Positioning and manual techniques
This technique allows you to position your baby to allow gravity to assist with the movement of mucus in the lungs, and you can perform percussion (chest clapping).
Sustained head down tilt positions (with the head lower than the rest of your body) should always be avoided no matter what age you are. This position if held for too long can cause reflux (gastro-oesophageal reflux: GOR) and this can cause damage to your airways. Modified postural drainage (ensuring the head is not lower than rest of the body) can be a useful alternative. Your physiotherapist can show you appropriate positions for you to use for your child.
If you are using positioning and manual techniques, position yourself so you can watch your child’s face. This helps you watch for any changes in their breathing or any discomfort they might show. If you are the person delivering the manual techniques make sure you look after your posture. Percussion (or as it is sometimes called chest clapping/tapping/pats) should never be uncomfortable and should be done over a thick layer of clothing or using a towel to avoid any discomfort. The hand is held in a cupped position with relaxed wrists and shoulders. The clapping frequency produces vibrations through the chest wall. This helps to mobilise mucus in the airways. You may start with just using 2-3 fingers patting the chest, or using a percussor, depending on the age and size of your child. The baby is supported in different positions while performing percussions to help target different parts of the lungs. In toddlers or larger babies, percussion can be performed using one hand, or two depending on the size of the child’s chest wall.
With the regular change of positions and the potential for coughing when performing percussion there is a risk of causing reflux or vomiting in children. It is recommended to perform percussion prior to feeding or at least 30-45 minutes post-feeding.
Once your child is older and likes to play with toys, you can set them up in each position with toys to keep them distracted. When old enough you can incorporate blowing games or singing during percussion to mimic deep breathing.
Need a photo of a percussor included in this section
Develop a summary of the key points from Julie’s videos for this section and include Julie’s videos in this class.
Other techniques your physiotherapist may introduce during this age are:
- Blowing games – incorporated in play from 1 year old
- Bath PEP – once your child has learnt to blow out your physiotherapist might introduce bath PEP to help your child to blow out against resistance which will help their airways
- Bubble PEP – once your child can blow out in the bath and is not sucking in the water, your physiotherapist may introduce Bubble PEP and start introducing more structured treatment sessions with cycles of breathing with the device.