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Chest physical therapy (CPT) is a method for clearing mucus out of the lungs. Keeping the lungs clear helps your child breathe easier. CPT involves 3 main steps:
Putting your child in certain positions
Clapping on the body
Having your child cough
Do CPT with your child 1 to 4 times a day for no more than 20 to 60 minutes at a time. If your child has a respiratory infection, you may need to do CPT more often. Discuss the schedule with your child’s physical or respiratory therapist. It may be helpful for more than one person to know the technique, so you can stay on schedule. In general, do CPT:
First thing in the morning and right before bedtime.
When your child’s stomach is empty, either before meals or at least one hour after meals.
Before or after breathing treatments (as instructed).
After exercise, which helps loosen mucus (check with the doctor first about this).
Special positions help you use gravity to drain mucus from your child’s lungs. This is sometimes called postural drainage. Make sure to have a box of tissues handy for when your child coughs up mucus. A healthcare provider will show you positions to use with your child. It may depend partly on your child’s age. For example, you can place a small child in your lap. You can have an older child lie on a flat surface, such as a bed or floor. In either case, when the child is lying down, have the child’s head and chest lower than his or her hips. You can use pillows or a foam wedge to create this position. Do not use this position, however, with an infant or if your child has problems with gastroesophageal reflux (GERD). GERD is a chronic condition in which stomach acid backs up into the esophagus.
Once your child is positioned, you can start clapping to loosen secretions in the lungs. Remove any rings, watches, or bracelets before you start. Here are steps for clapping:
If your child is not wearing a shirt, put a thin cloth or sheet on his or her body.
Cup your hand to trap air between the hand and your child’s body. Keep your thumb next to your index finger.
Clap against your child’s rib cage, moving your wrist, not your arm and shoulder. Clap on the left side of the rib cage, then the right side. Be careful not to clap on the stomach area, breastbone, or spine.
Continue clapping firmly and steadily, but not too hard, for about 3 to 5 minutes in each area.
You can also use other airway clearance devices, such as a vest, to get a similar effect. The vest is attached to an air generator that causes gentle, continuous vibration. The motion vibrates the chest to loosen mucus. Oscillating positive expiratory pressure (PEP) is another technique. With PEP, your child may use one of a variety of devices to blow air all the way out, while the device creates air waves to help break up the thick mucus. You can ask your child’s doctor or physical or respiratory therapist about these options.
Coughing clears mucus out of the lungs. If your child is older, have him or her cough after you clap on each area. Don’t resume clapping until your child has stopped coughing. To get your child to cough, have your child do this:
Sit up and bend forward slightly.
Take a breath.
Open the mouth and tighten stomach muscles to cough deeply, not just from the throat.
Take another breath.
Repeat until lungs are clear.
You can do many things to make CPT easier for your child. With experience, your child may feel better and come to enjoy this time with you.
Think of ways to help your child relax and take control. When possible, have your child choose the position to start in.
Explain in simple ways how the techniques help.
Have your child choose a fun activity to do during CPT, such as listen to music or watch a video.
Praise your child for cooperating.
Some children have side effects of CPT. Most are mild and go away soon after stopping CPT. Make sure a small infant is positioned so that you can check breathing and the color of the face. Here are possible side effects of CPT:
Unrelieved coughing. Stop CPT. Resume only when your child can breathe easily.
Nausea. Have your child rest for a while. If your child vomits, end that CPT session. Make sure you do CPT when your child’s stomach is empty. Encourage your child to spit out the mucus, not swallow it.
Pain. Stop CPT. Make sure your hand is cupped, not flat.
Trouble breathing. Stop CPT. Have your child sit up. When breathing returns to normal, resume CPT.
Crying. Distract your child by giving him or her something to do. Small children have trouble lying still.
Dizziness. Stop CPT for a while and let your child relax. Resume when dizziness passes.
Gastroesophageal reflux. This is when stomach acid backs up into the esophagus. If this happens, avoid positions with the head down.
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