How To Do Chest Physical Therapy on a Child Under Five

1
Getting Started

Correct hand shape. Lori Alma © 2008

Chest Physical Therapy (CPT) uses a technique called percussion to loosen mucus so the patient can get it out by coughing. To avoid injury, the technique is done with a cupped hand, never a flat hand. People often think that they must hit the chest hard to loosen mucus, but this is not true. The air that is trapped in the cupped hand is what hits the chest wall and shakes the mucus loose.

Before you begin doing percussions, there are a few ground rules you should know:

  • Never percuss over bare skin. Have the patient wear a t-shirt or place a thin piece of cloth between his or her skin and your hand.
  • Never percuss directly over the shoulder blade, collarbone, spine, breastbone, or breasts.
  • Place a towel under the child's face to protect your clothing from any mucus coughed up during the treatment.
  • Chest percussion should not hurt. If it does, you are not doing it correctly and should stop and reposition to avoid injury.

When performing percussion, the following technique should be used:

  • Place the cupped hand in the proper section of the patient's chest.
  • Keep the wrist anchored on the chest. Bend at the wrist as you move the hand quickly and firmly up and down in a tapping motion. This action should make a loud hollow sound, not a slapping sound.
  • Continue percussion for 3 to 5 minutes, then have the patient breathe deeply and cough for a minute or two before moving to the next section. The child should always be sitting upright during the coughing and deep breathing portion of CPT.

2
Clearing the Back Of the Right Upper Lobe

Correct hand position - Back right upper lobe. Lori Alma © 2008

The first thing you need to do is clear the mucus out of the upper lobes of the lungs to make room for mucus in the lower lobes to pass through. It doesn't really matter which side you do first, but for the purposes of these instructions, we will start with the right upper lobe.

  • Place the child facing you on your lap, resting the child's head on your right shoulder as if giving you a hug.
  • Place your cupped hand on the right side of the child's back, between the shoulder blade and the top of the shoulder. Begin percussions as described in step one.
  • Sit the child upright and ask him to cough and deep breathe.

3
Clearing the Back Of the Left Upper Lobe

Correct hand position - Back left upper lobe. Lori Alma © 2008

Now move the child to your left shoulder and repeat the percussions on the left side of her back.

Sit the child upright and ask the child to cough and deep breathe.

4
Clearing the Front Of the Right Upper Lobe

Correct hand position - Right front upper lobe. Lori Alma © 2008

Next, turn the child around on your lap so the child is facing away from you with arms above his head.

  • Place a cupped hand on the right side of the child's chest, between the collar bone and nipple.
  • Begin percussions, then sit the child upright and ask him to cough and deep breathe.

5
Clearing the Front Of the Left Upper Lobe

Correct hand position - Left front upper lobe. Lori Alma © 2008

Reposition your child as you did in the previous step and repeat the percussions on the left side of the chest between the collar bone and nipple.

Again, sit the child up and ask him to deep breathe and cough.

6
Clearing the Side Of the Right Lower Lobes

Correct hand position - Right side lower lobes. Lori Alma © 2008

Now that you have made some space in the upper lobes of the lungs, it is time to start clearing out the lower lobes. In this example, we will begin with the right side.

  • Lay the child facing you across your lap on her left side.
  • Place your cupped hand on the side of the child's rib cage below her underarm
  • Percuss, then sit the child upright and ask her to deep breathe and cough.

7
Clearing the Side Of the Left Lower Lobe

Correct hand position - Left side lower lobe. Lori Alma © 2008

Turn the child around on your lap so she is still facing you, but laying on her right side.

  • Percuss on the left side of the rib cage just as you did on the right side.
  • Remember to sit the child upright and ask her to deep breathe and cough.

8
Clearing the Back Of the Lower Lobes

Correct hand position - Back lower lobes. Lori Alma © 2008

Turn the child so he is laying face down horizontally across your lap.

  • Place your cupped hand on one side of the child's back, toward the bottom of the rib cage.
  • Percuss and allow the child to cough if needed.
  • Keeping the child in the same position, repeat percussions on the other side of his back
  • Once again, sit the child upright and ask him to cough and deep breathe.

9
Clearing the Front Of the Lower Lobes

Correct hand position - Front lower lobes. Lori Alma © 2008

The last section of the lungs to be cleared is the front of the lower lobes.

  • Place the child on her back lengthwise on your lap, feet toward you and head at your knees. Her head should hang slightly over the edge but remain fully supported.
  • Place your cupped hand on one side of the child's chest just below the nipple area.
  • Percuss, sit the child up and allow her to cough and deep breathe.
  • Resume the same position and repeat on the other side of her chest.

    10
    Clearing It All Out

    Correct cough and deep breathing position. Lori Alma © 2008

    Over the last 30 minutes or so, you have loosened up a lot of mucus with CPT. You've been having the child bring some of it up by coughing and deep breathing after each lung section percussed. Now, the final step is to try to get rid of the rest of the loosened mucus that may be lurking around.

    • Sit the child up at a 90-degree angle on your lap.
    • Put your arm around the child's chest and have him lean over it slightly.
    • Ask the child to deep breathe and cough until no more mucus comes up

    Source:
    Carroll, P. (1987). The right way to do chest physiotherapy. RN 50(5): 26-9.

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