Experience of chest physio/acapella/bubble PEP?

[SuffolkLatch]

DD is only 2 but we have been doing chest physio for a year or so now. She has recently been introduced to bubble PEP and now has an Acapella device. Does anyone else use these? What age did your DC "get it"?

Needy bump

Hi Suffolklatch

I'm presuming by the fact that you're doing chest physio that your child has some kind of chronic respiratory condition?

Around the age of 2 or 3 is probably the most difficult time of life for getting children to do airway clearance and the key is to try and make it as fun as possible. For that reason I think bubble PEP is an excellent choice, it is important to make sure you are encouraging some kind of fast expiration between sets of bubble blowing i.e. coughs, "huffs".

In my experience I have tended to use acapella (or other PEP devices such as flutter) in slightly older children, from around the age of 8, although sometimes earlier depending on individuals. My concern at 2 would be how compliant a child would be and, on a technical note, whether they could generate good enough expiratory flow for the acapella to function correctly.

Whichever method of airway clearance you choose, I can't overstate the value of cardiovascular exercise as a part of any airway clearance routine. Not only is it very effective but generally getting a 2 year old to run around a garden is far easier than getting them to blow into a plastic tube!

Do remember that your physiotherapist knows the details of your child's condition in far more detail than anyone here, so their advice is always likely to be the best.

Hi Suffolk, id agree with what george said. having been a child who required chest physio my mum used to spend a lot of time chasing me round and tickling me. Quite honestly even to this day I swear by laughter being the best physio, it really gets everything moving on the lungs. At 2 I'd imagine its hard to get little one to want to stay still for long but it is doable through other methods.

We used to use chest percussion alongside a bubble pep when DS was two. We also encouraged blowing gamed (a bowl full of soapy water and a straw is a great way to entertain whilst doing physio).

I am surprised your DD has been given an acapella at this age, DS was four/five before his technique was good enough to rely on an acapella for routine phsyio (2x 30min sessions daily). Although I suppose it might be useful to play/get used to the acapella.

Bubble pep was much easier to learn at 2 and is a good pre cursor to the acapella.

We are now progressing to Active Breathing Cycle and combining with lots of exercise in place of physio, on the recommendation of our paed physio.

If i were you I would contact your DD's physiotherapist and just check if they can assess DD's technique on the bubble pep, so you can be sure DD is getting good chest clearance.

Thanks so much for the replies.

Yes, DD has a congenital abnormality leading to recurrent infections and atelectasis. The infections may have caused bronchiectasis, though the last CT scan looked more positive in this regard.

The idea with introducing the acapella and the bubble pep was definitely described to me as getting her familiar with them and seeing them as fun not scary medical things. She can manage to do some longer blows with the bubble pep but only mucks about with the acapella so far. As we have done nebs then chest physio for as long as she can remember she is quite compliant with these, and is able to do a forced cough most times too.

We have used her DLA to join a sports centre and she goes trampolining and swimming there. I have noticed a real improvement since we've upped her activity levels so it's great to hear that "backed up".

DDs physio team see her quite regularly but she rarely complies with examination etc when she feels well. They have also suggested lots of blowing games and windmills etc.

I'm slightly concerned about how all of this is going to work once she starts preschool and goes on to school.

RB how old is your son now? I just googled Active breathing Cycle and I would imagine we're a long way from that.

Sorry, I meant to ask about nebs as well. Dd has hypertonic saline pre physio and obviously this is more time consuming. Have any of you had experience of regular nevs in childcare/school?