry 
• Flutter
• Positive expiratory pressure 

These chest physiotherapy techniques and devices help your child by removing : 

• Inflammatory secretions 
• Tracheobronchial secretions 
• Airway obstructions

Thus, it will lead to your child benefiting from:

• Improved breathing
• Reduced airway resistance 
• Enhanced gaseous exchange 

Despite this, in some situations, chest physiotherapy can be harmful or have no effect, andit could lead to: 

• Pulmonary hypertension
• Bronchospasm 
• Repositioned foreign bodies
• Worsened sick state of the infant

Summary 

Respiratory conditions can cause anxiety, discomfort and complications to your child. Fortunately, respiratory therapy can help and provide more benefits to your child. This therapy makes use of techniques and equipment to help your child’s health. These include:

• Inhalational therapy: nebulisers and inhalers 
• Oxygen therapy
• Mechanical ventilation
• Cough assist devices
• Chest physiotherapy 

Each technique and equipment has:

• Benefits
• Requirements for usage 
• Potential side effects 

Hence, with the information you just received, speak to your specialist and get a plan curated for your child.